Opinion: Policymakers must do more to support midwives like me

I’m a midwife in Lagos, Nigeria. I’m a health worker on the front lines of the COVID-19 pandemic. And, by necessity, I am also an advocate.

I work in a primary health center — the first tier of health care in Nigeria. Midwives like me run the center and provide immunizations for babies and care for pregnant women. But COVID-19 changed the care we could offer.

When the lockdown in Nigeria went into effect in March 2020, midwives in my center were scared. Many of my colleagues stopped coming to work because their partners told them to stay home.

That meant we had a shortage of midwives at our facility. Shifts that would normally be eight or 24 hours instead lasted an entire week to cover for missing staffers and reduce potential COVID-19 exposure.

Due to our low numbers, government restrictions, and social distancing, we had to cancel some essential services for women and their babies. Immunization clinics closed. Prenatal classes stopped. We even had to direct some women to have their babies elsewhere.

Unlike other front-line health workers, midwives were not prioritized to receive personal protective equipment. We experienced significant anxiety because we couldn’t protect ourselves and we didn’t have guidelines on properly caring for pregnant women with COVID-19.

Many women missed family planning appointments and got pregnant when they weren’t intending to. Immunizations for newborns fell by half.

Nigeria has a long way to go to meet our maternal and child health goals. We have one of the highest maternal mortality rates in the world, and only 11.7% of women are using a modern method of contraception with their partners.

If we’re going to end the pandemic, stop preventable maternal and child deaths, and better respond to the next outbreak, policymakers in my country, as well as at donor agencies and development organizations around the world, must start prioritizing midwives.

Here are five things I want them to do:

1. Raise the status of midwives

First, policymakers and the public must treat midwives as essential front-line health workers. Some people believe we’re only working in small communities and don’t serve a lot of people. Or they don’t realize that our work with women gives us a crucial opportunity to provide education about public health threats such as COVID-19.

“The State of the World’s Midwifery 2021,” a newly released report, shows that over 90% of midwives are women. Because of sexism and gender norms, midwives and our role of caring for women and newborns are undervalued. Nurses and community health workers face similar gender barriers.

But the report shows midwives can provide 90% of essential care related to sexual, reproductive, maternal, newborn, and adolescent health over the course of life. And with increased investment, midwives could save up to 4.3 million lives annually by 2035 by preventing 65% of maternal deaths, neonatal deaths, and stillbirths.

2. Protect midwives

Many midwives in Nigeria put ourselves and our families at risk for COVID-19 by continuing to provide care for women and babies. In my community, we’ve already lost two much-needed senior nurse midwives to the disease.

Midwives deserve proper water and sanitation, adequate PPE, and access to COVID-19 testing, treatment, and vaccines. Midwives at my facility have had to reuse PPE and, even with our little pay, purchase face masks with our own money. I’m thankful that Nigeria’s National Primary Health Care Development Agency prioritized health workers in the distribution of COVID-19 vaccines — I’ve already received mine — but other front-line health workers around the world also need vaccines.

3. Invest in training and deploying skilled midwives

Nigeria only has 15 nurses and midwives per 10,000 people, compared with 157 for the same amount of people in the United States.

There’s a global shortage of all health workers, mostly in low- and middle-income countries. Unfortunately, very little global health funding from international sources is addressing this. During the pandemic, midwives have been moved from primary health care centers like mine to COVID-19 centers to deal with the national shortage of health workers.

Policymakers should increase investment in training more midwives and posting them where they’re needed most. They should also avoid redeploying midwives during emergency response and leaving pregnant women without access to skilled maternity care.

4. Pay midwives fairly

Midwives, and all front-line health workers, deserve and need to be paid fairly. In Nigeria, midwives earn as low as 40,000-50,000 naira ($100-$130) per month.

This is not only the case for Nigeria. Midwives’ salaries are among the lowest in low- and lower-middle-income countries, despite our huge potential and impact. This is also a major contribution to the low retention of midwives.

5. Involve midwives in decision-making

Midwives have the skills to lead us out of the pandemic and toward universal health coverage but need more opportunities to fulfill our potential. We are not adequately represented in leadership roles where we can guide health policy and investment.

Midwives need to be in important seats when and where decisions are being made. Instead, policies are being made for us and then brought to us to implement. Policymakers should involve midwives in determining health policy and response plans, and they should provide midwives with leadership training, mentorship programs, and access to professional networks.

I urge my fellow midwives around the world to join me in using data in the new midwifery report to initiate conversations with policymakers and advocate for policy changes.