During the recent Milken Institute Philanthropic Investors Forum held in Beverly Hills, I was specifically asked to elucidate upon my personal experience of childbirth in 1991, and its subsequent impact on my approach to knowledge acquisition, learning, and development in challenging, overcoming and rising positively from the adversity of birth trauma, which for me, had occurred in a low and middle income country, my home nation of Nigeria.

Throughout the conversation, I delved into the discovery of the maternal health trajectory and the alarming statistics regarding preventable maternal and newborn mortality, which I continuously encountered and recorded through a first-hand civil registrations and vital statistics approach across Nigeria’s public health system, during my tenure as the First Lady of Kwara State in 2003, and how through this confluence of experiences, I was ultimately inspired to establish the Wellbeing Foundation Africa which has worked to constructively empower and engender safer births and safe motherhood since 2004.

Later last week, which commenced the annual celebration of International Day of the Midwife on the 5th of May and looked to celebrating the annual International Nurses Day on the 12th of May, it was during the Baby Blues: The Early Days of the Motherhood Journey Roundtable Conversation at the Milken Institute Global Conference 2024, that I reflected on how the early days of motherhood are often painted with the great and good expectations of rosy hues, but in reality, and increasingly recorded around the world, the antenatal, perinatal and postpartum period can involve significant identity transformation, physical and emotional challenges, and even birth injuries, that persist far into the first year and 1000 days. Postpartum depression affects nearly one in five new mothers, often leading many to endure physical and emotional burdens for up to a year after childbirth. Consequently, roughly 43% of highly skilled women leave their careers either temporarily or permanently after giving birth, hampering economic productivity and labour markets as well. 

The Early Days of the Motherhood Journey Roundtable Conversation Session delved beyond the "baby blues," uncovering postpartum realities from physical recovery to mental health struggles and workforce impact. Having long championed the skills, capacities, and competencies of midwives and nurses as Emeritus Global Goodwill Ambassador to the International Confederation of Midwives (ICM), and as a supporter of the Nursing Now Challenge, which advocates for leadership development opportunities for student and early career nurses and midwives around the world, I was immediately propelled into asking why there were no professional midwives or nurses at the colloquium table: as the gathering fielded questions and answers, hearing from mothers, healthcare professionals, doulas, advocates, and investors, who addressed resource shortcomings, investment prospects, and strategies for enhancing maternal support during this pivotal period to create a future where mothers are truly seen, heard, empowered, and invested in the way they should be.

Having worked in Nigeria, and with many global efforts, such as the Every Woman Every Child #EWEC movement to intensify national and international commitment and action by governments, the UN, multilaterals, private sector and civil society to keep women's, children's and adolescents' health and wellbeing at the heart of development, Nigeria’s first and oldest country member of the esteemed and dedicated Partnership for Maternal Newborn and Child Health, and currently a PMNCH MNCH Workstream Working Group Member, for over 20 years towards safe motherhood, I am particularly alarmed and appalled by the rising data which finds that Black women are five times, and Asian women two times, more likely to die in the perinatal period than white women. Described in 2022 as an ‘urgent human rights issue and urgent action must be taken to address it’ (Birthrights, 2022), this annual report continues to show no positive change to the health outcomes of BAME (Black, Asian and minority ethnic) women. 

Within the UK, the All-Party Parliamentary Group #APPG on Birth Trauma has this year in January 2024, established the first national inquiry in the UK Parliament to investigate the reasons for birth trauma and to develop policy recommendations to reduce the rate of birth trauma. Today, the inquiry into traumatic childbirths has been released, and calls for an overhaul of the UK's maternity and postnatal care after finding poor care is "all-too-frequently tolerated as normal."

With harrowing evidence from more than 1,300 women - some said they were left in blood-soaked sheets while others said their children had suffered life-changing injuries due to medical negligence, women complained they were not listened to when they felt something was wrong, were mocked or shouted at and denied basic needs such as pain relief. A pivotal recommendation is to engage a new maternity commissioner who would report directly to the prime minister, along with ensuring safe levels of healthcare staffing.

