Thank you, Cathy.
It's a pleasure and a privilege for me to be here to speak on behalf of midwifery and the role that midwifery has to play in the reduction of maternal and newborn morbidity and mortality globally.
I want to start off by talking about this at an international level. Then I'd like to come back to look at what we're doing here in Canada as well, in terms of the potential recommendations coming out of your committee.
In The Lancet , in 2005, midwives were identified as the key health care providers for reducing maternal and infant morbidity and mortality globally. In 2008, the World Health Organization identified that among the 1.2 million health care workers needed to improve health systems globally, we needed 350,000 more midwives to attend to the issue of the high levels of morbidity and mortality.
When we look at the role of midwives in sub-Saharan Africa and in South Asia, where they have the highest incidence of maternal and newborn morbidity and mortality, we see a virtual invisibility of midwives in those countries. Midwives are often lost, in terms of their identity, within the ranks of those covered by the overarching term “health care workers”.
One of the issues that's really being highlighted this year is the issue of the female health care workforce and the low level of support and recruitment into the female health care workforce, especially in the low-resource countries where women and their infants are dying.
One issue that has been identified, and this is extremely important when we're looking at addressing maternal and infant mortality and morbidity, is the role of midwives in normal newborn and normal birth care. The facts are that 85% of all births in healthy women are normal. In most of our countries, in our own reference points, we have become very used to physicians and obstetricians taking on the greater part of care for maternal and newborn care.
In looking at the best health care providers for the continuum of care that has been identified, it is really important, in addressing human as well as economic resources, that if a mother survives, then, as you've said, her newborn and her older children have a much higher rate of survival as well. The continuum of care is basic to midwife care. Our scope of practice covers antenatal care through childbirth care, through looking after the mother in the postpartum as well as looking after her newborn.
In terms of the best use of resources, we should be working with countries and encouraging the G8 to identify the specific role of the midwife. Currently, and in most of the literature that's out there, we're still talking in vague, overarching terms and addressing this as a health care workforce issue. The problem is, unless we start to identify midwives and the need to develop a midwifery workforce, we will not accomplish the education, the regulation, and the professional development that midwives need at a global level.
The International Confederation of Midwives represents 250,000 midwives in 95 countries globally. One of the biggest issues that has been identified in the low-resource countries is the lack of good education for midwives, lack of standards of education, lack of regulation, lack of full integration into multidisciplinary teams of health care workers, lack of recognition by pediatricians, lack of recognition by obstetricians, and lack of recognition by governments of the important role that midwives can play in determining maternal and newborn health policy.
Midwives provide family planning, and in some countries are attending at first trimester abortions. We provide sexual and reproductive health care. We prevent mother-to-child transmission of HIV. We provide treatment for malaria. We provide bed nets. Most importantly, we provide women-centred care. Finally, coming onto the international agenda has been very important. It's not just important that a mother and her newborn survive, but that a mother survives with dignity and is treated with dignity.
It's very important in Canada that we recognize the role of midwives here in this country; we have developed one of the strongest models of midwifery care in the world.
The three pillars of any strong health care profession are a good education system, a strong regulatory system, and a strong professional association that can contribute to policy development and can work as colleagues and in conjunction with our other health care professionals.
Canada has developed a profession of midwifery that recognizes and respects the right of a woman to choose her place of care. This is the only jurisdiction in the world where women are supported in choosing their place of birth. We are required to provide women with informed choice in all decision-making, putting them at the centre of their care, and we are required to provide a continuity of care provider for women so that they are not seeing multiple health care providers during the course of their pregnancies and their childbirths.
Quebec has the only four-year undergraduate degree program in French for midwives in the world. The Maison de naissance is located in Quebec, the only jurisdiction in the world where midwife-led, out-of-hospital maternity facilities have existed for 10 years. It's a tremendous model that is being talked about globally. Nobody knows, not even here in Canada, if we really recognize this particular model and its success and the fact that many women in Quebec have chosen this model.
In fact, when they did a survey of women in the 1990s as to their preferred place of birth, the women of Canada chose an out-of-hospital birthing facility.
I want to come back to Canada before I end. The unanimous all-party resolution that went through our Parliament last June 5 called for the Canadian government to renew its commitment to reducing maternal and infant mortality and morbidity globally and to improve maternal and newborn health here in Canada.
I do want to make a plea that Canada join the ranks of Holland and Great Britain and develop a national strategy for maternal, newborn, and child health. It's so important to take this opportunity not only to look outside our country but also to look at the ways we can improve what's taking place here in Canada.
We need to improve our perinatal surveillance system. We still don't have all provinces on board with a cohesive national perinatal surveillance system. We don't really even know what's taking place at many demographic levels here in our own country. In strengthening the demographic components of the perinatal surveillance system, we need to look at health indicators, including diabetes, tuberculosis, and hypertensive disorders. We need to look at proximity to care. We need to address the social determinants of health and access to fresh food in our inner cities and in our remote communities. We need to address clean water and sanitation as we look at improving maternal, newborn, and child health in our own country. We need to address issues of safety and security at the personal and community levels.
We need to strengthen the continuum of care approach to maternal, newborn, and child health in our own country. We need to encourage our professional associations, pediatrics, obstetricians, nurses, and midwives to work together. They need to be invited to the table by the federal government to also identify maternal, newborn, and child health areas of research.
We need to have coordinated research efforts in this country to look at improving maternal, newborn, and child health--