Lilongwe: Malawi joined the world in commemorating International Day of the Midwife on Saturday, May 10, with midwives and health officials gathering here to reflect on the profession’s challenges and achievements.

The celebration kicked off with a Victory March from Mchesi to the Kamuzu University of Health Services (KUHeS) campus, a lively procession enhanced by music and dance from the Malawi Defense Force brass band.

And it was the right occasion for the Association of Malawian Midwives (AMAMI) to voice serious concerns about poor working conditions for midwives and nurses in Malawi.

Speaking at the event, AMAMI President Keith Lipato lamented low salaries and inadequate allowances, saying midwives still receive as little as K5,000 for night shifts, which is insufficient given the country’s rising cost of living.

“We are dedicated to our work, and we take pride in witnessing the first cry of a baby,” Lipato stated. “But our remuneration is simply not enough. Imagine working long hours and receiving only K3,500 or K5,000 for a night shift— that doesn’t even cover transport costs.”

This year’s theme, Midwives: Critical in Every Crisis, highlights the urgent need to include midwives in crisis preparedness and response planning.

AMAMI recalled that midwives played a vital role during COVID-19 and Cyclone Freddy, ensuring expectant mothers received essential care despite disasters.

Despite midwives’ dedication, staffing shortages remain a concern. While Malawi has over 23,000 nurses and midwives, only 15,000 are officially recognized, and just 13,000 hold valid licenses to practice.

Government Responds to Concerns

Chief of Health Services (Technical) at the Ministry of Health, Dr. Lilian Chunda, acknowledged these challenges and assured that midwives will benefit from the ongoing civil service working condition review.

“Midwives are crucial, especially in times of emergency,” Chunda stated. “Since 2020, the government has recruited over 22,000 health personnel, including midwives and nurses. However, it is important to ensure that recruitment efforts properly balance general nurses and midwives.”

The Role of Midwives in Crises

The International Confederation of Midwives (ICM) recognizes midwives as critical responders in crises, whether caused by natural disasters, conflicts, or climate change.

It observes that midwives can provide up to 90% of sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) services, even in humanitarian emergencies.

In the case of Malawi, in crisis situations, midwives help mitigate the impact of displacement and ensure pregnant mothers receive the care they need, according to AMAMI.

Through home visits, outreach clinics, and supply distributions, midwives provide essential items like baby clothes, sanitary pads, and traditional fabrics (zitenje) for new mothers. This was evident during the Freddy crisis. 

Reflecting on Frontline Experiences

Nurse trainer Ruth Kagolo, from Daeyang Luke University, shared a firsthand account of midwives working under extreme conditions.

“I remember how we set camp in Blantyre in a place that was never meant to be used to deliver babies,” Kagolo recalled. “We had to use each and every means available to us to ensure no life was lost. And, indeed, we delivered our best.”

Midwifery Workforce Shortages

According to the 2024 State of Midwifery Report for Eastern and Southern Africa (ESA) Region, Malawi’s midwifery density has declined from 7.2 in 2022 to 5.5 in 2024. 

If the trend continues, Malawi may be among the seven countries projected to face a severe midwifery shortage by 2030.

This shortage presents major challenges, including burnout, fatigue, and demotivation among midwives. Without adequate staffing, maternal and newborn health services could suffer, threatening Malawi’s progress in reducing maternal and infant mortality rates.

Call for Action from Health Partners

The United Nations Population Fund (UNFPA), has, meanwhile, commended Malawi’s progress but emphasize areas needing improvement.

“We have very competent midwives, but financial constraints and supply shortages affect their ability to provide care, especially in rural areas,” said Grace Hiwa, UNFPA Sexual Reproductive Health Officer.

She noted that urban hospitals are relatively well-equipped, but rural communities struggle with shortages of midwives and medical supplies.

“We need more midwives in hard-to-reach areas to ensure equitable healthcare,” Hiwa stressed.

As Malawi moves forward, strengthening the midwifery workforce will be key to ensuring quality maternal and newborn care. 

Addressing recruitment gaps, improving working conditions, and increasing midwife deployment in rural areas are crucial steps in reversing the current trend.

With continued collaboration between the government, health organizations, and midwives themselves, Malawi has an opportunity to build a more resilient healthcare system — one where midwives are fully supported and recognized as essential responders in both everyday care and future crises.

If these issues are overlooked, calls for exporting workers in the health service delivery, including nurses and midwives, will grow louder, which, if not handled well, could lead to a serious brain drain in the local industry.