Every year on 5th May we celebrate International Day of the Midwife. We use this day to recognise the extraordinary contribution midwives make to the health and wellbeing of women, newborns, and families. Midwives support life at its very beginning, yet, despite their critical role, the world is facing a worsening shortage in this essential workforce. The International Confederation of midwives’ theme for this year’s International Day of the Midwife is One Million More Midwives.

Today, the evidence is clear, at least a million more midwives are urgently needed as part of a broader effort to close global workforce gaps and reduce preventable maternal and newborn mortality and morbidity. Without decisive action, hard‑won progress in maternal and newborn health risks stalling or reversing altogether.

Global Maternal and Newborn Health

In 2023, an estimated 260,000 women died during pregnancy or childbirth, equivalent to over 700 preventable deaths every day, one every two minutes. While global maternal mortality has declined by around 40% since 2000, progress has slowed significantly since 2016, particularly in fragile and conflict‑affected settings.

For newborns, the picture is equally stark. In 2024, an estimated 2.3 million babies died within the first 28 days of life, accounting for nearly half of all under‑five deaths worldwide. Complications related to preterm birth, labour and birth remain leading causes, conditions that are highly responsive to skilled midwifery care. Crucially, these deaths are not inevitable. Most occur in low‑ and middle‑income countries, where access to skilled care before, during, and after birth remains limited.

Why Midwives Are Central to the Solution

Midwives are uniquely positioned to address this crisis. When educated, regulated, and supported to international standards, midwives can deliver up to 90% of essential sexual, reproductive, maternal, newborn, and adolescent health services.

Evidence shows that universal access to midwife‑delivered care could prevent up to two‑thirds of maternal and newborn deaths and stillbirths. Midwifery‑led models of care are associated with:

• Reduced maternal and neonatal mortality

• Lower rates of unnecessary medical intervention

• Improved detection of complications and timely referral

• Better experiences of care for women and families

Midwives provide continuity across the reproductive life course, from family planning and antenatal care to postnatal and newborn support, often serving as a woman’s primary health professional.

Despite their impact, the global midwifery workforce remains dangerously under‑resourced. According to the World Health Organization, there are approximately 2.2 million midwives worldwide, yet shortages persist most acutely where needs are greatest.

More recent analysis from the International Confederation of Midwives estimates that nearly one million additional midwives are needed globally to meet population demand, with Africa alone accounting for almost half of the shortfall. Within this wider gap, the call for a million more midwives represents an achievable and urgent first step, one that could unlock immediate, life‑saving gains.

However, the shortage is not only about training more midwives. In many countries, midwives are underpaid, under‑protected, and under‑valued. Poor working conditions, lack of equipment, limited career progression, and unsafe environments contribute to burnout and attrition, particularly in humanitarian and fragile settings.

More than 90% of maternal deaths occur in low‑ and lower‑middle‑income countries, with sub‑Saharan Africa accounting for around 70% of global maternal mortality. Women in conflict‑affected settings are twice as likely to die during pregnancy or childbirth, and these settings now account for around 60% of global maternal deaths. Midwives are often the first, and sometimes only health professionals available in these contexts. Midwifery is not a luxury, it is a cost‑effective, evidence‑based investment that strengthens health systems from the ground up.

The Northern Ireland Context

In Northern Ireland workforce challenges also exist. The Renfrew Report (“Enabling Safe Quality Midwifery Services and Care In Northern Ireland”) was commissioned by the Department of Health and published in October 2024. The report highlights higher‑than‑expected maternal and perinatal morbidity, alongside persistent health inequalities. Health outcomes in maternity care are worse for women facing deprivation, who have minority status, or complex health needs.

The Renfrew Report makes clear that improving maternity care in Northern Ireland starts with strengthening the midwifery workforce. The report highlights that investing in safe staffing levels, prioritising retention through better working conditions, and developing compassionate, visible leadership is central to improving care for women and their families.

By stabilising the workforce, maternity services can expand continuity of midwifery care, improve safety, and offer women more personalised support. The report also calls for clearer governance, a learning culture where staff feel able to speak up, and an updated regional maternity strategy. Central to Professor Renfrew’s report is the need to put women, babies, and families at the heart of care. Women’s voices and experiences of care are so important in actively shaping services, ensuring care is respectful, personalised, and responsive to their needs.

Maternity services impact everyone in Northern Ireland, as we have all been born! This is what is unique about this specific area of the health service, getting care right at this important time has huge public health benefits for the entire population of Northern Ireland. With sustained political commitment and long‑term workforce planning, there is a now a real opportunity to reduce inequality, and create safer, more resilient maternity services for the future.

A Call to Action on International Day of the Midwife

International Day of the Midwife is both a celebration and a call to action. Achieving global maternal and newborn health targets as outlined in the Sustainable Development Goals will be impossible without a strong, supported midwifery workforce.

Meeting the need for a million more midwives requires coordinated action:

• Scaling up quality midwifery education

• Ensuring funded jobs and fair pay

• Improving working conditions and safety

• Including midwives in policy and leadership

On this International Day of the Midwife, let us move beyond recognition to responsibility. Because when midwives are supported, women survive. When women survive, families thrive. And when we invest in midwives, we invest in a safer world for everyone.

Dr Hannah McCauley is a clinical academic midwife with over 22 years’ experience across clinical practice, leadership, education, and global health research. Hannah is a Lecturer in Maternal and Child Health at Queen’s University Belfast where she contributes to postgraduate education, PhD supervision and research.   Hannah has worked in hospital and community settings across the UK and previously held senior roles including Consultant Midwife and Interim Head of Midwifery, leading service development, governance, and workforce education.  

She also worked as a Senior Research Associate at the Liverpool School of Tropical Medicine, leading multi-country maternal health research across sub-Saharan Africa focused on improving antenatal and postnatal care quality, competency-based training, and health system strengthening. Hannah completed her PhD in Tropical Medicine in 2024. Her research interests include global maternal health, midwifery education, quality improvement, and equitable, woman-centred care. Hannah is committed to strengthening the integration of research, education, and clinical practice.