Midwifery Care as a Catalyst for Sustainable Development Goals 3, 5, and 10

An analysis of maternal healthcare experiences indicates that midwifery-led models of care are pivotal in advancing several United Nations Sustainable Development Goals (SDGs). Specifically, this approach significantly contributes to SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 5 (Gender Equality) by improving health outcomes, addressing systemic biases, and empowering women in their healthcare decisions.

Enhancing Maternal and Newborn Health (SDG 3)

The midwifery model directly supports the targets of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. Research and patient testimonials highlight a strong correlation between midwifery care and improved maternal and infant health outcomes, which is central to achieving Target 3.1 (reduce global maternal mortality) and Target 3.2 (end preventable deaths of newborns).

• Improved Health Outcomes: Research co-authored by Michelle Telfer, Associate Professor of Midwifery at Yale School of Nursing, confirms that continuity of care with a known midwife leads to superior health outcomes, including lower rates of preterm birth.
• Physiological Benefits: When patients feel safe and cared for by a trusted provider, the natural hormones that facilitate labor function more effectively.
• Postpartum Care: The case of one mother who developed postpartum preeclampsia after being discharged from a hospital highlights a critical gap in conventional care. The continuous, relationship-based nature of midwifery can help in the early identification and management of such life-threatening postpartum conditions.

Addressing Health Disparities and Reducing Inequalities (SDG 10)

The personalized nature of midwifery care is a powerful tool for dismantling systemic inequities in healthcare, directly aligning with the objectives of SDG 10. By fostering deep, trust-based relationships, midwives can mitigate the effects of implicit bias, which contributes to disproportionately high mortality rates among minority groups.

• Combating Implicit Bias: Research published in JAMA notes that implicit physician bias has been associated with false beliefs about Black patients having a higher pain tolerance.
• Building Trust to Overcome Bias: The one-on-one, continuous care model central to midwifery is identified as a key strategy for overcoming such biases. This approach ensures that care is tailored to the individual, rather than being influenced by unconscious stereotypes, thereby promoting Target 10.3 to ensure equal opportunity and reduce inequalities of outcome.

Promoting Patient-Centered Care and Empowerment (SDG 5)

The principles of midwifery strongly resonate with SDG 5, which seeks to achieve gender equality and empower all women and girls. The model contrasts sharply with more medicalized approaches where patients, such as Jillian Perez, report feeling “like a number.” By prioritizing the patient’s experience and autonomy, midwifery empowers women to be active participants in their own healthcare.

1. Fostering Agency: Patients report feeling “listened to” and that their pregnancy is treated as a normal, natural process, which validates their bodily autonomy and experience.
2. Shifting from Problem-Solving to Wellness: The midwifery approach reframes pregnancy not as a medical problem to be solved, but as a natural life event where the patient’s body is trusted.
3. Establishing Trust and Continuity: The ability to build a relationship with a known and trusted provider is a cornerstone of this empowerment, ensuring women feel safe and respected throughout their pregnancy and birth.

SDGs Addressed in the Article

• SDG 3: Good Health and Well-being: The article’s central theme is maternal and child health, focusing on the quality of prenatal, labor, and postpartum care. It discusses how different models of care, specifically midwifery, can lead to better health outcomes, such as lower preterm birth rates and improved maternal well-being. It also touches upon serious health complications like postpartum preeclampsia.
• SDG 10: Reduced Inequalities: The article directly addresses health inequalities by highlighting how implicit bias in healthcare contributes to higher mortality rates among minority groups. It points out research showing that physicians’ false beliefs about Black patients’ pain tolerance lead to unequal and poorer health outcomes, and suggests that relationship-based care from midwives can help overcome these biases.
• SDG 5: Gender Equality: While focused on health, the article inherently relates to gender equality by discussing women’s experiences and autonomy in healthcare, particularly concerning reproductive health. It emphasizes the importance of women feeling listened to, respected, and empowered during pregnancy and childbirth, which is a key aspect of ensuring access to sexual and reproductive health services.

Specific SDG Targets Identified

1. Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

   • The article connects to this target by discussing factors that contribute to maternal mortality, such as implicit bias leading to “higher mortality rates among minority groups” and dangerous conditions like “postpartum preeclampsia.” It presents midwifery as a model of care that can improve outcomes and potentially reduce these deaths.

2. Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age.

   • The article supports this target by citing research that women who have continuity of care with a midwife experience “lower preterm birth rates.” Preterm birth is a leading cause of neonatal mortality, so reducing its incidence is crucial to ending preventable newborn deaths.

3. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory practices.

   • This target is addressed through the discussion of “implicit bias” in healthcare. The article cites research stating that this bias leads to “false beliefs that Black patients have greater pain tolerance than white patients,” resulting in a clear inequality of outcome. The promotion of midwifery is presented as a practice that can help reduce this discriminatory gap by “building relationships.”

Indicators Mentioned or Implied

1. Implied Indicator 3.1.1: Maternal mortality ratio.

   • The article directly implies this indicator by mentioning the problem of “higher mortality rates among minority groups.” Measuring the maternal mortality ratio, especially when disaggregated by race and ethnicity, is necessary to track progress on the issues discussed.

2. Implied Indicator 3.2.2: Neonatal mortality rate.

   • This is implied through the mention of “lower preterm birth rates” as a positive outcome of midwife-led care. Since preterm birth is a primary driver of neonatal death, a reduction in preterm births would lead to a lower neonatal mortality rate.

3. Implied Indicator 10.3.1: Proportion of population reporting having personally felt discriminated against.

   • The article implies this indicator through personal testimony. Jillian Perez’s feeling of being treated “like a number” and her desire to be “listened to” reflects a negative healthcare experience that can be rooted in systemic issues, including discrimination. The discussion of implicit bias against Black patients is a direct reference to discriminatory attitudes that lead to unequal treatment.

SDGs, Targets, and Indicators Analysis

Source: nationalgeographic.com