Midwives on frontline of childbirth deaths crisis denied visas for key summit
Midwives on frontline of childbirth deaths – The denial of visas to midwives from countries most affected by maternal and neonatal mortality has raised concerns about the global effort to reduce preventable deaths during childbirth. Leaders in the midwifery field have criticized the decision, arguing that it undermines critical progress in addressing the crisis. With experts from regions where the highest number of lives are lost excluded from the International Confederation of Midwives (ICM) congress in Lisbon, Portugal, the absence of key voices has sparked debates about equitable representation in international health discussions.
Global summit highlights urgent need for midwifery expertise
This week’s ICM congress, held in Lisbon, was intended to be a pivotal platform for discussing strategies to improve maternal and infant health outcomes. Over 1,000 delegates, including policymakers, donors, and UN agencies, gathered to explore solutions to the millions of avoidable deaths that occur annually. However, last-minute visa rejections left many midwives from Africa and Asia unable to attend, despite their crucial role in implementing life-saving practices. The event, meant to foster collaboration, now faces criticism for its exclusion of those most directly impacted by the issue.
Among those affected was Harriet Akello, a midwife in Uganda who leads a program aimed at transforming maternity care in her region. Her initiative, supported by the World Health Organization (WHO), has demonstrated how shifting from fragmented systems to midwifery-centered care can significantly reduce mortality rates. Yet, Akello was unable to attend the summit, forced to advocate for her right to travel from a remote area near the South Sudan border. “The world’s policymakers are in Lisbon, yet here I am in Uganda, trying to explain to an embassy why I should have the right to travel,” she said, expressing frustration and disappointment.
“These midwives are leaders working in countries that bear the highest burden of deaths. A mother dies every two minutes due to pregnancy or birth. How are we going to intervene if the researchers and professors at the heart of it are banned?” – Kate Stringer, ICM advisor
The visa issue has also impacted midwives from Bangladesh, where union leaders were denied entry despite a government official traveling to Lisbon to announce plans for 25,000 additional midwives. Similarly, Dr. Arthur Munkana from the Democratic Republic of the Congo noted the irony of his country’s struggle with maternal mortality, as four of his colleagues were left behind. “Our country is devastated by mothers dying. Good quality midwives are a key solution – yet only I got a visa,” he remarked, highlighting what he called “gender inequity laid bare.”
Barriers to participation challenge global health goals
Alison Perry, a researcher at Imperial College London, echoed these concerns, pointing out that her Ugandan collaborator was also excluded. “This represents overt discrimination against equitable participation in international conferences,” she said, emphasizing the importance of on-the-ground expertise in shaping policy. The exclusion of midwives from the summit has been seen as a setback for initiatives aimed at improving healthcare access in regions with limited resources. With the majority of maternal deaths concentrated in sub-Saharan Africa and a significant portion in Asia, the absence of these professionals has left a gap in critical dialogue.
Portugal’s Ministry of Foreign Affairs defended the visa process, stating it adhered to rigorous, objective standards aligned with Schengen rules. However, critics argue that the criteria may have been influenced by biases, particularly against women from developing nations. The ICM has long advocated for the expansion of midwifery services, noting that the world is currently short by a million midwives to meet safe staffing levels. Without these professionals, the capacity to respond to maternal and neonatal emergencies remains compromised.
Childbirth bleeding: A costly and deadly challenge
During the congress, the ICM also addressed the issue of postpartum hemorrhage, a leading cause of maternal mortality. New data published in the Lancet revealed that this condition affects 27 million women each year, resulting in 43,000 deaths and costing countries over £7 billion annually. The report identified six critical factors for survival, including timely diagnosis and access to blood transfusions, both of which are often lacking in resource-poor settings. These findings underscore the urgent need for investment in midwifery programs, which are central to addressing such complications.
Akello’s work with Mother Health International exemplifies the potential of midwifery models in improving outcomes. By reorienting maternity centers to prioritize skilled midwives over traditional fragmented systems, her initiative has helped stabilize care in a post-conflict region. “The WHO says we need ‘midwifery models of care’,” she explained. “I have a rare example of this, but I’ve been silenced.” Her ability to travel to Sweden earlier this year, where she worked under Schengen rules, only deepened the sense of injustice. “I didn’t overstay – I have too much to do for mothers in Uganda,” she added, emphasizing the personal and professional stakes of her exclusion.
The crisis in childbirth deaths is not just a statistic but a lived reality for millions. Every year, approximately 260,000 women die from complications during pregnancy or labor, while 1.9 million babies are stillborn and 2.3 million newborns perish within their first month of life. Sub-Saharan Africa accounts for 70% of these maternal deaths, with the remaining cases largely concentrated in Asia. These numbers highlight the disproportionate impact on low-income regions, where midwives are often the most accessible healthcare providers.
Stringer described the visa issue as a “colonial bias” that perpetuates systemic inequities. “This defies logic. It is a life and death situation,” she said, stressing that midwives are essential for translating research into practical solutions. The absence of these delegates may hinder the development of effective strategies, as their insights are vital for tailoring interventions to local contexts. For example, midwives in rural areas often navigate challenges such as limited infrastructure, cultural barriers, and inadequate training, which require targeted solutions.
As the ICM continues to push for global recognition of midwifery as a cornerstone of maternal health, the visa controversy serves as a reminder of the obstacles faced by those in the field. The summit in Lisbon was meant to be a turning point, but its exclusion of key midwives has sparked calls for greater inclusivity. With the world in dire need of additional midwives to meet safe staffing targets, the failure to secure their attendance could delay crucial progress. For Akello and her colleagues, the stakes are clear: their voices are not just absent from the conference, but from the fight to save lives.
Emily Maclean, a midwife and key figure in the ICM, has also been vocal about the need for systemic change. Her work, alongside others, highlights the importance of skilled professionals in addressing the global health crisis. As the summit concludes, the question remains: how will the exclusion of these midwives affect the future of maternal and infant care? The answer may depend on the willingness of policymakers to prioritize equity and inclusivity in their efforts to save lives.
