The Unsung Heroes: Why Midwives’ Voices Are Crucial in a Changing Climate

Why do midwives’ voices matter in a changing climate, and why should we listen to them?

This question has been at the forefront of my mind as I wrote this article. Midwives are on the front lines of maternal and newborn care, often working in the most vulnerable and underserved communities. Their insights and experiences are critical in understanding and addressing the challenges of a rapidly changing climate. They manage the health of mothers and babies amidst extreme weather, damaged infrastructure, and strained health systems, all while facing their own set of hardships. Yet, midwives’ voices are frequently drowned out amid this crucial work.

Artwork by Rajat Anilkumar

My name is Rajat, and as a global health professional focusing on enhancing climate resilience in healthcare, particularly for maternal and newborn health, I am deeply invested in the role of midwives in these changing times. In my master’s thesis, titled “Strengthening Climate-Resilient Midwifery: A Global Scoping Review,” I examined the current landscape of climate-resilient midwifery practices, identified gaps, and proposed actionable insights for strengthening the midwifery practice. This article builds on those findings, highlighting the often-under-recognized role of midwives in safeguarding maternal and newborn health amidst escalating climate challenges. Through this discussion, I aim to shed light on the crucial need for amplifying midwives’ voices and advocating for their empowerment.

Midwives are skilled healthcare providers, extending their role beyond pregnancy care to encompass a continuum of reproductive health services, including health education, support for breastfeeding, and family planning services (1). Research indicates that midwifery-led care results in fewer interventions, higher satisfaction, and improved outcomes such as increased breastfeeding rates and reduced maternal and newborn mortality rates (2,3). Furthermore, midwives who are fully educated, licensed, and integrated into interdisciplinary teams, while supported by a conducive environment, can deliver about 90% of essential sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) interventions (4).

Despite their extensive scope of practice and critical role, midwives make up less than 10% of the global SRMNAH workforce, underscoring the depth of neglect they face within the healthcare profession (4). The shortage of midwives, compounded by inadequate resources and infrastructure, particularly in low- and middle-income countries (LMICs), severely impacts their ability to provide consistent, quality care (5–7). Additionally, midwives face economic challenges with low salaries and socio-cultural barriers, including harassment, disrespect and gender discrimination- further undermining their effectiveness and well-being (8).

Climate change exacerbates these existing challenges, intensifying the burden on midwifery practice. Extreme weather events, like floods and hurricanes, disrupt access to care by damaging infrastructure and blocking transportation routes (9,10). Environmental changes, such as rising temperatures and shifting disease patterns, increase the frequency and severity of health issues, including heat stress and vector-borne diseases, that midwives must manage. For instance, extreme heat events are associated with increased risks of preterm births, stillbirths, and gestational diabetes, while vector-borne diseases are linked to higher rates of miscarriage and low birth weights (11–14). These climate-driven hazards make midwifery even more challenging and crucial, as midwives are often at the forefront in these vulnerable settings.

And yet, despite these escalating challenges and the critical role midwives play in ensuring maternal and newborn health, midwives often remain under-recognized and under-supported. The findings of my thesis revealed significant challenges faced by midwives working in regions vulnerable to climate change. These challenges include insufficient training to identify and address climate-related risks, and difficulties in accessing essential resources such as medical supplies, water, and electricity. Additionally, midwives in harsh climatic conditions experience heightened stress and exhaustion, which further impacts their ability to provide continuous and quality care. My research also revealed a significant gap: there is a scarcity of studies addressing the challenges midwives face. For instance, there is little to no research describing strategies to support the well-being of midwives facing these conditions. This lack of attention to their needs only deepens the existing barriers, leaving midwives under-supported in increasingly demanding environments. Addressing these issues is crucial not only for the well-being of midwives but also for the health of the communities they serve. The pressing question then becomes: how do we effectively address these challenges? The answer lies in acknowledging and amplifying the voices of midwives themselves.

Artwork by Rajat Anilkumar

Why do midwives’ voices matter in a changing climate and why do we need to listen to them?

First, midwives, being at the frontline of healthcare in vulnerable settings, possess invaluable insights into the realities of their work. Firsthand experiences provide a clearer picture of what support is needed and where resources should be allocated. Ignoring their voices means missing out on critical, firsthand knowledge that could drive more effective and practical solutions. Second, midwives’ voices are crucial for advocating for the resources and support they need to perform their roles effectively. Their insights can highlight gaps in current policies and practices, pushing for changes that ensure better preparation and resilience in the face of climate impacts. Finally, incorporating midwives’ perspectives into policy and practice ensures that solutions are not only effective but also feasible. When midwives are involved in decision-making processes, the resulting policies and strategies are more likely to address the actual needs on the ground.