It has been proven that BAME women report positive experiences when in receipt of woman‐centred midwifery care, and at the Wellbeing Foundation Africa, an element of the role of the WBFA midwife is to be an advocate for the women in our care, as midwives have a long and proud tradition of providing care that addresses health inequalities. I recall advocating and exemplifying the need for midwives for the most vulnerable populations through the Midwives Service Scheme established by the Nigerian federal government in 2009 until 2015 to address the scarcity of skilled health workers in rural communities by temporarily redistributing newly qualified, unemployed and retired midwives from urban communities to rural primary healthcare centres #PHCs to ensure improved access to skilled care. 

The scheme was designed as a collaboration among federal, state and local governments, yet the inability of the federal government to substantially influence the health care agenda of sub-national governments was a significant impediment to the achievement of the objectives of the Midwives Service Scheme, as the issues in retention, availability and training of midwives, and varying levels of commitment from state and local governments across the country, alongside women still choosing to deliver at home despite the availability of skilled birth attendants at MSS facilities, led to a lack of community and facility collaboration within the health sector, but provides many learnings we can take ahead in our journey to achieving the United Nations Sustainable Development Goals. 

The WBFA Mamacare360 Antenatal and Postnatal Education Classes, led as an Independent Maternity Program of Community Midwifery, are key patient advocates with regular and on-demand engagement for the central 1001 days of antenatal and postnatal care, while providing the full continuum of care through to child-centred personal, social, health and economic education and water, sanitation and hygiene practices at school age and beyond. 

Twenty years onwards since establishment, the Wellbeing Foundation Africa provides and delivers a lifesaving and quality improving panacea of programming for mothers and newborns across (number of hospitals, communities and yearly mothers) Nigeria, and while the challenges and solutions surrounding MNCH continue to evolve, certain foundational elements persist as revolutionary to this paradigm, including the imperative of respectful maternity care fostered by more midwives and nurses, which encompasses a holistic approach within specialised programmatic frontline solutions, such as Emergency Obstetric and Neonatal Care (EmONC) training for medical providers and midwives; a package of care for mothers and neonates when severe life-threatening complications occur during pregnancy, child delivery, and postpartum, believed to avert three-fourths of maternal mortality, the encouragement and uptake in breastfeeding in the Neonatal Intensive Care Units through lactation support programs, mental health safe spaces and services established by midwives and nurses, and a full spectrum of interventions designed to mitigate risks, provide timely interventions, and foster optimal health and wellbeing outcomes for both mothers and newborns.

A fundamental question continues to persist in all of these cases: when to seek medical assistance. This question underscores the critical need for robust birth preparedness education, ensuring that expectant mothers are equipped with the knowledge and resources necessary to make informed decisions regarding their health and that of their newborns, as partners in their own care journey, led by quality trained midwives and nurses. 

Looking ahead, the continued development of maternal and newborn care demands a multifaceted approach at a global scale, for full maternity care overhaul and reform. This includes the expansion of resources such as midwifery and nursing personnel, as according to the UNFPA State of the World’s Midwifery Report, midwives can meet about 90% of the need for essential sexual, reproductive, maternal, newborn and adolescent health interventions, yet there is a global shortage of 1.1 million SRH and MCA healthcare providers, with 900,000 being midwives. 

With less than 2 Midwives Per 1000 People in Nigeria, 4 Midwives per 1000 People in the United States, and 9 Midwives per 1000 in the United Kingdom as according to the World Bank, and with global recommendation of 1 Midwife per 26 to 34 births, we must recruit, remunerate, regulate, replenish and resource midwifery and nursing services through upskilling and training - a universal requirement in improving and increasing the availability and quality of maternity care, counsel and support. 

Alongside this, increased attention to Integrated Maternal Newborn Child Health strategies, whose original consultations began in Nigeria at my request in 2007, to bolster and fortify the foundation upon which all MNCH trajectories are built are required, advancing the global health community towards a future where every mother and newborn receives the care and support they deserve.