Nursing and Midwifery: The Backbone of Global Healthcare
Why 28 Million Nurses and Midwives Are Essential for Health Systems
Sarah Kamau has been a nurse at Kenyatta National Hospital in Nairobi for fifteen years. Every morning, she arrives at 6 AM to begin her 12-hour shift in the maternity ward, where she’ll care for up to twenty patients—laboring mothers, women recovering from cesarean sections, newborns needing special attention, and families requiring education about infant care. “People think doctors do all the work, but nurses and midwives are the ones providing continuous, hands-on care,” Sarah explains. “We monitor vital signs, administer medications, recognize when patients are deteriorating, comfort frightened families, assist during deliveries, resuscitate newborns, and coordinate care across multiple providers. Without nurses and midwives, hospitals simply cannot function.”
According to the World Health Organization, nurses and midwives constitute nearly 50% of the global health workforce, yet face severe shortages, inadequate working conditions, and insufficient recognition for their critical contributions. The world currently has approximately 28 million nurses and midwives, but WHO projects a global shortage of 9 million nurses and midwives by 2030—primarily in low and middle-income countries—threatening achievement of universal health coverage and health-related Sustainable Development Goals.
Understanding Nursing and Midwifery
Nursing is a healthcare profession focused on caring for individuals, families, and communities to maintain or recover health and quality of life. Nurses work across diverse settings including hospitals, clinics, community health centers, schools, workplaces, homes, and humanitarian emergencies. Their roles include assessing patient conditions, administering treatments and medications, monitoring patient responses, educating patients and families, coordinating care among healthcare providers, advocating for patient needs, and managing healthcare teams.
Midwifery is a specialized healthcare profession focused on pregnancy, childbirth, postpartum care, and reproductive health. Midwives provide essential care before, during, and after childbirth, conduct normal deliveries, recognize complications requiring medical intervention, provide family planning counseling, and offer sexual and reproductive health services. In many countries, particularly low-resource settings, midwives deliver the majority of babies and provide most maternal healthcare.
Both professions require extensive education and training. Entry requirements, program lengths, and scopes of practice vary globally, but professional nursing and midwifery require formal education programs, clinical training, regulatory licensure, and continuing education. Advanced practice nurses and midwives receive additional training enabling them to diagnose conditions, prescribe medications, and provide specialized care previously limited to physicians.
Like challenges ensuring newborn health and maternal health, nursing and midwifery shortages directly impact patient outcomes and population health.
The Critical Shortage
The global shortage of 9 million nurses and midwives by 2030 represents a crisis threatening health system functionality worldwide. This shortage isn’t evenly distributed—Africa, Southeast Asia, and Eastern Mediterranean regions face the most severe deficits. Some countries have fewer than one nurse per 1,000 population, compared to more than ten per 1,000 in many high-income countries.
Several factors drive this shortage. Insufficient education capacity means nursing and midwifery schools cannot train enough graduates to meet demand. Limited faculty, inadequate facilities, and insufficient clinical placement sites constrain enrollment. Migration of nurses and midwives from low-income to high-income countries drains workforce from areas of greatest need—wealthy countries actively recruit from poorer countries, exacerbating inequalities. Poor working conditions including excessive workloads, inadequate pay, limited career advancement, unsafe environments, and lack of respect drive nurses and midwives from the profession. An aging workforce means many nurses and midwives will retire in coming years without sufficient young professionals to replace them.
Gender issues compound the problem. Nursing and midwifery are predominantly female professions (over 90% women globally), yet these professions receive less investment, recognition, and compensation than male-dominated health professions. Gender discrimination, inadequate maternity protections, and workplace harassment affect retention and job satisfaction.
The COVID-19 pandemic highlighted nurses’ and midwives’ essential roles while simultaneously worsening shortages through burnout, illness, and death. Healthcare workers faced unprecedented stress, trauma, and risk. Many left the profession entirely, unable to sustain the physical and emotional demands.
Impact on Health Outcomes
Nursing and midwifery shortages have direct, measurable impacts on patient care and health outcomes. Studies consistently show that adequate nurse staffing improves patient outcomes—lower mortality rates, fewer complications, shorter hospital stays, and higher patient satisfaction. Conversely, inadequate staffing increases mortality, medical errors, hospital-acquired infections, and patient suffering.
In maternal and newborn care, skilled midwife attendance dramatically reduces maternal and newborn deaths. Countries with strong midwifery services have better maternal and newborn health outcomes than countries where midwives are scarce or marginalized. WHO estimates that universal coverage with quality midwifery care could avert 67% of maternal deaths, 64% of newborn deaths, and 65% of stillbirths—potentially saving over 4 million lives annually.
