DOI: 10.12688/f1000research.184196.1 ISSN: 2046-1402

The Fastest Route to Fewer Maternal Deaths: Scaling Midwife-led Continuity of Care

Shyamkumar Sriram
Show PDF Cite
Background Maternal mortality has fallen by about 40% since 2000, but the progress has stalled. In 2023 roughly 260,000 women still died from causes tied to pregnancy and childbirth, one death about every two minutes, and the world remains far from the Sustainable Development Goal of fewer than 70 deaths per 100,000 live births by 2030. Almost all of these deaths can be prevented. They happen overwhelmingly where women cannot reach a skilled, trusted health worker who stays with them across pregnancy, birth and the weeks that follow. Policy and implications Midwife-led continuity of care (MLCC), where a known midwife or small team looks after a woman through pregnancy, birth and the postnatal period and refers her promptly when specialist care is needed, is recommended by the World Health Organization and backed by trial evidence: more spontaneous vaginal births, fewer unnecessary interventions, better experiences of care and lower costs. The problem is not the evidence. It is that midwifery remains underfunded, fragmented and only loosely stitched into most national health systems, with a global shortage of roughly 900,000 midwives. The real constraints on progress now sit in workforce, financing and regulation. Recommendations Four moves would change the trajectory: write MLCC into national strategies and the services that public funding pays for; invest in midwives by training, deploying, retaining and paying them properly; fix the referral systems and conditions that limit their scope of practice; and fund the disaggregated data needed to track who is still being left behind. Conclusions We already have what we need to prevent most maternal deaths. Reaching the 2030 target is less a technical problem than a political one: it means moving from scattered pilots to system-wide investment in continuity-based midwifery, then paying for it and holding someone accountable.

More from our Archive