300,000 Missing…and Counting
The midwife shortage causing public health concerns across the region
By Muna Abdullah, Health Systems Specialist
UNFPA East and Southern Africa
Originally posted on UNFPA ESARO
Somewhere in East and Southern Africa tonight, a woman will go into labor without a skilled health worker nearby. She may survive or she may not, an unforgivable roulette that is repeated hundreds of thousands of times across our region every year.
This year’s International Day of the Midwife carries a theme that should stop us cold: One Million More Midwives. Because that is how short the world is. The global midwifery workforce stands at 1.9 million, roughly two thirds of what is needed, and over half that gap is in Africa. In East and Southern Africa alone, more than 300,000 midwives are missing.
Africa knows what saves lives in childbirth as the solutions are obvious. What has been missing is the sustained political will and financial commitment to close the gap between what we know and what we do. The 2nd Africa Health Workforce Investment Forum in Accra carries a deceptively simple mandate: to move from words to action.
East and Southern Africa has a shortage of over 300,000 midwives. Its maternal mortality ratio stands at 276 deaths per 100,000 live births, nearly four times the 2030 SDG target. Between 2000 and 2023, the region reduced maternal mortality by 54 per cent: real progress, genuinely hard-won. But at the current pace of just 3.4 per cent annual reduction, we will not reach the target. Not even close. Six countries are projected to have a larger midwife shortage in 2030 than they do today not because the problem is unsolvable, but because investment has not matched need.
The case for midwifery is one of the strongest calls in public health. Skilled, regulated midwives can deliver 90 per cent of essential maternal and newborn health services. Achieving universal midwifery coverage by 2035 could avert 67 per cent of maternal deaths, 64 per cent of newborn deaths, and 65 per cent of stillbirths, saving 4.3 million lives per year. For every dollar invested, the return in economic and social benefits is sixteen dollars. This is the highest-yield public investment available to African governments right now.
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So why has progress been so slow? Three failures must be confronted in Accra.
The failure to plan. Too many countries produce workforce strategies disconnected from budgets and rural realities. Planning must be costed, accountable, and equity-driven: ensuring women in the most marginalized communities are not last in line for the professionals who could save them.
The failure to train: East and Southern Africa now has 209,000 midwives, the highest ever recorded. But too many are trained to curricula that have not kept pace with global standards. Botswana, Tanzania, Uganda and Zambia have shown acceleration is possible when education systems are reformed. The question is whether others will act on that lesson.
The failure to retain: Every midwife lost to migration or burnout is years of training and community trust, gone. Brain drain is the predictable consequence of poor pay, under-resourced facilities, and denied career progression. If governments want midwives to stay, they must make staying worthwhile.
There is a fourth failure that too rarely enters this conversation: the failure to protect midwives in crises. Across Africa’s fragile and conflict-affected settings, midwives are often the last health worker standing when systems collapse, and among the least protected. UNFPA is bringing to Accra evidence on Midwifery Models of Care in humanitarian settings: autonomous, evidence-based models where midwives provide continuity of high-quality care precisely when and where formal health systems break down. These are proven, cost-effective models that save lives, and they must be integrated into national emergency preparedness frameworks as a matter of policy, not improvisation.
The 1st Forum in Kigali produced the Africa Health Workforce Investment Charter. Charters are only as valuable as the actions they generate. Accra must deliver concrete, costed national pledges not the usual aspirations. Development partners must align behind country-led plans, not fragment investment across competing programmes. The Accra Roadmap must function as a living accountability instrument with clear milestones, published progress, real consequences for inaction.
The midwife is not a luxury at the margin of some fuller health system that will materialize later. In the communities that need her most, she is often the only clinician a woman will ever see. When she is absent, everything else, every hospital built, every policy written, is diminished.
One million more midwives. The evidence tells us what to do. The resources, while constrained, are not beyond reach. What is required is the willingness to act on what we already know, fund what we already believe, and hold ourselves accountable for what we have already promised.
From words to action. The moment is Accra.
The 2nd Africa Health Workforce Investment Forum takes place 6 to 8 May 2026 in Accra, Ghana, organized by the WHO Regional Office for Africa and the Government of Ghana. Sources: UNFPA State of the World’s Midwifery ESA 2024; UNFPA Midwifery Accelerator 2025
