Evidence map›Paper›PMID 39039518›Full record

ArticleHuman resources for health2024

Increasing the number of midwives is necessary but not sufficient: using global data to support the case for investment in both midwife availability and the enabling work environment in low- and middle-income countries.

Andrea Nove, Martin Boyce, Sarah Neal, Caroline S E Homer, Tina Lavender, Zoë Matthews, Soo Downe

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Article in Human resources for health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Andrea NoveNovametrics Ltd, 4 Cornhill Close, Duffield, Derby, DE56 4HQ, United Kingdom. andrea@novametrics.org.ORCID 0000-0001-5272-3014
Martin BoyceNovametrics Ltd, 4 Cornhill Close, Duffield, Derby, DE56 4HQ, United Kingdom.
Sarah NealDepartment of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom.
Caroline S E HomerMaternal, Child and Adolescent Health, Burnet Institute, Melbourne, VIC, Australia.
Tina LavenderDepartment of International Public Health, Centre for Childbirth, Women's and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
Zoë MatthewsDepartment of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom.
Soo DowneSchool of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom.

Funding

Bill and Melinda Gates Foundation INV-061463
6 · The paper itself

Abstract

backgroundMost countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries' (LMICs') midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration.

methodsUsing the most recent available data from publicly available global databases for the period 2000-2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality.

resultsIn LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10-15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country.

conclusionsA complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes.

Indexed as

Developing CountriesInfant MortalityMaternal Health ServicesMaternal MortalityMidwiferyCesarean SectionFemaleGlobal HealthHealth Services AccessibilityHumansInfantInfant, NewbornPregnancyWorking ConditionsCaesarean sectionMaternal mortalityMidwiferyMidwivesModel of careNeonatal mortalityValue based healthcare

Identifiers

PMID39039518
PMCPMC11264417

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.