Anna af Ugglas and Olubunmi Oyebanji (Lead writers)
International Day of the Midwife 2026 should not be treated as another health calendar moment. Under the theme, “One Million More Midwives,” it is a direct call to governments, donors, and health leaders to invest in the workforce that can save more women and newborns.
Recent analyses show that continued declines in development aid could have devastating consequences. In a severe defunding scenario, this could mean an estimated 22.6 million additional deaths across all ages by 2030. Even under a more moderate scenario, following current downward trends, the toll could still reach 9.4 million excess deaths, equivalent to around 1.3 million per year.
This should be a major warning sign. While resources are tightening, health needs are not decreasing. Quite the opposite: climate shocks, conflict, and rapid population growth are placing even greater pressure on already stretched health systems, particularly across Africa. The gains of the past two decades are now at risk.
Expanded access, improved maternal and newborn survival, and stronger health systems cannot be assumed to continue at the same pace with less funding. This is quickly becoming a question of efficiency. In a shrinking aid landscape, every dollar must deliver more impact. What we invest in now will determine whether progress continues or reverses.
Progress in maternal and newborn health is fragile and uneven
Over the past two decades, important gains have been made in maternal and newborn health, with more women and newborns surviving pregnancy, birth, and the postnatal period. But progress has been uneven. In too many countries, maternal and newborn deaths remain unacceptably high, particularly across Africa.
We know that most of these deaths are preventable, yet they continue because too many women still cannot access timely, woman-centred, high-quality care. Health needs are growing faster than the workforce available to meet them. Across health systems, there are not enough trained professionals to deliver essential care, and attrition is adding pressure.
Within this broader gap, the shortage of midwives is particularly acute. The world is short nearly one million midwives. Additionally, the shortage of midwives is not evenly distributed. It is most acute where needs are highest, and systems are under the greatest strain. Africa carries a disproportionate share.
Around 9 in 10 women live in countries with a midwife shortage, driven by population growth and persistent underinvestment in the health workforce. For Nigeria, this distinction is significant. Nigeria does not only face a training gap; it also faces gaps in deployment, retention, financing, regulation, and working conditions.
More midwives need to be trained, but they also need to be employed, fairly paid, posted to underserved communities, protected in difficult working environments, supplied with essential commodities, and linked to functional referral systems.
The issue is not only access to funding, but also how that funding is used
Many health systems have prioritised highly centralised, hospital-based specialist care rather than investing in primary and community-based care closer to where women live. These models are expensive, resource-intensive, and difficult to scale in resource-constrained settings.
This approach too often means women can only reach care late, sometimes when complications have already become severe. This means health systems, and often families paying out of pocket, must spend far more on emergency interventions, surgical births, and intensive hospital care that could have been prevented through earlier access to skilled care.
Most complications can be prevented or managed earlier, closer to communities, and at lower cost. Yet investment in primary and community-based care has lagged. In a constrained funding environment, this approach is not sustainable. Efficiency is no longer a secondary concern; it is the central question for governments and donors deciding where limited resources should go.
Nigeria has already begun responding through significant policy restructuring. The Nigeria Strategic Directions for Nursing and Midwifery 2025–2030 provides a national framework to strengthen the training, deployment, regulation, performance, leadership, and workforce planning of nurses and midwives. These reforms are important, but their success will depend on whether midwives are placed at the centre of implementation.
Midwives deliver the highest return on investment in healthcare
Universal coverage of midwifery services could prevent 67% of maternal deaths, 64% of newborn deaths, and 65% of stillbirths, saving an estimated 4.3 million lives per year by 2035. Skilled, regulated and supported midwives can deliver up to 90 per cent of essential sexual, reproductive, maternal, newborn and adolescent health services across the continuum of care.
Midwives provide care before, during, and after pregnancy. They ensure continuity of care, which helps detect complications early and prevents them from becoming life-threatening emergencies. Midwives are also central to family planning, supporting healthy timing and spacing of pregnancies.
They are often based in the communities they serve. This makes care more accessible, more trusted, and more likely to be used, particularly in rural and underserved areas where distance, transport, and cost prevent many women from reaching facilities.
In Nigeria, this community connection is especially important. Many women still face delays in deciding to seek care, reaching a health facility, and receiving quality care after arrival. Midwives can help close these gaps by linking households to antenatal care, skilled birth attendance, postnatal care, newborn care, family planning, nutrition counselling, immunisation, and timely referral.
Midwifery models of care, including midwife-led birth centres and primary midwifery clinics, are associated with equal or better health impact at lower cost. These models reduce unnecessary and costly interventions, shorten hospital stays, and shift care safely to primary and community settings. They are also more efficient to scale.
Educating and training a midwife requires less time and investment than educating a physician, and midwifery models rely on appropriate use of interventions and fewer resource-intensive supplies, making expansion more feasible. The return on investment is strong. As highlighted in a recent UNFPA report, every dollar invested in midwifery care can generate up to $16 in economic and social returns.
zIn crisis settings, the value of midwives becomes especially clear
Nearly two-thirds of global maternal deaths occur in countries affected by conflict or fragility. The risk of a woman who lives in a country affected by conflict dying due to maternal causes is around five times higher for each pregnancy she undergoes compared to her peers in stable countries.
When systems are disrupted, midwives often become the most reliable part of the health response. Because they are already embedded within communities, they remain accessible when facilities are damaged, overwhelmed, or out of reach. Midwives continue to provide antenatal, birth, postnatal, and newborn care, ensuring essential services do not stop when other parts of the system are disrupted.
This makes midwives one of the most resilient and dependable parts of the health workforce. In a world of more frequent and overlapping crises, this reliability is essential. This is especially true for Nigeria, where conflict, insecurity, displacement, poverty, poor transport, and weak referral systems continue to shape maternal and newborn outcomes in several parts of the country.
In these settings, investing in midwives also supports health system resilience. When women cannot easily travel, facilities are overstretched, and families delay care because of cost or insecurity, community-linked midwifery services can help keep essential maternal and newborn care within reach.
In an era of constrained aid, investing in midwives is the most strategic investment
Today, we know the global health landscape is drastically changing. Access to funding is tightening, and priorities are shifting, while health needs continue to grow. The margin for inefficiency is shrinking, and governments can no longer afford to invest in expensive, difficult-to-scale models that fail to reach women early enough.
The evidence is clear. Midwives are not an optional investment. Investing in midwives means investing in safer pregnancies, safer births, newborn survival, stronger health systems for women and newborns, and is a more efficient use of limited resources.
In a shrinking aid landscape, investing in midwives is one of the most strategic, cost-effective, and evidence-based decisions available today. The question is simple: will we act on the evidence and invest in midwives, where the greatest impact can be achieved?
Anna af Ugglas is Chief Executive of the International Confederation of Midwives. A midwife, educator, and global health leader with over three decades of experience, she works to strengthen midwifery, maternal and newborn health, and woman-centred care globally.