The State of the World's Midwifery 2021


Published on May 5, 2021, this report was released by the United Nations Population Fund in partnership with WHO and the International Confederation of Midwives, the Netherlands. It is the third report in The State of the World’s Midwifery series, the first of which was released in the year 2011.

Due to their crucial position in the wider sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workforce, midwives are the primary focus of this report. It states that licensed midwives who have the required degrees (when aided by other health professionals) can deliver about 90 per cent of all essential SRMNAH services – such as maternal and newborn healthcare, sexual and reproductive health counselling, contraceptive services and abortion care. However, they make up less than 10 per cent of the SRMNAH workforce in the world. The report highlights the need for greater investment in education and training of midwives; planning, management and regulation of the workforce; and prompt service delivery to help midwives deliver better healthcare services.

This 80-page document is divided into seven chapters: Introduction (Chapter 1); Midwives: a vital investment (Chapter 2); Education and regulation of midwives to ensure high-quality care (Chapter 3); Need for and availability of midwives and other SRMNAH workers (Chapter 4); Equity of access to the SRMNAH workforce (Chapter 5); Enabling and empowering the SRMNAH workforce: Gender matters (Chapter 6); Progress since 2011 and looking forward to 2030 (Chapter 7).


  1. The report states that there is a lack of 1.1 million ‘dedicated SRMNAH equivalent’ (DSE) workers worldwide. Of these, the greatest lack – of about 900,000 workers – is noted among midwives and the larger midwifery workforce including nurse midwives, perinatal and maternity nurses, assistant midwives, auxiliary midwives and auxiliary nurse-midwives.

  2. The global SRMNAH workforce is currently capable of providing 75 per cent of the basic SRMNAH care. However, in low-income countries, the workforce is capable of fulfilling 41 per cent of the existing demand. By 2030, the global SRMNAH workers are projected to meet only 82 per cent of the total need.

  3. The need for SRMNAH workers is calculated by the hours they will have to work to provide universal high-quality healthcare. The need in 2019 is calculated to be 6.5 billion hours of work by SRMNAH workers globally. By 2030, the number is estimated to reach 6.8 billion hours of work.

  4. To bridge the rising inequalities between low-income, and high- and middle-income countries, 1.3 million new posts for DSE workers need to be created by 2030, the report states. At the current rate of progress, only 0.3 million such posts are expected to be created in the next 10 years.

  5. Among SRMNAH personnel globally, 93 per cent of midwives and 89 per cent of nurses were women, the report notes. On the other hand, women made up 50 per cent of SRMNAH doctors.

  6. The report analyses 88 countries with highest maternal deaths, neonatal deaths and stillbirths. It notes that a 25 per cent increase every five years in midwife-delivered interventions – such as family planning, diabetes management, assisted delivery and breastfeeding support – could reduce maternal and newborn deaths by 40 per cent and stillbirths by 26 per cent.

  7. The International Confederation of Midwives surveyed its 140 member associations across the world to gauge the impact of the Covid-19 pandemic on midwives. As of December 2020, 70 per cent of the responses received from participating associations reported that midwives lacked the necessary personal protective equipment.

  8. Around 91 per cent of the countries which responded in the survey mentioned above reported that at least a bachelor’s degree was necessary to qualify as a midwife.

  9. The report recommends increasing investment in the education and training of midwives and other SRMNAH workers. It also recommends creating positions for midwives in national ministries to involve them in the policymaking and implementation processes.

    Focus and Factoids by Devi Divija Singal Reddy.

    PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.


United Nations Population Fund, World Health Organization and International Confederation of Midwives


United Nations Population Fund, World Health Organization and International Confederation of Midwives


05 May, 2021