SDG 3: Good Health and Well-being | SDG 5: Gender Equality
Ministry of Health and Family Welfare (MoHFW) | National Health Mission (NHM)
The UNFPA Policy Note (2025) outlines the transformative potential of the Midwifery Services Initiative, launched by the Government of India in 2018 to establish a dedicated cadre of Nurse Practitioners in Midwifery (NPMs). While India has reduced its Maternal Mortality Ratio (MMR) by 86% since 2000, it remains the second-highest contributor to maternal deaths globally, with rising over-medicalization evidenced by a 21.5% C-section rate.
Key findings and evidence for expansion include:
Life-Saving Impact: Universal coverage of midwife-delivered interventions could avert 67% of maternal deaths and 64% of neonatal deaths, potentially saving 4.3 million lives annually by 2035.
Operational Progress: As of 2024, India has established 8 National and 23 State Midwifery Training Institutes, with Midwifery Led Care Units (MLCUs) functional in select district hospitals.
Resource Optimization: Midwives can deliver 87%–90% of essential maternal and newborn care, easing the burden on specialists who currently face an 80% shortfall in rural Community Health Centers.
Respectful Care: Midwifery-led models prioritise physiological birthing and Respectful Maternity Care (RMC), addressing high reported instances of disrespectful treatment in public facilities.
Climate Resilience: Investing in midwifery strengthens health systems against climate-induced disasters, ensuring continuity of care during heatwaves, floods, and cyclones.
What is a Nurse Practitioner in Midwifery (NPM)? An NPM is a specialized nursing professional trained to the standards of the International Confederation of Midwives (ICM) to provide autonomous, woman-centered care during pregnancy, childbirth, and the postpartum period. Unlike traditional birth attendants or general nurses, NPMs are equipped to manage normal physiological births independently, identify complications for timely referral, and provide essential emotional and educational support, thereby reducing unnecessary medical interventions like C-sections.
Key Recommendations for the Path Forward:
Legal and Regulatory Reform: Ensure the National Nursing and Midwifery Commission Bill explicitly defines autonomous roles for NPMs and streamlines state-level licensure to uphold uniform professional standards.
Institutional Integration: Strategically deploy NPMs beyond tertiary care to primary and secondary levels (Ayushman Arogya Mandirs), especially in rural and tribal areas, to bridge service gaps.
Workforce Sustainability: Establish permanent roles and clear career pathways for Midwifery Educators and NPMs to improve retention and attract undergraduate interest.
Public Awareness: Launch national advocacy campaigns to position midwifery as a respected, autonomous career path and a trusted choice for pregnant women.
Gender Inclusivity: Implement affirmative action to encourage male nurses to pursue midwifery, thereby diversifying the workforce and mitigating critical shortages.
Policy Relevance
The expansion of midwifery is central to India’s goal of reaching a national SDG target MMR of 70 and ensuring equitable healthcare across economically disadvantaged regions. By transitioning from a physician-heavy to a midwifery-led continuity of care model, India can achieve a 16-fold economic return on investment while addressing the critical deficit of 1.8 million healthcare workers. This strategic shift is essential for operationalizing LaQshya and SUMAN initiatives, moving the maternal health discourse from mere “survival” to “dignity and quality”.
Follow the full report here: Realising the Promise of Midwifery in India: Dignity, Care and Safer Births