Child survival

Missing midwives

One in three women around the world gives birth without the help of anybody who has been trained to help – and two million give birth entirely alone. ²

Giving birth without a midwife or skilled birth attendant puts women and their babies at a much higher risk of death from one of the many serious complications that can happen during childbirth.

Midwives can reduce the number of deaths in childbirth, but there aren’t enough of them.

There are profound inequalities in the access to and use of reproductive health services within and across regions.

• Globally there was an estimated 289,000 maternal deaths in 2013, which is equivalent to about 800 women dying each day. ³
• Almost all of these women – 99 per cent – live and die in developing countries. ⁴ More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. ⁵

The world needs 350,000 more midwives. ⁶ Without them, women and new-born babies will continue to die from easily preventable complications. Every year, more than one million children are left motherless and vulnerable because of maternal death.

A key strategy for reducing maternal mortality is ensuring that every birth occurs with the assistance of a skilled health worker – meaning a doctor, nurse or midwife. Health workers bring vital basic health services to the poorest and most marginalised children, saving lives every day. Yet, the world currently faces a gap of at least 7.2 million professional health care workers, whose services are desperately needed.

² Save the Children (2011) “Missing Midwives”
³ UN (2015) “The Millennium Development Goals Report.”
⁴ UNFPA (2012) “Giving birth should not be a matter of life and death.”
⁵ WHO (2015) “Maternal mortality”
⁶ Save the Children (2011) “Missing Midwives”

In 2010, Save the Children committed to training 400,000 health workers by 2015. To date, we have exceeded our target, supporting the training of 494,906 health workers around the world.

Over 90 percent of deaths during childbirth could be prevented if women in developing regions had access to sufficient diets, basic literacy and health services, and safe water and sanitation facilities during pregnancy and childbirth. ⁷

⁷  UN (2015) "The Millennium Development Goals Report"
⁸ UNFPA (2012) “Giving birth should not be a matter of life and death.”

A well trained midwife does much more than deliver babies. A midwife working at the heart of the community and within a functioning health service is able to visit women to give care, advice and support – before, during and after pregnancy.

Many countries have invested in bicycles or motorbikes for midwives, enabling them to travel to remote communities more easily and to provide more frequent visits and support to more pregnant women.

Antenatal care by midwives can identify problems and prevent some complications, referring cases where necessary – for example, if it is a multiple pregnancy, if the baby is very small or very large, or if the baby is not in a good position for delivery.

Clean drinking water and sanitation

The lives of new mothers and babies are being put at risk due to a lack of safe drinking water, good hygiene and an adequate number of toilets.

Each year diarrhoea kills around 760,000 children under five, and is a leading cause of malnutrition. ⁹

The world met the millennium development target of halving the proportion of people without ongoing access to safe drinking water, five years ahead of schedule in 2010. While this is a remarkable achievement, much still remains to be done.

In 2015, 663 million people still lack improved drinking water sources and 2.4 billion people still lack improved sanitation facilities. ¹⁰

⁹ WHO (2013) “Diarrhoeal disease.”
¹⁰ WHO & UNICEF (2015) “Progress on sanitation and drinking water.”

Solution to world hunger

Interventions to prevent malnutrition can be as simple as providing vitamin A and zinc supplements, iodised salt and promoting healthy practices such as handwashing, breastfeeding and nutritious diets. Fortification (adding vitamins and minerals to food) is one of the most cost effective direct interventions.

Improving the access of nutritional food needs to be met with improved education about nutrition. The global system by which food is produced, distributed and consumed is currently failing to meet the nutritional needs of much of the world’s population. More food does not automatically mean better nutrition, our focus must be improving children’s diets so that they can access the nutrients necessary for a healthy life.

One of the main causes of malnutrition is poverty. For many families, their children become malnourished and stunted not because there is no nutritious food available, but because they cannot afford to buy it. In such cases, social protection schemes – which provide families with regular cash transfers or food parcels – have helped protect families from the worst effects of poverty.

16. Save the Children (2012) "A life free from hunger: Tackling child malnutrition."