Podcast In/Equality 09
Over the past several years, Canada has emerged as an international leader in feminist policy.
The federal government’s feminist values have led to historic financial commitments to women’s health rights, meaningful improvements to global health architecture and efforts to empower women and girls. They have also laid the groundwork for Canada’s Feminist International Assistance Policy, which aims to ensure that international development initiatives are guided by a strong commitment to gender equality and women’s rights.
But as every feminist knows – if we aren’t moving forward, we’re moving backward.
The world is changing, and investments in women’s and children’s health have failed to keep pace. As intersecting global crises like COVID-19, climate change and international conflict threaten to undo hard-won gains in sexual and reproductive health rights and gender equality, Canada must redouble its efforts to advance the health and rights of women and girls. That’s where midwives come in.
May 5 marked the International Day of the Midwife, which calls us to celebrate the invaluable contributions of midwives worldwide. But for Canada, the day should also serve as a timely reminder: midwives harness incredible potential to realize impact for women and girls, in all their diversity, around the globe.
In 2021, there were over 48,000 midwife-supported births in Canada, with midwives operating from coast to coast to coast. Unmet demand for midwives in Canada is on the rise, with schools scrambling to create programs to train enough midwives to meet the growing need.
When I gave birth to my first daughter in Saskatchewan 22 years ago at age 19, there were no licensed midwives. A decade later, supported by a midwife during my second pregnancy in Ontario, I was grateful for the care I received, which included longer appointments and time to ask my questions, clear options and choices. My dignity was front and centre to the model of care. This is what I would wish for my younger self and, as it turns out, it is a model that could change the world.
As skilled, front-line health workers who provide care before, during and after pregnancy, midwives promote maternal and child health and reduce maternal and infant mortality rates. They also provide education on sexual and reproductive health, access to contraception and gender-based violence prevention. In many communities around the world, midwives aren’t one of many health-care providers – they are the only health-care provider.
Despite the crucial role that midwives play in improving the health of women and girls in developing countries, they are in short supply. Worldwide, there is a shortage of 900,000 midwives – roughly one-third of the required workforce.
A woman dies every two minutes of preventable causes related to pregnancy and childbirth, according to the World Health Organization. Ninety-five per cent of these deaths occur in low- and middle-income countries. One major reason for this high mortality rate is the lack of skilled health-care professionals to provide care.
To invest in midwifery is to invest in the prevention of needless maternal deaths, as well as neonatal deaths and stillbirths. One study has estimated that a substantial increase in midwife-delivered interventions could avert 2.2 million deaths per year by 2035.
Canada has an opportunity to lead the way in filling this gap, advancing its commitment to its Feminist International Assistance Policy in the process. By investing in midwifery associations and training institutions, Canada can help increase the number and quality of midwives in low-income countries.
There is precedent for this type of investment. In 2017, the Canadian government announced a $241.5-million investment in women’s sexual and reproductive health rights, including support for midwifery education and training. Two years later, Canada made a historic 10-year commitment to reach $1.4 billion in funding each year by 2023 to support the health of women, children and adolescents around the world, with $700 million of the annual investment dedicated to sexual and reproductive health rights.
Cuts to international aid in the 2023 federal budget cast some doubt on the feasibility of Canada’s feminist investments, but a commitment to midwives may signal a renewed attentiveness to policy that is both effective and economical. The United Nations Population Fund estimates “that for every dollar invested in family planning and maternal health in developing countries, the return on investment to families and societies is US$8.40.”
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With fewer resources on the table, Canada must prioritize midwifery as a critical component of its development assistance efforts.
One way to do this is through education. Canada could support the development of midwifery training programs in low- and middle-income countries. This would help to build the capacity of midwives to provide a higher level of care and increase the number of trained midwives overall.
Similarly, Canada should support recognition and policy development. In many countries, midwives are not recognized as health-care professionals, nor do they have access to the resources needed to provide care. Canada could support policy development efforts to improve the recognition and support of midwives in partner countries.
Through organizations like the Canadian Association of Midwives, which plays a key role in advocating for midwives as health-care professionals, Canada can support the development of midwifery associations in other countries. This builds the capacity of midwives to advocate for their profession and improve their working conditions.
There have been successful examples of this. As part of a north-south midwifery “twinning” initiative, the International Confederation of Midwives matched midwifery associations with a twin in another part of the world. *
One of those pairs was the Canadian Association of Midwives and the Tanzania Midwives Association, which led to the development of the Midwife Emergency Skills Training module. This was delivered to over 1,000 Tanzanian midwives, improving the quality of maternal care in the region.
Another key area is research. Research on the effects that midwifery has on maternal and child health outcomes provides evidence-based best practices to advance midwifery-led models of care.
Finally, Canada should support initiatives that tackle the root causes of maternal mortality, including poverty, food insecurity and inadequate access to health care. That means working with partner countries to address the social, economic and political factors that contribute to poor maternal and child health outcomes.
Every day, almost 800 women die from preventable causes in pregnancy and childbirth. While there is no roadmap to solving the systemic issues plaguing women’s and children’s health around the world, midwives offer Canada a promising path forward.
* Editor’s note: A previous version of this paragraph misattributed the “twinning” example to a different project. This has been corrected.