2.

The impact of
midwifery education
“Midwifery education… is the
bedrock for equipping midwives
with appropriate competencies
to provide high standards of
safe, evidence-based care.”
Bharj et al. Midwifery (25).

2.1 Evidence shows improved

outcomes
Over the past two decades, scientific findings
from a range of disciplines have converged.
The evidence is clear. Midwifery, where care
includes proven interventions for maternal and
newborn health as well as for family planning,
“could avert over 80% of all maternal deaths,
stillbirths, and neonatal deaths” (1).

Midwives, when educated to international

standards of midwifery, are able to provide the
full scope of interventions needed when they
are licensed, regulated, fully integrated into a
well-functioning health system and an
interprofessional team with referral services
when required for emergencies (1, 2). Quality
midwifery care reduces harm, enhances
survival and the short- and long-term health and
well-being of women and children (2).
Good-quality midwifery care improves over 50
other outcomes (Fig. 2) (2). Midwifery goes far
beyond a set of clinical skills for pregnancy,
childbirth and caring for the mother and her
baby in the six-week postnatal period (Fig. 3).
From a health systems perspective, midwifery
results in more efficient provision of
interventions and more efficient use of health
service resources (2, 26). The term “midwifery”
is defined in Box 1.
The geographical and social proximity of
midwives to the communities they serve is a key
strength in the provision of UHC, maximizing
integrated people-centred care, and ensuring
local knowledge and flexibility in responding to
changing circumstances including in humanitarian
and fragile settings such as conflict, natural
disasters and forced displacement (12).
International standards and resources for
education have been developed by the
International Confederation of Midwives (ICM),
which has also collaborated with WHO and
other implementing partners to develop the
WHO Midwifery educator core competencies
(27). ICM has also developed a clear definition of
the midwife (Box 2) and the Essential
Competencies for Midwifery Practice (28).

2.2 Midwife-led continuity of care

has the greatest impact
Outcomes for women and newborns are
improved even further where a midwife
educated to international standards, or a small
team of midwives, is enabled to lead on all care
needed by women and newborns from
pregnancy to the end of the six-week postnatal
period, supported by a well-functioning
midwifery programme should complications
arise (Fig. 4) (23, 29). This complex intervention
is known as midwife-led continuity of care
(MLCC) (23).

“Care led by midwives – educated,

licensed, regulated, integrated in
the health system and working in
interdisciplinary teams – had a
positive effect on maternal and
perinatal health… even when
compared with care led by other
health professionals in combination
with midwives” (2).
Renfrew et al. Lancet Series on Midwifery (2).