By Kepher Otieno - Reporter
Kenya, 14 June 2026 - The global shortage of nearly one million midwives is no longer an abstract policy debate — it is a lived reality in communities where women still face childbirth with limited skilled support, and where overstretched health systems rely heavily on community-level workers to bridge the gap.
At the 34th International Confederation of Midwives (ICM) Triennial Congress in Lisbon, new evidence has sharpened the scale of the crisis: the world could save up to 4.3 million lives annually by 2030 if the midwifery gap is closed. Researchers say improved coverage could prevent about 67% of maternal deaths, 64% of newborn deaths and 65% of stillbirths.
Health leaders say the missing workforce — estimated at about 980,000 midwives across 181 countries — represents one of the most critical bottlenecks in global maternal health.
“This is not a future risk. It is a present reality,” said Anna af Ugglas, Chief Executive of the International Confederation of Midwives.
“Nearly one million missing midwives means care becomes rushed and fragmented. This is a quality and safety issue for women and babies.”
Professor Jacqueline Dunkley-Bent, Chief Midwife of the ICM, said the crisis is not just about training but also utilisation.
“In many settings, midwives are educated but not employed or enabled to practise fully, leaving women without access to the care they need,” she said.
Kenya's Frontline Reality: CHWs as the Health System Backbone
In Kenya, where maternal health outcomes still vary sharply by region, the response to workforce shortages increasingly depends on community health workers (CHWs) and midwives operating at the frontline of primary care.
Kisumu Governor Prof. Anyang’ Nyong’o has in recent years defended county-led community health financing systems, insisting that counties must retain control over CHW coordination and stipends to ensure accountability and sustainability in service delivery.
His position reflects a wider national shift toward formalising CHWs as a paid, structured cadre within the health system — a major departure from earlier reliance on unpaid volunteers.
Health system data shows Kenya has moved to integrate more than 100,000 CHWs into formal structures, with payment systems gradually being standardised as part of broader primary healthcare reforms.
Among those representing this frontline workforce is Millicent Atieno, a community health worker from Kisumu County, who describes her role as a daily balancing act between households, expectant mothers and overstretched clinics.
“When you find a mother who is far from a facility, you become the bridge between life and loss,” she said.
“Sometimes it is about reaching her early enough before complications begin.”
Midwife Maryiane Onyango also working within Kenya’s county health system, says the shortage of skilled birth attendants often shifts pressure to existing staff.
“We are constantly managing too many cases with too few hands,” she said.
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“When referrals come late, the risk is always higher — for both mother and baby.”
Community health worker Jane Akinyi says the challenge is often not knowledge but capacity.
“We are trained, we know what to do, but sometimes the system is overwhelmed. You cannot replace enough hands on the ground,” she said.
For Faith Achieng, another frontline worker in Kisumu, continuity of care is the missing link.
“Pregnancy is not a one-day event. It needs follow-up. But when staff are few, that continuity becomes difficult to maintain,” she said.
East Africa: Shared Strain on Weak Health Systems
Across East Africa, including Uganda and Tanzania, similar challenges persist: uneven distribution of skilled birth attendants, rural access barriers, and overstretched maternity wards.
In many rural Kenyan counties, a single facility may serve thousands of residents, with limited midwives covering night shifts, emergencies and postnatal care simultaneously. Delays in reaching care remain a major driver of preventable maternal deaths.
Health experts say even where CHWs are active, gaps in referral systems and emergency obstetric care continue to weaken outcomes.
More than Numbers: A System Under Pressure
The ICM Congress in Lisbon has framed the issue not just as a workforce shortage, but as a structural failure in how health systems value and deploy midwives and community health workers.
Organisers say closing the nearly one-million midwife gap would not only reduce deaths but strengthen resilience in systems facing growing pressure from disease outbreaks, climate shocks and funding constraints.
As global leaders debate solutions, the message from both Lisbon and Kisumu is increasingly aligned: the future of maternal health will depend not only on hospitals and policies, but on the midwives and community health workers holding fragile systems together at the grassroots — often with too few resources, but with lives directly in their hands.
The Midwives and CHWs: Inside Kenya’s Frontline Health Push as World Warns of One-Million Worker Gap
The world could save up to 4.3 million lives annually by 2030 if the midwifery gap is closed.