Midwives on the front line

“I believe midwives are important everywhere we work, but more so now given the changing humanitarian landscape we see, where many sexual reproductive health programs have been defunded,” says Kate Charlton, a midwife who now coordinates medical activities for MSF in emergency contexts such as Gaza, Sudan, and post-earthquake Myanmar. 

“We're also in a period where we see more conflicts than ever, and we know that women disproportionately suffer during conflicts.”

Embedding midwives in health systems could prevent more than 4 in 5 maternal deaths, stillbirths, and neonatal deaths, according to the World Health Organization. But these often preventable deaths disproportionately take place in fragile settings: Nearly 2 in 3 maternal deaths — deaths caused by pregnancy or childbirth complications and which occur up to 42 days after the end of pregnancy — are borne in countries affected by conflict or considered fragile.  

Integrating midwifery from the onset

The ongoing civil war in Sudan has destroyed infrastructure, caused indiscriminate loss of life, decimated livelihoods, and displaced nearly 14 million people. As a result, people are often left trying to survive in the face of escalating health risks. But women will always need safe prenatal care and delivery. Maternal care cannot be an afterthought in the humanitarian response.

Blessing Odagwe is a midwifery activity manager coordinating outreach activities from Nyala Teaching Hospital in South Darfur, a facility MSF supports. She and her team travel hours by road to assist the health center’s midwives and the remote communities that rely on them. But insecurity in the Nyala area has been a major challenge to maintaining their routine.

A key focus of their outreach is capacity-building, often through on-the-job training. “If we don't have skilled birth attendants in the community, there will be an increase in maternal and newborn death,” says Blessing, who first worked with MSF in Nigeria. “So I train [local midwives] in normal delivery, postpartum hemorrhage, postnatal complications both for mother and baby, how to identify danger signs in mothers and babies, and making prompt referrals for cases we cannot manage in the primary health care centers.”

During a training session, a woman arrived in labor. “I used that as a scenario to train the midwife,” recalls Blessing. “At the end of the day, the mother named the child after me, saying, ‘your presence made a difference.’ For me, that is not a personal recognition, but a reflection of the impact MSF is making in the community by creating a positive outcome for many families.”

Many midwives who work with MSF come from the same communities they serve.

MSF’s team in Tawila, North Darfur, includes Zoubeida, who is originally from Zamzam. Displaced first to El Fasher, she undertook an exhausting and painful trek to reach Tawila, the destination of more than half a million people who were newly displaced in 2025. After finding support for essentials such as food and water, she joined MSF as a midwife and now provides much-needed care to pregnant women and newborns inside one of Tawila’s displacement camps.

Women-led and women-centered

Midwifery is a women-centered health care profession and service — exclusively so in Afghanistan, where sexual and reproductive health services for women can only be provided by women. Yet the future of those services and women’s health is under threat, as women have been banned from education beyond primary school. Afghanistan ranks among the top 10 countries worldwide for maternal mortality and the top five for neonatal mortality, according to the most recent estimates for 2023.

Maryam Saidy joined MSF as a medical translator in Khost maternity hospital in eastern Afghanistan in 2012. Inspired by seeing midwives at work and the impact of their care, she retrained as one herself. After first serving as a midwife outreach supervisor, she is now the hospital’s midwife activity manager, supervising a team of 150 midwives, midwife supervisors, and midwife aides.

“I'm responsible for checking that the patients, the midwives, and the staff who are working under me are in a safe environment, and that the patients are receiving quality care,” says Maryam.

MSF’s hospital in Khost focuses on treating patients with obstetric complications “who come here in a very critical situation,” says Maryam. “They come already in active labor and most of them have severe bleeding. When the mother comes in, it is the midwife who is the first person to answer [her] call for help. We take her directly to the ICU, we pass IV lines, we call the ‘gynes’ (OB-GYNs) [and] the anesthesia team, and we try our best to save the mother as soon as possible, because the whole family is worried about this mother and the newborn.”

A holistic approach to support women's health

Care for sexual and gender-based violence and safe abortion are inseparable from women’s health needs in emergencies and conflict. These services are lifesaving health care, evidence-based, and grounded in humanitarian principles. Midwives are at the forefront of enabling a respectful, person-centered approach to both.

Sexual violence is frequently used as a weapon of war, a form of torture, and a tool of intimidation and control. Stripped of the security of the life they’ve left behind, women and girls face the risk of violence on their displacement journey as well as in the place where they seek refuge.

Between January 2024 and November 2025, MSF treated more than 3,396 survivors of sexual violence in South and North Darfur alone. More than 90 percent of the survivors in North Darfur were assaulted while traveling between towns to reach safety. Women in South Darfur reported being assaulted while collecting firewood or water, searching for food, working in fields, or traveling to farmland.

MSF research shows that abortion-related complications can be five to seven times more severe in fragile and conflict affected settings than in stable settings. The contributing factors are always the same: delays in care, stigma, and a lack of contraception and safe abortion services.

It is often midwives who drive these areas of care, unflinchingly advocating for the women and girls who are their patients as well as the wider community.

Midwives’ call to action

Despite their important role and the evidence of their impact, there are simply not enough midwives available where they are needed most. Not surprisingly, midwives themselves are quick to identify the benefits that more midwives would bring.

For Maryam in Khost, having another midwife activity manager in the hospital would mean one could be doing all the office work and management — overseeing rosters, training plans, capacity building — while the other could work with patients and staff in the hospital, being “present with them in the complicated and critical cases which they are managing.”

For Ygline Saint Clair, a midwife providing care for sexual violence survivors in Cité Soleil, Haiti, having another midwife on hand would mean a shorter waiting time for survivors and more opportunities to raise awareness about seeking early care.

Kate points out there are decision-making gaps. To ensure that women's and girls’ health needs are prioritized in any emergency response, we need more midwives involved in setting up emergency health programs.

“We need resources, we need policies, we need implementation, and we need the training and the capacity-building of midwives around the world to make sure we have more midwives to provide care and prevent unnecessary suffering and death.”