Asia Faces Severe Midwife Shortage, UNFPA Warns

Strong health systems start with midwives.

Asia-Pacific’s midwives are a healthcare lifeline, capable of delivering nearly 90 percent of essential maternal and newborn services. Yet the region faces severe shortages, underinvestment, and systemic neglect.

The newly released State of Asia’s Midwifery 2024 report, issued by the United Nations Population Fund (UNFPA), reveals that despite midwives’ lifesaving potential, many countries lack sufficient personnel, have poor training and support systems, and struggle with weak policy backing. The findings underscore an urgent need to elevate midwives from auxiliary roles to central pillars of health systems across the region.

Drawing on data from 21 countries in the UNFPA Asia-Pacific (AP) region, the report aims to help nations meet the challenges of the health-related SDGs and the Every Woman Every Newborn Everywhere (EWENE) agenda, a global initiative to accelerate the reduction of preventable maternal and newborn deaths.

The report shows that hundreds of thousands of maternal and newborn deaths occurred in 2023 across the Asia-Pacific — most of which timely midwife interventions could have prevented. The region faces a shortage of approximately 200,000 midwives, contributing to an annual toll of roughly 66,000 maternal deaths. These stark figures highlight both the human cost and the systemic failure to invest in this essential healthcare workforce.

At least five Asia-Pacific countries — including Lao PDR, Mongolia, Pakistan, Papua New Guinea (PNG), and Timor-Leste — face needs-based midwife shortages, with Pakistan and PNG experiencing the most severe gaps.

The report projects that Pakistan and PNG will still face shortages by 2030, even if they maintain current rates of midwife graduation and full employment. Other countries, such as Afghanistan, Myanmar, and Viet Nam, are also likely to experience ongoing shortages; however, limited data prevents precise estimates.

Beyond shortages, the report identifies alarming gaps in education quality, regulatory frameworks, and leadership pathways for midwives. Many countries still struggle with limited pre-service training, scarce continuing education opportunities, weak licensing systems, and fragmented governance. Retention suffers as poor pay, inadequate infrastructure, and lack of professional recognition drive midwives away, particularly from rural and underserved areas.

The report also emphasises that placing midwives in leadership roles can strengthen decision-making on policies that directly affect maternal and newborn health, improve supervision and mentoring, and ensure midwifery perspectives shape regulation, training, and service delivery.

Countries such as Afghanistan, Iran, and Malaysia show how midwife-led governance can integrate professional expertise into national health strategies, ultimately improving the quality, reach, and effectiveness of sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) services.

Since 2021, nine countries have increased midwife availability (Bangladesh, Cambodia, Iran, Lao PDR, Maldives, Nepal, PNG, Sri Lanka, and Viet Nam), four have seen decreases (Indonesia, Malaysia, Pakistan, and the Philippines), and two show no significant change (Mongolia and Timor-Leste). This indicates that while some nations are making progress, regional gains remain uneven, and shortages can worsen without sustained investment and retention strategies.

The WHO estimates that countries with fewer than 25 doctors, nurses, and midwives per 10,000 people will struggle to provide adequate primary healthcare — a general threshold that offers a benchmark for minimum workforce density.

Acting on this information is imperative because midwives are the most cost-effective and accessible solution to achieving safe motherhood and newborn survival goals. As the World Health Organization notes, when well-trained and integrated, midwives can address roughly 90 percent of essential reproductive and newborn health needs. Still, the world faces a global shortfall of nearly 900,000 midwives, and many in Asia endure poor working conditions, low pay, and limited career opportunities. Saving lives therefore demands investment in midwifery education, fair compensation, regulation, leadership, and full integration into health systems.

Midwife supervisor Arafin Mim, who oversees a team serving more than 32,500 Rohingya refugees on the remote island of Bhasan Char in Bangladesh, captures the importance of her work simply:

“I feel this profession from the corner of my heart. It’s about making a connection with a pregnant woman, building a relationship during her pregnancy.”

Mim’s dedication illustrates the commitment and resilience midwives bring to some of the world’s most challenging environments.

In UNFPA’s recent opinion piece, Regional Director Pio Smith described midwives delivering in remote Bangladesh during climate crises as a testament to their resilience:

“When non-stop rain caused flooding in her village, the maternity ward, pharmacy, and storage room were submerged. She still continued to deliver babies without electricity, even supporting emergency caesarean sections with doctors on call.”

The report urges governments and partners to close needs-based midwife shortages by expanding education in line with ICM standards, improving faculty and curricula, and ensuring equitable deployment. It recommends updating policies so midwives can work to their full scope, using data-driven workforce planning to create sanctioned posts, and adopting fair recruitment, deployment, and retention strategies.

Finally, it calls for empowering midwives with leadership roles in SRMNAH governance, regulation, and service improvement.

UNFPA Executive Director Dr Natalia Kanem reminds us:

“Midwives are instrumental in navigating these challenges. They can provide up to 90 percent of essential services for sexual and reproductive health and bring their expertise and counsel to women wherever they are.”

Country examples such as Bangladesh, Nepal, and Cambodia offer hope. Bangladesh’s midwife-led birthing centres, Nepal’s rural midwifery deployments, and Cambodia’s regulatory reforms are exemplary — but far more action and investment are needed.

Midwives must be valued and supported as key professionals with quality education, fair pay, robust licensing, leadership opportunities, and a seat at health policymaking tables. This will result in fewer maternal and infant deaths, stronger newborn health, and more resilient healthcare systems.