- Associated Press - Monday, June 20, 2011

JOHANNESBURG (AP) - In Ethiopia, only 6 percent of births are attended by a doctor, nurse or midwife. In Niger, many women have more pregnancies than is safe. In Botswana, the AIDS virus is linked to almost 80 percent of maternal deaths.

According to a United Nations Population Fund study released Monday, more and better trained midwives could help save millions of lives in these and scores of other countries with high mother and newborn death rates.

“We have now realized that there is a huge potential in the hands of the midwives that was not being exploited. They can do much more than deliver babies. They can deliver health services,” Vincent Fauveau, a doctor who coordinated the study of 58 countries, said in a telephone interview from the coastal South African city of Durban.

Midwives should be looked to in countries that need to increase the number of births attended by trained professionals if there is a shortage of doctors and nurses, Fauveau said. Midwives, often particularly trusted among women in their communities, can also offer birth control counseling and services, he said.

Fauveau said broad improvements are needed, including increases in other health professionals, but that the role of midwives should not be neglected.

In the West African country of Sierra Leone, midwives often have to handle 10 to 15 deliveries a day during the highest pregnancy case load from February to July, said Tobias Bowen, administrator of a government hospital in the capital.

The load “puts a lot of strains on them,” Bowen said. “They are doing a tremendous job.”

Fauveau said the U.N. health agency recommends midwives handle only one or two births a day, to ensure that women and children get the right care, and that the midwives don’t burn out.

Dozens of aid, development and educational institutions endorsed the study’s message that governments, donors and others must invest in and respect midwives. The study and new recommendations for training and licensing midwives were released at an international midwives conference in Durban Monday. USAID, Save the Children and Johns Hopkins Bloomberg School of Public Health were among the groups endorsing the study.

The U.N. surveyed health officials in 58 countries identified as “suffering from a crisis in human resources for health.” Two-thirds of the surveyed countries are in Africa.

The countries surveyed accounted for 58 percent of all the world’s births in 2009 _ but 80 percent of stillbirths around the world, 82 percent of newborn deaths and 91 percent of maternal deaths.

Johns Hopkins determined as many as 3.6 million maternal, fetal and newborn deaths a year could be prevented if health services in the 58 countries are upgraded by 2015 and if the women there delivered in or near a clinic or hospital and had a professional to monitor their health during pregnancy and birth and immediately after. Such conditions are the norm in the developed world.

In 2000, the U.N. set Millennium Development Goals that included reducing child mortality by two-thirds and maternal mortality by three quarters by 2015. Many poor countries are struggling to meet the targets.

“Investing in midwifery saves lives,” Monday’s U.N. study concluded.

Fauveau added other investments were needed, including building more clinics, particularly in rural Africa. War, poverty and hunger also threaten women and children.

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