Global review of midwifery and the situation in Senegal.

The first comprehensive analysis of midwifery services and staffing in 58 countries in all regions of the world found that the world lacks 350,000 skilled midwives--112,000 in the neediest 38 countries surveyed, if the needs of women are to be met. (1)

In Senegal, the maternal mortality ratio in 2005 was 401 deaths per 100,000 live births. Only 52% of births overall (only 20% for the poorest quintile of women) were accompanied by a qualified birth attendant. There are many private midwifery training schools, but with only two government inspectors to oversee these schools, many are reported to have low standards. Even with a national test that all midwives must pass to work in a public hospital or clinic, many who fail the exam can still obtain a diploma and find work in a private clinic. The current curriculum excludes vital aspects of birthing support such as administration of antibiotics. Senegal not only requires better midwifery training but also more midwives, especially in rural areas. UNFPA reports that Senegal needs to recruit 250 additional midwives per year in order to have any chance of reaching MDG4 and 5 targets. In 2010, the government did a recruitment push and hired "hundreds of additional midwives" to work in rural areas, yet half of them had returned to Dakar within a year, according to the Health Minister. The National Midwives Association is lobbying for more creative ways to recruit to rural areas, including incentives such as lodging, transport, health insurance for midwives' families, and career development training. (2)

(1.) UNFPA, State of the World's Midwifery: Delivering Health, Saving Lives. New York: UNFPA; 2011.

(2.) Senegal: poorly-trained midwives pose danger. kin News, 30 June 2011.

DOI: 10.1016/S0968-8080(11)38593-X