Rethinking Uganda’S Midwifery Crisis Beyond the Numbers

By Dr. Ziidah Namwaya

Uganda’s fight against maternal morbidity and mortality will not be won by numbers alone. While increasing the number of midwives is essential, the deeper reality is that Uganda needs midwives who are highly skilled, adequately supported, and strategically placed where mothers need them most especially in Rural Health Centre IIIs.

According to the 2022 Uganda Demographic and Health Survey, Uganda’s maternal mortality ratio declined from 336 deaths per 100,000 live births in 2016 to 189 deaths per 100,000 live births in 2022. Yet despite this progress, nearly 6,000 Ugandan women and girls still die each year from preventable pregnancy and childbirth complications, while for every mother who dies, an estimated 20 to 30 more suffer severe injuries or lifelong disabilities such as obstetric fistula, ruptured uterus, chronic infections, or permanent reproductive damage.

According to The United Nations Population Fund (UNFPA) 2017 and Uganda’s midwifery policy discussions, Uganda has historically faced a shortfall of at least 3,000 midwives below minimum staffing needs, with many facilities operating far below recommended levels. In many underserved Ugandan facilities, one midwife handles between 350 and 500 deliveries per year, yet WHO recommends not more than 175 deliveries annually per midwife for safe, quality maternal care.

Across rural Uganda, pregnancy and childbirth remain dangerous for many women, not simply because complications are unavoidable, but because too often the health system is unable to detect, prevent, or manage them early enough. For women in underserved communities, these outcomes are often linked to one painful reality: too few skilled and hands on midwives, too little time, and too limited support.

In many rural Health Centre IIIs, two or three midwives are responsible for the entire continuum of maternal care. They must manage antenatal care, labour and delivery, postnatal care, family planning, immunisation, and outpatient reproductive health services, often while supervising junior nursing assistants who may still lack sufficient hands-on experience.

This is not just a staffing challenge; it is a quality-of-care crisis.

A midwife stretching across multiple service points cannot consistently monitor labour, identify subtle warning signs, or provide timely referrals for mothers at high risk of obstructed labour, haemorrhage, or hypertensive disorders. Poor monitoring, delayed intervention, and limited knowledge-sharing can quickly turn manageable complications into lifelong disability or death. Maternal health does not begin in the labour ward. It begins before conception, through reproductive education, nutritional support, and health screening. It continues throughout pregnancy with routine antenatal care that identifies danger signs early. And it depends on skilled, vigilant support during labour to ensure both mother and child survive and thrive.

This is why Uganda’s maternal health response must go beyond recruitment and focus on competence. We need midwives with advanced practical training who can anticipate complications before they escalate. We need continuous professional development that equips rural midwives and nursing assistants with hands-on emergency obstetric skills. We need systems that support midwives with adequate equipment, mentorship, transport for referrals, and manageable workloads.

Equally important, midwives must be strategically deployed beyond facility walls. They should be empowered to conduct village-level needs assessments, identify women at risk, promote preconception care, and ensure early referral for mothers likely to develop complications. Preventing maternal morbidity requires community-based prevention as much as facility-based treatment.

Uganda must also recognize that staffing policies on paper mean little if rural facilities remain critically understaffed in practice. A Health Centre III serving large populations cannot function safely with two or three overwhelmed midwives. No woman should suffer fistula because obstructed labour was not detected early. No mother should lose her life because there were too few trained professionals available to act.

If we are serious about ending preventable maternal suffering, then our priority must be clear: not just more midwives, but competent, supported, and strategically deployed midwives who can protect women before, during, and after childbirth. Because saving mothers is not only about increasing workforce numbers, but also about strengthening the quality, reach, and readiness of maternal care where it matters most.

Dr. Ziidah Namwaya is a Midwifery Instructor at Aga Khan University School of Nursing & Midwifery, East Africa