WHO African Region: Ethiopia

WHO Representative’s Keynote address at the International Day of Midwives

Addis Ababa
24 May 2006

Distinguished guests,

Ladies and Gentlemen,

It is indeed an honor and a privilege for me to give this keynote address at this celebration of the International Day of Midwives.

Motherhood is one of the happiest moments in a woman’s life but it can also prove life threatening for the mother and the newborn if there is no skilled care during complications of pregnancy, child-birth or the immediate post-natal period. The unacceptably high maternal and neonatal mortality and disability in the developing countries has become a priority global human rights and development issue.

Since the development of modern medical profession, midwives are one of the key health manpower with distinguished track records; unfortunately, their services are often not well recorded or told. They are the health cadres that serve the rural people who have little access to health care. They are the unsung heroines of the health system that save the lives of the mothers and the newborns. Many of us here owe our survival to midwives.

The theme for this year’s celebration which reads as “The World Needs Midwives now more than ever” carries a most appropriate and timely message because of the following reasons:

One: The maternal mortality ratio and the proportion of births attended by skilled health personnel are the two indicators used to monitor progress towards achievement of the 5th Millennium Development Goal (MDG) which aims to improve maternal health. Among the potential process indicators to track changes in maternal mortality levels, “proportion of births attended by skilled health personnel” is being accepted to be the most relevant due to the historical data showing a correlation between having skilled care at delivery and declining maternal mortality. The availability of midwifery services is, therefore, a key indicator for the MDG 5 of improving maternal health and its target of reducing maternal mortality.

The second reason is that the theme can highlight the fact that there is a great disparity between the rich and the poor in access to skilled attendants. According to a WHO world-wide survey, there is a great disparity in the coverage of skilled attendants. It is on average 61.5%, highest in developed countries, but as low as 12% in Ethiopia, a country with one of the highest maternal mortality and the most acute shortage of midwives.

There is enough evidence that investing in midwives is wise; they have proved to be the key health providers that remain close to the communities therefore they are optimally placed to serve as a link between mothers and the health system. Moreover, because of the high esteem they earned over the years midwives have proved to be effective as promoters of healthy practices, as advocates for women’s health and as agents for community mobilization.

The government of Ethiopia has adopted several initiatives and strategies for both community level and health facility based services. There are challenges particularly that of the lack of human resource and the weakness of the health system. In-order to improve the availability of skilled attendants at birth, importance must be given to the training of midwives, to regulations and incentives to improve their working conditions, and provide them with opportunities to improve quality of services. We believe that much can be done through concerted efforts through partnership that will improve and maintain services with a high quality standard.

Finally, I would like to reiterate WHO’s appreciation and commitment to support the government’s effort for the development of human resources for health, particularly for the vulnerable group such as mothers, newborns and children.

I would like to thank the organizers and please have my best wishes to all of you here and all to midwives