Geneva: The World Health Organization (WHO) today released guidance urging countries to adopt and expand midwifery models of care, where midwives serve as primary care providers for women and newborns during pregnancy, childbirth, and the postnatal period. This call for a global shift to midwifery care models aligns with WHO’s ongoing efforts to address maternal and newborn mortality, as emphasized in a related statement on October 16, 2024, which highlighted the need for increased investment in midwifery to improve health outcomes.
The guidance focuses on communication and partnership between women and midwives, noting that women receiving midwifery care are more likely to experience vaginal births and report satisfaction with services. According to WHO’s fact sheet on nursing and midwifery, midwives trained to international standards can deliver 87% of essential sexual, reproductive, maternal, and newborn health services, reducing complications when integrated into health systems. This capacity underscores the potential of midwifery models to transform care delivery globally.
Anshu Banerjee, Director for Maternal, Newborn, Child and Adolescent Health and Ageing at WHO, stated that expanding midwifery models improves health outcomes, optimizes resource use, and is adaptable to all countries. These models enhance women’s and families’ experiences by fostering trust and collaboration during pregnancy and childbirth. WHO’s maternal health division emphasizes that midwifery care prioritizes women-centered approaches, ensuring access to informed and respectful care, a key factor in the global shift to these models.
Maternal and newborn deaths remain high, particularly in low-income and fragile settings. Modeling cited in the guidance indicates that universal access to skilled midwives could prevent over 60% of maternal and newborn deaths, equating to 4.3 million lives saved annually by 2035. The October 2024 WHO statement further notes that scaling midwifery could reduce maternal mortality by two-thirds and prevent 40% of newborn deaths, reinforcing the urgency of a global shift to midwifery care models.
Midwifery models emphasize informed choice, communication, and non-invasive techniques, such as mobility during labor, breathing guidance, varied birthing positions, and emotional support, which empower women and reduce the need for invasive procedures. WHO’s midwifery framework indicates that these techniques align with physiological birth processes, minimizing risks associated with unnecessary interventions while supporting women’s autonomy, a core principle of the shift to midwifery care.
The guidance addresses over-medicalization in childbirth, noting that while interventions like caesarean sections, inductions, and forceps are necessary when clinically indicated, their routine or excessive use increases short- and long-term health risks. WHO data shows caesarean rates exceed 50% in some countries, often reflecting unnecessary procedures. The organization’s fact sheet states that midwives, when supported by enabling environments, can reduce reliance on such interventions, improving safety and aligning with the global shift to midwifery-led care.
Ulrika Rehnstrom Loi, a midwifery expert at WHO and technical lead for the guidance, stated that investing in midwifery models enhances health outcomes and equips midwives to provide individualized, respectful care. Midwives ensure women are part of decision-making, have access to accurate information, and receive emotional support. WHO’s midwifery resources note that this approach strengthens trust, particularly in underserved communities, supporting the global shift to these care models.
The guidance provides tools and examples to assist countries in transitioning to midwifery models, requiring political commitment, strategic planning, and financing with dedicated budgets. WHO’s October 2024 statement indicates that investments in midwifery education and deployment yield a 16-fold return through improved health and economic benefits. The guidance also emphasizes midwifery regulation and education aligned with international standards to enable evidence-based practice, a critical step in implementing midwifery care models globally.
Collaboration is essential for implementation, with midwives empowered to work independently while integrated into healthcare teams alongside doctors and nurses. In cases of complications, midwives should partner with other professionals to ensure multidisciplinary care. WHO’s fact sheet highlights that midwives are most effective when supported by functional health systems, including referral mechanisms for emergencies, facilitating the global shift to midwifery care.
Millions of women give birth without a skilled health worker, and one-third do not receive at least four of WHO’s recommended eight antenatal checks. Progress in reducing maternal and newborn mortality has stagnated since 2016, with WHO data reporting 287,000 maternal deaths in 2020, primarily in low-resource settings. The guidance positions midwifery as a solution to address these gaps, supporting WHO’s call for a global shift to midwifery care models.
Anna Ugglas, Chief Executive of the International Confederation of Midwives, which contributed to the guidance, stated that midwifery models offer an evidence-based, person-centered approach that ensures safety for women and newborns. The Confederation’s collaboration with WHO reflects a global consensus on midwifery’s role in strengthening health systems, a key component of the shift to these care models.
The guidance describes midwifery models, including continuity of care, where a known midwife or small team supports women throughout pregnancy, birth, and the postnatal period; midwife-led birth centres, facilities where midwives provide intrapartum care for women at low risk of complications, sometimes offering antenatal, postnatal, or family planning services; community-based approaches, where midwives deliver care through mobile units or local health centres; and private practice, where regulated midwives operate independently or through organizations within national health systems. WHO’s midwifery framework notes that these models are adaptable to diverse contexts, from rural areas to urban hospitals, supporting their global adoption.
The guidance aligns with WHO’s 2016–2030 Global Strategy for Women’s, Children’s, and Adolescents’ Health, emphasizing that midwives require supportive policies, adequate staffing, and access to essential supplies. WHO’s fact sheet reports a global shortage of 900,000 midwives, with significant gaps in sub-Saharan Africa and South Asia, necessitating action to train and retain professionals to achieve the global shift to midwifery care models.
– global bihari bureau
