Deploying midwives in poor nations could avert millions of maternal and newborn deaths

Researchers have said that a small increase in number of skilled birth attendants in the world's poorest nations could save the lives of a substantial number of women and their babies.

Study leader Linda Bartlett, MD, MHSc, a faculty member in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, said that even deploying a relatively small number of midwives around each country could have a profound impact on saving maternal, fetal and newborn lives. He said that their study shows that maternal mortality can be prevented, even in the most difficult of places.

In their analysis, researchers found that a 10 percent increase in midwife coverage every five years through 2025 could avert more than a quarter of maternal, fetal and infant deaths in the world's 26 neediest countries such as Ethiopia and Somalia.

The estimates were done using the Lives Saved Tool (LiST), a computer-based tool developed by Johns Hopkins Bloomberg School of Public Health researchers that allows users to set up and run multiple scenarios to look at the estimated impact of different maternal, child and neonatal interventions for countries, states or districts. For this analysis, the tool compared the effectiveness of several different alternatives including increasing the number of midwives by varying degrees, increasing the number of obstetricians, and a combination of the two.

In a separate study of the 58 poorest countries, reported last week in the journal PLOS One, Bartlett and her team used the LiST tool to estimate that 7 million maternal, fetal and newborn deaths will occur in those nations between 2012 and 2015. If a country's midwife access were to increase to cover 60 percent of the population by 2015, 34 percent of deaths could be prevented, saving the lives of nearly 2.3 million mothers and babies.

Bartlett says maternal mortality is the public health indicator with the greatest disparity between developed and developing countries. "With a very functional medical system," she says, "maternal deaths become extremely rare events."

The 58 countries studied account for about 91 percent of maternal deaths worldwide.

The study has been published in the journal Lancet.