Every second, across the 73 developing countries profiled in the The State of the World’s Midwifery
2014: A Universal Pathway. A Woman’s Right to Health report, another five women become pregnant.
This totals 300 pregnancies each minute, which is well over 400,000 per day.
Each of these women needs, and must have access to, the essential maternal health services that can
keep her safe and healthy throughout her pregnancy, labour, and beyond. All of the 135 million babies
born per year need and deserve care to bring them safely through the critical first days and weeks of life.
And every woman — young and old, poor and wealthy, in every region and country — has a right to re-
productive health and family planning services and information that empower her to make her own de-
cisions about whether and when to have a baby. They need, quite simply, the care that midwives provide.
Today, the world is failing far too many of those women and newborns. For tens of millions of them,
essential reproductive health services, and the skilled midwives and other health workers trained to
provide them, are just not available. Even when available, services are not accessible to many women,
because they are too far away or are unaffordable. In order to be effective in saving lives, services
must actually be used, and often the care provided is not acceptable to women — disrespectful of their
culture, their rights, or their personal wishes and needs. Services, in far too many cases, are of poor
quality, due to insufficient resources for midwifery education and supportive supervision, stock-outs of
medicines and other commodities, and gaps in the regulatory and policy environment.
The result, tragic and terribly unjust, is a world in which nearly 300,000 women and 3 million newborns
die each year, and where 2.6 million stillbirths occur, nearly all of them from preventable causes.
The State of the World’s Midwifery 2014 (SoWMy 2014) report contains a rich and valuable presentation
and analysis of current data and trends on the state of midwifery in 73 countries, and recommenda-
tions for strengthening midwifery programmes and policies at all levels. This toolkit has been devel-
oped as a companion piece to support national efforts to use the SoWMy 2014 report, through national
launches and other follow-up actions at the country level. This is not a stand-alone tool, but one meant
to support the use of the SoWMy 2014 report.
The midwives and other providers of midwifery services for whom this toolkit was developed are at the
heart of the solution. You and your colleagues are committed to providing women and babies with the
care they need. Midwives educated to international standards can save lives every day.
Well-educated, regulated, and supported providers are also a key to progress, because midwives
and others — through professional associations — can be a profound and powerful voice for change
in countries. Midwifery service providers understand the health care needs of women and newborns,
because they work to meet those needs every day. They see the gaps in their health care systems — in
resources, staffing, facilities, and policies — because they struggle to fill those gaps, day in and day out.
They speak the truth about midwives’ need for training, for support, and for enabling policies — be-
cause this is the job to which they have dedicated their lives and livelihoods.
Although this toolkit is geared towards midwives and midwives associations, its broader message can
be adapted and utilised by other technical and professional organisations, community- and coun-
try-level stakeholders, and opinion leaders. Improving midwifery services and meeting the needs of
women and newborns is the responsibility of all; the more partners and supporters that take up this
toolkit and call to action, the more successful the advocacy movement will be.
When service providers speak in a united voice, filled with knowledge and passion, policymakers
listen. Now is the time to speak up. Change will come, lives will be saved, and countries will move for-
ward to a brighter, healthier future.