Midwives on the Front Line: Africa’s Health Workers, Humanitarians, and Heroes
Written By Maxine Ansah
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When disaster strikes be it war, natural calamity, or the slow-burn emergencies of poverty and systemic neglect midwives are often the only health professionals left standing. Across the globe, and particularly in Africa, they are not only birth attendants but lifelines, delivering babies in the shadow of conflict, tending to mothers amid floodwaters, and offering dignity and care in refugee camps and rural villages.
On this year’s International Day of the Midwife, marked under the theme “Midwives: Critical in Every Crisis”, a powerful tribute to those who navigate the front lines of emergency response, UNFPA Executive Director Dr. Natalia Kanem described midwives as the “first responders and the last line of defence” delivering life-saving care to pregnant women and their newborns during a crisis. In humanitarian settings, maternal mortality can more than double, yet midwives often persist where formal health systems collapse. Their role is especially critical in Africa, where over half of global maternal deaths occur, according to the World Health Organization (WHO, 2023).
A Profession Undervalued, A Contribution Unmatched
Despite their irreplaceable role, midwives remain underpaid, under-resourced, and undervalued. According to UNFPA’s 2021 State of the World’s Midwifery report, Africa faces the most severe midwife shortages, accounting for over 70 per cent of the global midwifery workforce gap. The continent would need to train and deploy nearly 400,000 midwives to meet its current needs.
These shortages are more than a staffing problem. They are a health crisis. Midwives can deliver 90 per cent of essential sexual, reproductive, maternal and newborn health services, including antenatal care, family planning, safe deliveries, and emergency obstetric referrals. Studies have shown that investing in midwifery could avert two-thirds of maternal and newborn deaths, which translates into saving 4.3 million lives per year by 2035 (UNFPA, WHO, ICM, 2021).
But midwives’ contributions go beyond the clinic. In contexts where gender-based violence experience spikes such as in war zones or during displacement midwives often provide the first point of care and counselling for survivors. Their community ties and trustworthiness position them uniquely to respond to the specific needs of women and girls in ways that are both lifesaving and culturally sensitive.
Frontline Stories from Africa
In South Sudan, where years of conflict have decimated the healthcare system, UNFPA-supported midwives have walked for miles through floodwaters to reach pregnant women in need. In Ethiopia, midwives are stationed at mobile clinics serving internally displaced persons. And in Sierra Leone, a country that once had the world’s highest maternal mortality rate, trained midwives have helped reduce maternal deaths significantly through targeted community interventions.
Yet these efforts face severe headwinds. Recent global funding cuts to humanitarian assistance have already led to rising maternal and newborn death rates in fragile contexts. UNFPA reports that in conflict-affected zones of Sudan, for example, there are fewer than 10 midwives per 100,000 people far below the WHO’s recommended threshold.
Investing in Midwives is Investing in the Future
Amid this sobering reality, the UNFPA-led Midwifery Accelerator initiative offers a blueprint for change. The initiative urges governments and donors to increase both financial and programmatic investments in midwifery training, fair wages, professional development, and supportive infrastructure. These investments are not just moral imperatives; they are sound economic choices. According to the Lancet Global Health (2020), every $1 invested in midwifery yields up to a 16-fold return through reduced health costs and improved productivity.
In African countries, scaling up midwifery education and retention could catalyse progress toward multiple Sustainable Development Goals, including gender equality, decent work, and universal health coverage. Midwives are also instrumental in achieving Ending Preventable Maternal Mortality (EPMM) targets, a core focus of global health strategy through 2030.
A Call to Action
Africa’s midwives do not ask for accolades. They ask for respect, resources, and the ability to do their jobs safely and effectively. As we mark another International Day of the Midwife, let us listen to Dr. Kanem’s urgent call: “Midwives save lives. Let us work together to end the global shortage of nearly 1 million midwives and to ensure that we can end preventable maternal deaths once and for all.”
This is not just about childbirth it is about justice, equity, and survival. For too long, midwives have carried the burden of care. It is time the world carried its share of responsibility.
