Urgent call to address the shortage of midwives in Bangladesh

Bangladesh loses over 4,000 women every year from preventable causes related to pregnancy and childbirth[1]. The maternal mortality rate is falling, but at 156 deaths per 100,000 births[2], it is still a long way from the Sustainable Development Goal target of 70. Most of these deaths occur in poorer families and communities, although everyone, even the rich or famous, can lose someone in childbirth.  For instance, in March 2024, a national women’s football star sadly died after giving birth at home in Bangladesh without the support of a midwife[3]. These tragic deaths highlight the critical shortage of midwives in Bangladesh, undermining the health of women and their babies.
Midwives only entered the workforce in Bangladesh in 2018 but a new study by Johns Hopkins University has shown that they have already saved hundreds of lives in Bangladesh and could save thousands more, if policy makers committed to significant investment in midwifery. Efforts to reduce maternal deaths through the provision of high-quality midwifery care must therefore be scaled up and accelerated.
Although midwives, where deployed, now conduct a staggering 78% of all normal births in Bangladesh, there remain many health facilities where midwifery care is not available, especially at Union level, where services are accessible to the majority of women and their families.  Moreover, many midwives face challenges in working to their full scope of practice even though evidence shows that midwives can provide almost 90% of essential sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) services. Midwives are independent professionals, expert in providing sexual and reproductive health services and in responding to the impact of climate change on health in Bangladesh, but many people confuse them with nurses, thus limiting their recognition, and curtailing the support and resources they need to save lives. A 2022 survey conducted by the Bangladesh Midwifery Society showed that many local authorities did not have a clear understanding of the midwifery profession and held misconceptions about midwives' competencies, leading to ambiguity about their role.
We call upon the Ministry of Health and Family Welfare (MOHFW) to deploy midwives with the utmost urgency, to improve access to midwifery services and, in doing so, to save lives. Specifically, we recommend that the MOHFW immediately implements the directive, as indicated in the 2022 circular from the Directorate General of Nursing and Midwifery (DGNM), to employ 401 midwives. We suggest that Government (DGNM) provides midwife mentors for students in clinical settings.
We also call upon the Directorate General of Nursing and Midwifery (DGNM), Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP) to raise awareness about the midwifery Scope of Practice (SOP) in public and private health facilities to ensure autonomous midwifery practice.
Furthermore, we urge the Government and other key midwifery stakeholders to work with the Bangladesh Midwifery Society (BMS), the professional association and collective voice for midwives in Bangladesh, which has over 6,000 members across the country and can work to ensure that midwives receive the support and ongoing education needed to provide high quality care.
Midwives are first responders when climate disasters strike. Bangladesh is one of the countries in the world that is experiencing the devastating effects of climate change, with excessive heat and flooding affecting a large and growing proportion of the population, and posing significant health risks, especially to vulnerable groups such as pregnant women. As we celebrate International Day of the Midwife (IDM) under the theme; Midwives: A Vital Climate Solution, we urge government to immediately deploy more midwives, create an enabling environment and empower them to work to their full scope of practice. This will strengthen primary health care systems and provide a pathway to Universal Health Coverage. By investing in midwives, we can save lives and ensure that every woman and newborn has access to the quality care they deserve.

Bangladesh Midwifery Society (BMS)

Website: https://bmsone.com/

Address: House 4, Road-10, Sector-10, Uttara, Dhaka-1230

                                                                                                                                            Email: bmspresident.bd@gmail.com

[1] UNFPA/Government of Bangladesh (2023) Maternal and Perinatal Death Surveillance and Response (MPDSR) in Bangladesh

[2] Bangladesh Bureau of Statistics (2024) Bangladesh Sample Vital Statistics 2023: Key Findings

[3] SAFF-winning footballer Razia dies after childbirth https://www.daily-bangladesh.com/english/sports/92905