The report says that among the 21 countries studied, Pakistan and Papua New Guinea (PNG) display the most acute midwife shortages. Projections indicate that even by 2030, these shortages will persist despite current efforts.

Midwives are foundational to maternal and newborn health. According to UNFPA’s landmark State of Asia’s Midwifery 2024 Report, midwives deliver up to 90 percent of essential sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) services – yet across the Asia-Pacific region, severe workforce shortages undermine this potential.

In 2023 alone, roughly 260,000 women worldwide died during or shortly after childbirth, with 22 per cent (about 58,000 maternal deaths) occurring in the Asia-Pacific – many of which were preventable with timely midwife-led care. Additionally, almost a million newborns died in the region in 2022. This grim reality illustrates that midwifery gaps are not just technical deficits – they translate directly into lost lives.

Countries Facing Critical Shortages

Among the 21 countries studied, Pakistan and Papua New Guinea (PNG) display the most acute midwife shortages. Projections indicate that even by 2030, these shortages will persist despite current efforts.

Other countries – Lao PDR, Mongolia, and Timor-Leste – also face needs-based shortages, though to a lesser extent.

Meanwhile, India, along with Afghanistan and Myanmar, could not be included in workforce availability analyses due to insufficient or outdated data. India is currently in the process of establishing a new cadre of professional midwives, signalling recognition of the gap – but data limitations hamper precise understanding of scale and urgency.

Beyond Numbers: India’s Context and Challenges

Though the report doesn’t provide headcount data for India, its absence speaks volumes. As a country with the fifth-largest number of contributors to the report and a vast maternal caseload, India’s midwifery system carries immense responsibility. The decision to establish a professional midwifery cadre signals a policy shift, but implementation remains in its early stages and needs sustained momentum.

Several factors suggest that India, like many of its regional peers, likely experiences a midwife density below the global average of 4.4 per 10,000 population. The report explicitly notes that midwife density in India, Afghanistan, and Myanmar may be below average, though this cannot yet be confirmed quantitatively.

Midwife Density Spectrum: From High to Critically Low

Across reporting countries, midwife density varies starkly – from 42.9 per 10,000 in the Democratic People’s Republic of Korea (DPRK) to just 1.4 per 10,000 in PNG. Four of the countries – Mongolia, Pakistan, PNG, and Viet Nam – fall below the global average of 4.4.

While India’s specific placement on this spectrum is unknown, this context underscores the need for urgent attention to midwifery investment, especially in densely populated and underserved areas.

Barriers to Midwifery Impact

The midwifery gap is not just about numbers – it’s about enabling environments:

• Only a handful of countries (8 out of 20) have midwife-specific deployment strategies, with just three – Bangladesh, Lao PDR, and the Philippines – reporting sanctioned midwife positions in the public sector.
• In India, the recent policy move to recognize professional midwives is promising, but deployment schemes and sanctioned positions remain in development, demanding careful planning.
• Licensing, continuing professional development (CPD), and regulatory oversight vary widely. While most countries have regulatory bodies and licensing systems, others allow automatic licensing or lack CPD requirements completely.
• Midwives are frequently limited in scope of practice, being barred from medical abortion (where legal), instrumental delivery, and other key services.
• Education quality, faculty training, and alignment with International Confederation of Midwives (ICM) standards are inconsistent across the region. This undermines both competency and trust.

What India Must Prioritize

The UNFPA report lays out clear, actionable recommendations – many aligned with India’s evolving context:

• Accelerate midwife production by expanding educational programs aligned with ICM standards, and scale up faculty development.
• Revise practice policies to ensure midwives are empowered to operate at full scope, backed by clear regulations.
• Scale up sanctioned midwifery posts in public sector facilities, ensuring deployment and retention, especially in underserved districts.
• Invest in data systems, enabling real-time tracking of workforce availability, deployment, and active practice.
• Empower midwives through leadership roles in policy, regulation, research, and national SRMNAH decision-making structures.

A Turning Point for India

India stands at a pivotal moment. The initiative to create a professional midwifery cadre is a bold and encouraging sign. Yet, without robust data, regulatory frameworks, deployment mechanisms, and professional recognition, this policy’s impact may remain limited.

For India and the entire Asia-Pacific region, the midwifery gap is not just a statistic – it’s a matter of lives. The UNFPA’s comprehensive assessment and forward-looking recommendations offer a roadmap. The report says that if India seizes this moment, invests in education, regulation, and workforce planning, it could dramatically advance maternal and newborn health, reduce preventable deaths, and uphold the dignity and rights of women across the country.