Up to 3.6 million maternal and child deaths could be avoided each year if midwifery services were upgraded, according to a new report released by the United Nations Population Fund (UNFPA) and partners at a conference in Durban, South Africa.

\”Public health advisors and practitioners are not relying on the key health professional that can improve maternal mortality – the midwife,\” said Vincent Fauveau, Senior Maternal Health Advisor with UNFPA, who led the drafting of the report.

Of the nearly 1,000 women who die every day as a result of complications during pregnancy and childbirth, 99 percent live in developing countries, mainly in sub-Saharan Africa. A woman in Sweden has a roughly 1 in 11,000 chance of dying from pregnancy-related causes, while a woman in Niger faces a 1 in 16 chance during her lifetime.

The first State of the World\’s Midwifery report released on 20 June at the International Confederation of Midwives (ICM) 29th Congress, said most of these deaths, as well as many of the severe illnesses and disabilities caused by childbirth, could be prevented by a proficient, motivated and supported midwifery workforce.

The report focuses on the 58 countries with the highest rates of maternal, foetal and newborn mortality. These countries account for 91 percent of the global burden of maternal mortality, but have less than 17 percent of the world\’s skilled birth attendants.

The fifth Millennium Development Goal (MDG), which focuses on reducing maternal health, had seen the least progress, Fauveau told IRIN. Nearly half of all deliveries occur at home without a skilled birth attendant. To meet the MDG 5 target of 95 percent of all births being assisted by a skilled birth attendant, some countries will need to increase the number of midwives by six to 15 times.

\”It is not unusual to find one midwife managing 200 women in one facility. We must prioritize investment in midwives to deliver life-saving care in the communities where mothers are needlessly lost,\” said Lennie Kamwendo, a midwife and Chairperson of the White Ribbon Alliance for Safe Motherhood in Malawi.

Ahead of the congress, more than 2,000 midwives marched in Durban in solidarity with midwives across the world to urgently call for more midwives to save mothers and their babies. The report highlights the uneven distribution of midwives, with rural areas losing out to urban areas, and the fact that not all midwives are adequately trained.

The International Confederation of Midwives (ICM), a global umbrella body and host of the Durban conference, has launched new standards and regulations for midwifery but Fauveau said these will only be successful if \”countries revise their educational curriculum\”.

Many women also struggle to access midwifery services, especially in rural areas, because of the distance they must travel to reach health facilities or because they cannot afford the transport costs and fees.

\”We must advocate for free health services for all pregnant women in all countries. Women often do not have the funds to pay to get into the health facility during childbirth or pregnancy, so they die at home,\” said ICM President Bridget Lynch. Fauveau added that \”a complication with childbirth is one of the most common ways to bring a family to poverty.\”

The report calls for governments to recognize midwifery as a distinct profession, and to increase investment in the number of schools, trainers and tutors for midwives, with adequate budget allocations for midwifery services included in national health plans.

\”Midwives do far more than deliver babies,\” said Bunmi Makinwa, Africa Regional director of UNFPA. \”They are the first to identify and treat HIV, tuberculosis and malaria, and sexually transmitted diseases. They also provide counselling to expecting women, and family planning advice. Midwives play a critical role.\”