title: The projected effect of scaling up midwifery.
abstract: We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the countries with the lowest HDI, 61% of all maternal, fetal, and neonatal deaths could be prevented. Family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies. Midwifery with both family planning and interventions for maternal and newborn health could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care.
authors: Faculty of Health, University of Technology Sydney, NSW, Australia. Electronic address: caroline.homer@uts.edu.au.
authors: Caroline S E
authors: CS
authors: Homer
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Ingrid K
authors: IK
authors: Friberg
authors: Department of Obstetrics, Instituto Fernandes Figueira-FIOCRUZ, Rio de Janeiro, Brasil.
authors: Marcos Augusto Bastos
authors: MA
authors: Dias
authors: Instituto de Cooperación Social Integrare, Barcelona, Spain.
authors: Petra
authors: P
authors: ten Hoope-Bender
authors: Division of Women's Health, King's College London, Women's Health Academic Centre King's Health Partners, St Thomas' Hospital, London, UK.
authors: Jane
authors: J
authors: Sandall
authors: Autonomous University of Barcelona, Barcelona, Spain.
authors: Anna Maria
authors: AM
authors: Speciale
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Linda A
authors: LA
authors: Bartlett
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D005193:Family Planning Services / Q000458:organization & administration; D005260:Female; D014943:Global Health; D006801:Humans; D007231:Infant, Newborn; D008428:Maternal Mortality; D008880:Midwifery / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D018743:Perinatal Care / Q000458:organization & administration; D054238:Perinatal Mortality; D016742:Preconception Care / Q000458:organization & administration; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000458:organization & administration; D019472:Universal Health Insurance