First stop on the ICM Safer Motherhood World Tour 2007: Lilongwe, Malawi: Nester T Moyo, ICM Programme Manager, describes an innovative event which puts midwives at the heart of action to make childbirth safer in Malawi.

• Auteur: Moyo, Nester T.

The Safe Motherhood Initiative, conceived in 1987 in Nairobi, Kenya, celebrates its 20th anniversary in 2007. Twenty years ago, WHO, UNFPA and the World Bank issued a call to reduce maternal mortality, particularly in developing countries. Halfdan Mahler, Director General of WHO at the time, said, 'This has been a seriously neglected problem, largely because its victims are those with the least power and influence in society' and called for 'good prenatal care, with early detection and referral of those at high risk [and] the assistance of a trained person at all births'.

The tragedy of maternal and newborn deaths and disability remains a pressing global issue. Midwives continue to make huge contributions to the health of the mothers and newborns in their countries. But in many parts of the world, strengthening and scaling up midwifery remain important basic needs to be met. The ICM has planned a series of workshops and activities aimed toward profiling and positioning midwifery in countries with a high burden of maternal and neonatal mortality, as a means of achieving safer motherhood and Millennium Development Goals 4 and 5. This initiative is to be known as the ICM Safer Motherhood World Tour. Malawi is the first country to host a workshop of this series. The theme of this event was 'Advocating for Strengthening and Scaling up of Midwifery'.

Motherhood in Malawi

In Malawi, of the 600,000 pregnancies every year, 57% of women are delivered in health institutions: 50% of births are attended by midwives, 6% by doctors or clinical officers and 1% by patient attendant. The Demographic Health Survey Report, 2004, indicated a high maternal mortality ratio of 984/100,000 and an estimated neonatal mortality rate of 27 per 1,000 live births. The tragedy is that 14 maternal and 37 neonatal deaths occur every day.

There is a crisis in the skilled health care work force in Malawi. The nurse:patient ratio ranges from 1:50 to 1:120 and over 95% of nurse-midwives are urban based, leaving the underserved rural areas with significantly higher vacancy rates. Many women are still cared for by unskilled attendants. No country in the world has been known to reduce the number of maternal and neonatal deaths without substantial support and involvement of midwives.

The overall goal of the workshop was to initiate a sustainable dialogue between midwives, policy makers and stakeholders that will ultimately result in a measurable increase in the quantity and quality of care given to women and newborns in order to reduce maternal and neonatal mortality. The specific objectives were:

* to explore the current status of midwifery in Malawi and its contribution to the reduction of maternal and neonatal mortality and morbidity

* to determine what support Malawian midwives need in order to optimise their contribution to the reduction of maternal and neonatal mortality in Malawi

* to initiate dialogue between midwives, policy makers and stakeholders on strengthening and scaling up of midwifery and the provision of midwifery care to women and newborns

* to facilitate midwives to engage policy makers and stakeholders in developing a consensus document (agreed plan of action) for future action for scaling up midwifery in Malawi

* to disseminate information from the First International Forum on Midwifery in the Community held in Hammamet, Tunisia, in December 2006.

Among those represented at the workshop were the government of Malawi, the UNFPA Malawi country office, midwives from all 28 districts in the country, rural health facilities, central and private hospitals, the university, the Health Foundation of Malawi, the Nursing Council, Department of Human Resources in the Ministry of Health, Sector Wide Approach, the Nursing and Midwifery Organisation, the Nursing Directorate and the mentors and mentees from the ICM Young Midwifery Leaders Programme.

Key speakers

The...