Nove Andrea, Ten Hoope-Bender Petra, Boyce Martin, Bar-Zeev Sarah, de Bernis Luc, Lal Geeta, Matthews Zoë, Mekuria Million, Homer Caroline S E
Novametrics Ltd, Duffield, DE56 4HQ, UK.
UNFPA, 7 rue de Varembé, 1202, Geneva, Switzerland.
Hum Resour Health. 2021 Nov 27;19(1):146. doi: 10.1186/s12960-021-00694-w.
The third global State of the World's Midwifery report (SoWMy 2021) provides an updated evidence base on the sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workforce. For the first time, SoWMy includes high-income countries (HICs) as well as low- and middle-income countries. This paper describes the similarities and differences between regions and income groups, and discusses the policy implications of these variations. SoWMy 2021 estimates a global shortage of 900,000 midwives, which is particularly acute in low-income countries (LICs) and in Africa. The shortage is projected to improve only slightly by 2030 unless additional investments are made. The evidence suggests that these investments would yield important returns, including: more positive birth experiences, improved health outcomes, and inclusive and equitable economic growth. Most HICs have sufficient SRMNAH workers to meet the need for essential interventions, and their education and regulatory environments tend to be strong. Upper-middle-income countries also tend to have strong policy environments. LICs and lower-middle-income countries tend to have a broader scope of practice for midwives, and many also have midwives in leadership positions within national government. Key regional variations include: major midwife shortages in Africa and South-East Asia but more promising signs of growth in South-East Asia than in Africa; a strong focus in Africa on professional midwives (rather than associate professionals: the norm in many South-East Asian countries); heavy reliance on medical doctors rather than midwives in the Americas and Eastern Mediterranean regions and parts of the Western Pacific; and a strong educational and regulatory environment in Europe but a lack of midwife leaders at national level. SoWMy 2021 provides stakeholders with the latest data and information to inform their efforts to build back better and fairer after COVID-19. This paper provides a number of policy responses to SoWMy 2021 that are tailored to different contexts, and suggests a variety of issues to consider in these contexts. These suggestions are supported by the inclusion of all countries in the report, because it is clear which countries have strong SRMNAH workforces and enabling environments and can be viewed as exemplars within regions and income groups.
第三份全球助产士状况报告（《2021年助产士状况报告》）提供了关于性健康、生殖健康、孕产妇、新生儿和青少年健康（SRMNAH）劳动力的最新证据基础。《助产士状况报告》首次将高收入国家（HICs）以及低收入和中等收入国家纳入其中。本文描述了各地区和收入群体之间的异同，并讨论了这些差异的政策含义。《2021年助产士状况报告》估计全球短缺90万名助产士，这在低收入国家（LICs）和非洲尤为严重。除非进行额外投资，预计到2030年短缺情况只会略有改善。有证据表明，这些投资将产生重要回报，包括：更积极的分娩体验、改善健康结果以及包容性和公平的经济增长。大多数高收入国家拥有足够的SRMNAH工作人员来满足基本干预措施的需求，并且它们的教育和监管环境往往很强。中高收入国家的政策环境也往往很强。低收入国家和中低收入国家的助产士执业范围往往更广，许多国家的助产士还在国家政府中担任领导职务。主要的地区差异包括：非洲和东南亚存在严重的助产士短缺，但东南亚的增长迹象比非洲更有希望；非洲高度重视专业助产士（而不是助理专业人员：这是许多东南亚国家的常态）；美洲、东地中海地区和西太平洋部分地区严重依赖医生而非助产士；欧洲有强大的教育和监管环境，但国家层面缺乏助产士领导人。《2021年助产士状况报告》为利益相关者提供了最新数据和信息，以便他们在新冠疫情后努力建设得更好、更公平。本文针对《2021年助产士状况报告》提出了一些针对不同情况的政策应对措施，并提出了在这些情况下需要考虑的各种问题。报告将所有国家纳入其中，为这些建议提供了支持，因为很清楚哪些国家拥有强大的SRMNAH劳动力和有利环境，并且可以被视为各地区和收入群体中的典范。
