Experts call for more midwives at health centres as 85% demand unmet

Taraganj Upazila Health Complex in Rangpur sees 20-25 normal deliveries every month, with 2-4 critical caesareans but zero maternal deaths, a significant improvement from just 2-3 normal deliveries six years ago. 

Three midwives are driving this increase at the health facility. 

Nusrat Jahan, one of those midwives, said she does regular check-ups, monitors foetal movement, and provides medical advice. 

"During labour, we monitor both mother and baby closely for about 10-12 hours, referring patients for caesarean delivery if necessary, although this is rare," she said.

Despite these successes, there is still an 85% shortage of midwives nationwide. 

Experts say 20,000 midwives are needed in the country, while data show only around 3,000 are currently appointed at different hospitals. They say the number must be increased to reduce maternal mortality and improve the rate of normal deliveries. 

According to the United Nations Population Fund, Bangladesh has 8,646 certified midwives. Of them, 2,557 have been appointed in 407 upazila health complexes, 376 work in private hospitals, and around 400 serve in Rohingya camps in Cox's Bazar. 

Dr Ishtiaq Mannan, a public health worker with an international organisation, has long been working to raise awareness about C-section deliveries. 

He said over 20,000 midwives need to be appointed across various healthcare facilities, including district and medical college hospitals.

In 2019, government guidelines aimed at reducing C-section deliveries were supposed to lead to the recruitment of more midwives, said Dr Mannan, who is a former country director of Save the Children.

"However, the actual hiring rate remains low," he added. 

The health ministry last year requested the public administration ministry to create 5,000 additional midwife positions, said Md Nasir Uddin, director (administration) at the Directorate General of Nursing and Midwifery. 

"While the public administration ministry agreed to the proposal, the finance ministry only approved the creation of 450 midwife posts," he added.

Nasir Uddin pointed out that currently the process of appointing midwives to the 450 posts is going on. "We have written to the ministry again reiterating the need for midwives. I'm hopeful of creating additional midwife positions."

Midwives save thousands of lives

Midwives institutionally entered the workforce in Bangladesh in 2018. However, a recent study by Johns Hopkins University found that they have already saved hundreds of lives in Bangladesh and could save thousands more if policymakers were committed to significant investment in midwifery. 

According to data from the Bangladesh Sample Vital Statistics-2023, the country's caesarean delivery rate in 2023 was 50.7%, significantly higher than the 10%-15% maximum recommended by the World Health Organization. 

Dr Rowshan Ara Begum, a renowned gynaecologist and former president of the Obstetrical and Gynecological Society of Bangladesh, said midwives play a vital role during normal deliveries, as specialist gynaecologists cannot always be present throughout the process. 

"While many midwives have been trained in Bangladesh, there is still a need for better training and employment opportunities for them to effectively safeguard maternal health," she added.

Bangladesh, along with the rest of the world, will observe International Day of the Midwife today. This year's theme is "Midwives: A Vital Climate Solution." 

In a statement, the Bangladesh Midwifery Society said, "We urge the 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."