Advocacy strategies for advancing midwifery in Mexico

By Eliana Monteforte and Aishling Thurow

(Leer la versión de español aquí.)

Eliana Monteforte is a Senior Technical Advisor, and Aishling Thurow is a Project Support Associate at Management  Sciences for Health

Photo by Eliana Monteforte/ MSH

Midwives can be powerful advocates for change because, as frontline health workers, they know all too well the enormous challenges that threaten their ability to deliver high-quality care to every woman they see in their clinic or community.  Midwives understand the health care needs of women and newborns because they work to meet those needs every day. They see the gaps in their health care systems–in resources, staffing, facilities, and policies–because they continuously struggle to fill those gaps. And they speak the truth about their needs for training, support, and enabling policies–because this is the job to which they have dedicated their lives and livelihoods.

The Mexican government is receptive to strengthening the role of professional midwifery in the continuum of women’s health care, and midwives are ready to leverage this political will to advocate for their profession in their respective states. In February, the FCI Program of MSH, with support from the John D. and Catherine T. MacArthur Foundation, convened teams of midwifery providers from five Mexican states to develop advocacy strategies to advance state-level policies that enable midwives to provide high-quality, respectful care for women, adolescents, and newborns.

Since the United Nations Population Fund (UNFPA) launched the first State of the World’s Midwifery report in 2011, the global health community has increasingly supported the expansion of midwifery-led care to address the shortage and inequitable distribution of health workers in many countries. Evidence shows that midwife-attended deliveries –particularly when pregnancies are low risk and the appropriate reference systems are in place–result in better outcomes for women and their babies, such as increased vaginal deliveries, decreased medicalized births, and higher satisfaction levels among patients.[1] By providing compassionate, respectful, and culturally appropriate care to women throughout their reproductive life,[2] well-trained and regulated midwives are critical to closing the gaps in human resources for health. With competencies defined by International Confederation of Midwives (ICM), they can effectively respond to 87% of sexual, reproductive, maternal, and newborn health (SRMNH) care needs.[3]

Photo by Pablo Romo

In Mexico, skilled health workers are unable to meet nearly 40% of the need for essential obstetric and newborn care[4], leading to the unnecessarily high maternal mortality rate of 38 per 100,000 live births[5] and neonatal mortality rate of 8 per 1,000 live births.[6]

Mexico’s Ministry of Health aims to improve the quality and coverage of maternal health services and relieve the excessive demand for maternity services in hospitals by authorizing midwives to attend low-risk births at public and private primary care facilities when a secondary referral system is in place.[7]

The FCI Program of MSH is working with midwives and key stakeholders to foster an enabling environment for professional midwifery and to support the placement of midwives in the public health sector. This program led virtual seminars and participatory workshops with teams of midwives, doctors, and nurses from Chiapas, Guerrero, Hidalgo, Morelos and San Luis Potosi to build their advocacy capacity to make compelling arguments that are responsive to and effective within Mexico’s political context, in support of the three pillars of midwifery: 1) education to provide a competent, qualified workforce; 2) regulation of activities and of the workforce; and 3) association of midwifery professionals.[8]

Photo by Eliana Monteforte/ MSH
Photo by Eliana Monteforte/ MSH

Workshop teams developed the following recommendations for advancing midwifery in their respective states:

Create a midwifery champion group to build support for the integration of midwives into the state health system. For instance, in San Luis Potosi, professional midwives attend only 3.3% of births, compared to 95% attended by medical doctors. The champion group will demonstrate the benefits of midwifery-led obstetric care to health professionals, managers, and the general population.

“As a result [of the advocacy plan] we hope to engage a multidisciplinary group of people committed to  enriching and supporting professional midwifery and continuing implementation of new midwifery strategies in the many hospitals the state depends on for [maternity care],” said Fernando Ramos Camarillo, a licensed obstetric nurse (LEO) from San Luis Potosi.

Develop a proposal to improve the quality of midwifery care that includes the promotion of respectful maternity care and the elimination of violence and discrimination against patients, particularly those from indigenous populations.

“Professional midwifery should be a movement that is rooted in the health system to improve the services for mothers and new families,” said Carolina Maricela Menchu Perez, a professional midwife from Chiapas.

Develop guidelines that define the roles and functions of primary-level professional midwives and implement those guidelines throughout the state’s health system, with the endorsement of the state’s Intersectoral Technical Group.

“It concerns me that in Morelos we have many [midwifery] specialists that are integrated into secondary level hospitals when they should be functioning at the primary level to avoid saturation of our hospitals,” said Gloria Flores, a perinatal nurse from Morelos.

Lead a series of advocacy meetings with the municipal presidents to generate signed financial commitments to support the education and recruitment of midwives.

Rodolfo Javier Orozco Mendoza, an indigenous doctor from Guerrero, said, “ I hope that this work will result in advocacy messages…that will turn politicians’ eyes toward [providing respectful maternity care] to the more vulnerable and unprotected populations.”

State teams will continue to refine and implement their advocacy strategies throughout 2018 through facilitated virtual exchanges.

For more information:

[1]Sandall, J. et al, Midwife-led continuity models versus other models of care for childbearing women, Cochrane Pregnancy and Childbirth Group, August 21, 2013
[2]FamilyCare International, 2013, Caja de herramientas para el fortalecimiento de la partería,
[3] Ibid.
[4] UNFPA et al, State of the World Midiwfery Report, 2014, Available on
[5] World Health Organization.
[7] Midwifery in Mexico baseline report.

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