Nurse-led primary healthcare and community-based services improve access for underserved populations. Nurses provide vaccinations, health education, chronic disease management, and preventive care that keep people healthy and out of hospitals. In many rural and remote areas, nurses and midwives are the only healthcare providers available.
Like ensuring access to essential medicines and medical devices, having sufficient, well-trained health professionals is fundamental to health system functioning.
Challenges Facing the Profession
Beyond shortages, nurses and midwives face numerous challenges that affect their wellbeing and ability to provide quality care. Workload and burnout are endemic—many nurses work excessive hours with inadequate breaks, caring for more patients than safe practice guidelines recommend. Chronic understaffing means remaining nurses must work harder, creating vicious cycles where burnout drives attrition, worsening shortages and increasing stress on those who remain.
Violence against healthcare workers, particularly nurses and midwives, represents a serious occupational hazard. Physical assault, verbal abuse, sexual harassment, and threats occur in healthcare settings worldwide. Female nurses and midwives face particular vulnerability to gender-based violence from patients, families, and colleagues. Inadequate security, insufficient institutional support, and cultural acceptance of violence against women enable this abuse.
Inadequate compensation relative to education level, responsibility, and workload demotivates nurses and midwives. In many countries, nurses and midwives earn poverty-level wages despite providing life-saving care. Gender discrimination in pay—female-dominated professions consistently earning less than comparable male-dominated professions—contributes to undervaluation.
Limited career advancement opportunities frustrate ambitious nurses and midwives. Hierarchical health systems often limit nurses’ and midwives’ scopes of practice, preventing them from working to their full potential. Physicians may resist expanded nursing roles, protecting professional territories despite evidence that advanced practice nurses provide quality care.
Lack of voice in health policy and decision-making means nurses’ and midwives’ perspectives are often excluded from decisions affecting their work and patients’ care. Despite comprising half the health workforce, nurses and midwives rarely hold senior leadership positions in health ministries, hospitals, or international health organizations.
The Path Forward: Nursing Now and Beyond
Addressing the nursing and midwifery crisis requires comprehensive, coordinated action. WHO’s State of the World’s Nursing and Midwifery reports provide evidence-based recommendations for strengthening these professions.
Education and training must expand to increase graduate numbers—investing in nursing and midwifery schools, increasing faculty, improving clinical training sites, and providing scholarships for students. Curricula should prepare nurses and midwives for evolving health challenges including noncommunicable diseases, aging populations, and climate-related health impacts.
Improving working conditions through safe nurse-to-patient ratios, reasonable working hours, adequate compensation, supportive management, safe work environments, and zero tolerance for violence will improve retention. Investing in nurses’ and midwives’ wellbeing—mental health support, stress management programs, peer support—acknowledges the emotional demands of healthcare work.
Enabling practice to full scope by removing unnecessary restrictions, supporting advanced practice roles, and empowering nurses and midwives to use their full skills and knowledge improves health system efficiency and effectiveness. Evidence shows that advanced practice nurses provide care quality equivalent to physicians for many conditions while improving access and reducing costs.
Leadership development should prepare nurses and midwives for senior positions in healthcare organizations, policy-making bodies, and international health institutions. Including nursing and midwifery perspectives in health policy decisions improves policies and demonstrates professional respect.
Ethical international recruitment requires high-income countries to invest in their own nursing education rather than depleting low-income countries’ workforces. The WHO Global Code of Practice on International Recruitment of Health Personnel provides guidelines, though enforcement remains inadequate. Countries losing nurses to migration deserve compensation and support for training replacements.
Recognition and respect for nursing and midwifery as essential professions requiring high-level education, skill, and judgment must replace outdated stereotypes. Public awareness campaigns, professional advocacy, and celebration of nurses’ and midwives’ contributions during events like International Nurses Day and International Day of the Midwife help shift perceptions.
Sarah’s Perspective
After fifteen years, Sarah has seen both progress and persistent challenges. “I’ve delivered hundreds of babies, saved countless lives, comforted dying patients, and taught new mothers how to care for their infants,” she reflects. “I love my work, but it’s exhausting. We’re chronically understaffed—I often care for patients who need one-on-one attention while simultaneously managing emergencies. I’ve been physically assaulted by angry family members, verbally abused, and work twelve-hour shifts without adequate breaks. My pay barely covers my family’s basic needs despite my university education and years of experience.”
