'The evidence is strongly in favour of midwives as the main providers'--says The Lancet; The Lancet has published a landmark series of articles on 'Maternal Survival' that show strong support for expanding midwifery: Elizabeth Duff reports from the launch.

• Auteur: Duff, Elizabeth

On September 28, 2006, a state-of-the-art series of papers on 'Maternal survival' was published by The Lancet. The conclusions of the authors emphasise the importance of a midwife attending births, and propose that women should for optimum safety give birth in a health facility.

The ICM's response

The ICM, represented at the launch held at the University of London, welcomed the majority of the proposals and in particular the emphasis on skilled attendance at birth and the scaling up of midwifery, along with creating enabling environments. ICM commends the view that investment in multi-skilled community workers is an unhelpful option compared to investment in midwifery services.

As regards the recommendation for facility-based birth, ICM maintains its position that women have a right to make an informed decision to give birth at home and midwives who elect to provide professional services for women in their homes should be able to do so within a nation's health service. However, community-based healthcare facilities with midwife-led maternity services are a viable option, as midwives can practice basic emergency obstetric care and make timely referrals to district level for comphrehensive emergency obstetric care when necessary. This reduces the barrier of distance between women and the clinic, and may contribute to the retention of midwives who can work closer to home and families.

The five articles

The five papers that form The Lancet Maternal Survival Series present the evidence for prioritising the health centre and midwifery strategy and detail the action required for its roll-out, including immediate actions for governments and donors. The authors warn that, without political commitment and investment into this approach, substantial declines in maternal mortality are unlikely in the next 10-20 years, and the fifth Millennium Development Goal--to reduce maternal mortality by 75% by 2015--will not be met.

The first paper, 'Maternal mortality: who, when, where and why', in detailing the causes of maternal deaths, points out that 'most pregnant women die in labour, delivery, or during the 24-hour period after delivery, mainly from severe bleeding and hypertensive disorders. Midwives have the skills to prevent 88-98% of these deaths but currently, over half the world's women deliver their babies without professional care.'

The second paper, 'Strategies for reducing maternal mortality', makes projections, using data from Bangladesh, which...