As we look to the future, it is clear that climate change will continue to impact health systems worldwide. The resilience of midwives will be increasingly tested, and their role will become even more critical in safeguarding maternal and newborn health. Their voices must be amplified, and their needs must be addressed to ensure that they can effectively respond to the evolving challenges.

But how do we ensure that midwives are supported and their voices are heard?

To effectively include and amplify midwives’ voices, several actions can be taken. First, integrating midwives into policy discussions is crucial. This can be achieved by creating platforms where midwives can share their experiences directly with policymakers and by including them in health and climate decision-making bodies. For instance, reports like WHO’s “Midwives’ Voices, Midwives’ Realities“ provide a comprehensive understanding of the challenges midwives face and offer critical insights directly from their experiences. These reports serve as essential resources for policymakers, highlighting midwives’ recommendations and the need to ensure that health and climate policies are grounded in real-world perspectives. Second, equipping midwives with training and resources is essential for adapting to climate challenges. Programs like the Baby Mamma Fund provide vital support, offering mentorship, equipment, and mobile clinics, including boats, to reach remote areas. These initiatives empower midwives to continue delivering care even in the face of disrupted infrastructure, ensuring they remain resilient in challenging environments. Third, raising awareness through social media campaigns can amplify midwives’ voices on a global scale. Organizations like the International Confederation of Midwives (ICM) provide advocacy toolkits for occasions such as International Day of the Midwife, helping midwives share their stories, advocate for their needs, and highlight their role in improving maternal and newborn health. Finally, creating platforms for midwives to share their experiences is vital. For example, the Wilson Center’s recent webinar on climate resilience provided a space for midwives to discuss challenges and innovations. Supporting such platforms helps midwives advocate for needed changes and ensures their voices are heard in policy discussions.

Midwives are vital yet often overlooked pillars of healthcare, especially as climate change intensifies the challenges they face. Their crucial role in supporting vulnerable communities is hindered by inadequate resources, low recognition, and socio-economic barriers. Addressing these challenges requires amplifying midwives’ voices through active policy inclusion, enhanced training, dedicated support, and effective advocacy. Recognizing their contributions and integrating their insights into climate resilience and healthcare strategies is essential. As climate impacts escalate, prioritizing midwives’ needs and ensuring they are heard will be pivotal in shaping a more resilient and equitable healthcare system for the future.

References:

1. International Confederation of Midwives [Internet]. [cited 2024 Sep 18]. International Definition and Scope of Practice of the Midwife. Available from: https://internationalmidwives.org/resources/international-definition-of-the-midwife/

2. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2016 Apr 28;4(4):CD004667.

3. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study – The Lancet Global Health [Internet]. [cited 2024 Sep 18]. Available from: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30397-1/fulltext

4. The State of the World’s Midwifery 2021 | United Nations Population Fund [Internet]. [cited 2024 Jun 11]. Available from: https://www.unfpa.org/sowmy

5. Adatara P, Amooba PA, Afaya A, Salia SM, Avane MA, Kuug A, et al. Challenges experienced by midwives working in rural communities in the Upper East Region of Ghana: a qualitative study. BMC Pregnancy Childbirth. 2021 Apr 9;21(1):287.

6. Bogren M, Grahn M, Kaboru BB, Berg M. Midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo—an interview study. Hum Resour Health. 2020 Sep 17;18(1):65.

7. Pettersson KO. Major challenges of midwifery in Africa. British Journal of Midwifery. 2007 Aug;15(8):470–4.

8. Midwives’ Voices Midwives’ Realities [Internet]. [cited 2024 Sep 18]. Available from: https://www.who.int/publications/i/item/9789241516112

9. Keim ME. Building human resilience: the role of public health preparedness and response as an adaptation to climate change. Am J Prev Med. 2008 Nov;35(5):508–16.

10. Mboera LEG, Mayala BK, Kweka EJ, Mazigo HD. Impact of climate change on human health and health systems in Tanzania: a review. Tanzania Journal of Health Research [Internet]. 2011 [cited 2024 Jul 10];13(5). Available from: https://www.ajol.info/index.php/thrb/article/view/73045

11. Bekkar B, DeNicola N, Girma B, Potarazu S, Sheffield P. Pregnancy and newborn health – heat impacts and emerging solutions. Seminars in Perinatology. 2023 Dec 1;47(8):151837.