Midwives and Climate

The midwife-led continuity model of care throughout the pregnancy, childbirth and postnatal continuum is often community-based, reducing the carbon footprint associated with travelling to and from large, centralised health facilities. Research has shown that this type of care has excellent outcomes for the health and wellbeing of women and babies. It also ensures more equitable, easier access to care. 

According to The World Bank, approximately 43% of the world’s population lives in rural settings. These families living rurally are often required to travel long distances to reach healthcare facilities. In fact, a recent study in the Nature Medicine Journal found that close to 650 million people globally ​​cannot reach healthcare within one hour if they have access to motorised transport and that people facing long travel times to healthcare facilities are less likely to seek care when it is needed. This underscores the need for increased investment midwives — healthcare providers capable of delivering primary and preventative healthcare services such as antenatal checks, reproductive health services, infant vaccinations, breast examinations and general health education in a wide variety of settings. When women and families living rurally have access to quality, well-resourced midwifery services, they are less likely to travel long distances to hospitals and health facilities in search of care that could be provided in the comfort of their communities, thus limiting their carbon footprint and the healthcare costs where the default model of care involves travel to large, urban hospitals for everyone. 

Midwifery care is premised on the idea that pregnancy, birth and the postnatal period are normal, physiological events for most women and newborns. It is also premised on the autonomous role of midwives across the Midwifery Scope of Practice. Midwives are the only health professionals that are equipped and able to provide continuity of care to women and their newborns across the pregnancy and childbirth continuum. Midwives can provide more than 90% of essential care required by women and newborns and they work collaboratively with obstetricians, paediatricians, neonatologists, and other health professionals according to the needs of women and newborns. 

Rather than being surrounded by an array of medical tools and machines, the continuity model of midwife-led care provides safe care with an approach to safe birth practices that lets the physiological labour and birth process evolve as normal, intervening when necessary, using a one-on-one “watchful waiting” approach. Instruments and supplies are typically basic and re-usable: foetal heart monitors for intermittently listening to the baby’s heart, blood pressure cuffs, sterile gloves, and perhaps a birthing stool or pool. There's a focus on non-invasive methods, such as massage, water immersion, or position changes to aid in the birthing process. Without the over-reliance on disposable medical supplies and single-use items often found in hospital settings, midwives generate much less waste.

Additionally, for women and gender diverse people without complex health needs, the continuity model of midwife-led care has been proven to be more cost-effective than obstetric care, while simultaneously producing equal if not better health outcomes for mothers and newborns. Health systems can allocate the savings from their investments in midwifery services towards initiatives and programs that protect communities from the impacts of climate change. 

The midwifery and obstetric models of care work best when used collaboratively - ensuring that the women and gender diverse people who need specialised, more resource-intensive care get it when they need it, without applying the specialised, obstetric model to the general population by default.

Midwives are essential in promoting breastfeeding and supporting women to meet their breastfeeding goals. Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants - it’s also an environmentally sustainable practice. Increasing breastfeeding rates is also a key public health measure that improves the health of women and babies. 

A 2019 study in the Infant Breastfeeding Journal found that feeding an infant on milk formula for 6 months instead of exclusive breastfeeding requires 21 kg of formula, and adds over 200 kg of CO2 eq GHG emissions to the planet. This study underscores the prevailing research on the impacts of formula feeding on women, newborns and the planet, demonstrating the urgent need for governments to heavily regulate the marketing of infant formula which requires water, land, and other natural resources to produce. 

As the dedicated care providers of women and gender diverse people, midwives are equipped with the education and training to support those in their care to breastfeed. No matter what their breastfeeding goals are, all mothers should get evidence-based education around breastfeeding, including the long-term health benefits of breastmilk and its role in improving health outcomes in adulthood for women and babies. Ultimately, these preventative benefits help health systems save costs, which can be put towards midwifery services. 

Midwives are trusted sources of information on sexual and reproductive health in communities, and provide information on family planning, contraception, and child spacing. Taking control of the number and spacing of their pregnancies means that women can reduce their family’s vulnerability to climate change and build their economic resilience by giving them the freedom to opt for smaller families, work outside the home and be more financially independent.  

As Dr. Natalia Kanem of the UNFPA notes, “family planning is not only a matter of human rights; it is also central to women’s empowerment, reducing poverty and achieving sustainable development.” A growing evidence base also links family planning with reduced human vulnerability to climate change and enhanced resilience in the face of climate change impacts. With this in mind, we must invest in midwives — community-based healthcare providers with the education to deliver culturally appropriate family planning services — as a strategy to empower women and other birthing people to make decisions about when, if at all, to have children, and how many children to have. 

According to UNFPA and Guttmacher Institute, approximately 222 million women in the world would like to plan the number and spacing of their children, but currently are not able to because they don’t have access to modern contraception. Meeting their needs through increased access to midwives and rights-based family planning services would be a win for women, their children and the climate. And as Kristen P. Patterson, the former program director at the Population Reference Bureau notes, the additional health, education and economic benefits that accompany family planning would reduce women’s vulnerability to the impacts of climate change and build their economic resilience. 

When climate disasters strike, midwives are uniquely positioned to quickly reach affected communities to provide vital reproductive and maternal health services. They are also an effective network through which information, supplies and medications can be distributed. 

During and after a disaster there are almost always interruptions in reproductive and maternity care, lack of menstrual products, severe shortages of clean water and food, and mental health crises and trauma brought on by the stress of displacement, missing, injured and deceased loved ones, and a shortage of housing. In the past year alone, ICM and its partners have supported midwives and their associations to respond to devastating climate induced-disasters. This includes:

• Midwives in Morocco who facilitated safe births outside of hospital settings after 6.8-magnitude earthquake rocked the region and destroyed healthcare infrastructure; and midwives in Afghanistan who did similar work after a devastating earthquake hit the western part of the country
  

• Midwives in Hawaii who, after a wildfire devastated parts of Maui, distributed bottles, chest pads and menstrual products and established a 24-hour hotline providing tele-health to displaced community members. They also facilitated medical abortions in an effort to uphold access to SRH services and reduce the long-term social and psychological impacts of the event 
  

• Midwives in Pakistan who supported the more than 7 million people displaced by flooding in the region by providing women with vital pre- and post-natal care, such as vitamins, iron supplements, food supplements and infant formula. Midwives here also helped women to safely deliver babies in boats, makeshift tent hospitals and on the sides of roads. 
  

We know the frequency of these events will only increase — health systems need to invest in midwifery services as a direct strategy to mitigating the worst impacts of our warming world. By directly resourcing community-level midwifery organisations, funders and healthcare systems are supporting providers capable of coordinating effective crisis response plans and quickly and efficiently accessing community members with vital health services.