Today, 5 May, we mark the International Day of the Midwife (IDM), a global moment to recognise the vital role of midwives in health systems worldwide, featuring insights from Esther Ruiter.
Esther is a registered midwife in Belgium and Kenya, with over 15 years of experience dedicated to strengthening healthcare systems. She will be appointed Global Health Connector Ambassador on 14 May.
Through Esther’s lens, we explore why midwifery is a global health imperative, the need for investment, and the barriers to equitable access.
From a global health perspective, IDM is not just a celebration of midwives. But this day is a critical advocacy tool to remind policymakers that midwives are not just “birth assistants,” but a distinct profession capable of providing 90% of essential sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) care.
For me, the journey from clinical midwifery to public health strategy has been defined by the recurring realisation: there is a profound gap between “surviving” a shift and “thriving” within a health system. On International Day of the Midwife, we don’t just celebrate the hands-on care provided at the bedside; we acknowledge the bridge between that clinical reality and the boardroom where policy is shaped.
While clinical skills save lives one by one, public health strategy ensures that the systems supporting those skills are sustainable, properly funded, and inclusive of all sectors. But to advocate for these systems effectively, we must first be clear about what we mean when we say “midwife.”
To understand the role of a midwife in a policy or clinical context, I always point people toward the International Confederation of Midwives (ICM) Professional Framework. It is our global anchor. Through the Global Standards for Midwifery Education and the Essential Competencies for Midwifery Practice (updated in 2024), the ICM has established a rigorous baseline for the profession worldwide.
These documents are not merely suggestions; they define the minimum knowledge, skills, and professional behaviors required to carry the title Midwife.
When we talk about strengthening midwifery, we are talking about a professional whose identity is built on specific competency statements. A midwife is more than a clinical provider; they are trained for:
As we mark the International Day of the Midwife (IDM), we must recognise that this is a call to action. The need to reshape midwifery training is urgent in many places, and we must keep working toward the ICM minimal standards.
However, we have to be realistic: reform will not be easy or straightforward. We cannot wait for “perfect” future systems to appear. Instead, we must be strategic and strengthen the profession by using the resources we have currently. By optimising our existing clinical settings, current training programmes, and partnerships, we can bridge the gap between today’s reality and the much needed midwifery standard.
The goal is clear: to ensure that every midwife is empowered to be exactly who the global framework says they should be.
Investing in midwifery is one of the most cost-effective “best buys” in global health. Research shows that universal coverage of midwife-delivered interventions could avert roughly 67% of maternal deaths, 64% of newborn deaths, and 65% of stillbirths.
Despite the importance of midwives, systemic barriers prevent them from reaching their full potential.
| Barriers | Practical Strategy |
|---|---|
| Professional Recognition | Moving midwifery from a “nursing sub-specialty” to an autonomous profession with its own regulatory bodies and leadership roles at the Ministry of Health level. |
| The “Gender Pay Gap” | Since midwifery is a female-dominated profession, it is historically underfunded. Addressing this requires gender-transformative policies and fair compensation structures. |
| Maldistribution | Most skilled midwives are in urban centers. Incentivising rural placement through housing, education stipends, and career progression pathways is essential. |
| Fragmented Private Sector | In many regions, the private sector operates in a silo. Integrating private midwifery practices into national health insurance schemes can expand access and increase quality of care. |
Real change happens when we stop viewing midwifery as a “charity” sector and start viewing it as a sustainable business and health imperative. To achieve this, we must align our clinical goals with strategic policy and innovation:
By combining these resource-smart innovations with decisive government action, we can move beyond isolated projects and create a resilient, self-sustaining healthcare system where midwives are empowered to lead.
In my work at Malaica, I see this shift happening in real-time. The whole team is focused on moving beyond traditional models to build a system where the mother’s care is central, yet supported by a robust, multidisciplinary framework that values adaptability and resource efficiency.
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