Yet Sarah remains committed. “Patients need us. When I help a frightened teenager through her first labor, resuscitate a baby who isn’t breathing, or catch a post-delivery complication before it becomes life-threatening, I know my work matters. But we need support—more nurses, better pay, safer working conditions, and respect for our expertise. We’re not just doctors’ assistants or warm bodies filling shifts—we’re highly educated professionals making clinical decisions that determine whether patients live or die.”
Sarah represents millions of nurses and midwives worldwide who, despite inadequate support and recognition, continue providing compassionate, skilled care. Their dedication sustains health systems and saves lives daily. They deserve better—adequate staffing, fair compensation, safe environments, professional respect, and voices in decisions affecting their work. Investing in nursing and midwifery isn’t just good for these professions—it’s essential for achieving universal health coverage, improving health outcomes, and building resilient health systems capable of meeting 21st-century challenges. The 28 million nurses and midwives currently working, and the millions needed in coming years, are not optional extras in health systems—they are the foundation upon which all health services rest.
Frequently Asked Questions (FAQs)
Nurses provide broad healthcare across diverse settings and patient populations—hospitals, clinics, communities, schools—caring for people with acute illnesses, chronic conditions, injuries, and various health needs. Their roles include assessing conditions, administering treatments, monitoring patients, educating families, and coordinating care. Midwives specialize in reproductive health, pregnancy, childbirth, and postpartum care. They provide prenatal care, conduct normal deliveries, recognize complications requiring medical intervention, offer family planning services, and provide newborn care. In many countries, midwives are the primary providers of maternal healthcare. Some healthcare systems have distinct nursing and midwifery professions requiring separate education and licensure, while others integrate midwifery within nursing as a specialty requiring additional training.
The projected shortage of 9 million nurses and midwives by 2030 results from multiple factors: insufficient education capacity (nursing schools cannot train enough graduates), international migration (nurses/midwives moving from poor to wealthy countries), poor working conditions (excessive workloads, inadequate pay, unsafe environments, lack of respect), aging workforce (many nurses/midwives retiring without sufficient replacements), inadequate investment in these predominantly female professions, and COVID-19 impacts (burnout, illness, deaths, professionals leaving the field). Shortages concentrate in low and middle-income countries, particularly Africa, Southeast Asia, and Eastern Mediterranean regions, while high-income countries actively recruit from countries experiencing shortages, exacerbating global inequalities.
Research consistently demonstrates that adequate nurse staffing improves patient outcomes including lower mortality rates, fewer medical errors and complications, reduced hospital-acquired infections, shorter hospital stays, and higher patient satisfaction. Conversely, inadequate staffing increases deaths, complications, and suffering. For maternal and newborn health specifically, WHO estimates universal coverage with quality midwifery care could prevent 67% of maternal deaths, 64% of newborn deaths, and 65% of stillbirths—potentially saving over 4 million lives annually. Countries with strong midwifery services consistently demonstrate better maternal and newborn outcomes than countries where midwives are scarce. Nurse-led primary care and community services improve access for underserved populations and effectively manage chronic diseases.
Major challenges include excessive workloads and burnout from chronic understaffing, inadequate compensation relative to education and responsibility (particularly problematic given the predominantly female workforce experiencing gender-based pay discrimination), violence and harassment (physical assault, verbal abuse, sexual harassment from patients, families, colleagues), limited career advancement opportunities, hierarchical systems restricting their scope of practice despite extensive training, lack of voice in health policy decisions affecting their work, inadequate safety equipment and resources, and insufficient recognition of their professional expertise. COVID-19 exacerbated these challenges through unprecedented stress, trauma, infection risk, and deaths among healthcare workers. These factors drive nurses and midwives from the profession, worsening shortages.
WHO, professional organizations, and many countries are implementing strategies including expanding nursing and midwifery education (increasing school capacity, faculty, clinical training sites, student scholarships), improving working conditions (implementing safe staffing ratios, reasonable hours, adequate compensation, violence prevention programs), enabling full scope of practice (supporting advanced practice roles, removing unnecessary restrictions), developing leadership pathways (preparing nurses/midwives for senior positions, including them in policy decisions), implementing ethical international recruitment (following WHO guidelines, wealthy countries investing in own education rather than depleting poor countries’ workforces), and increasing recognition and respect for the professions. The Nursing Now campaign (2018-2020) raised global awareness. However, progress remains insufficient given the magnitude of shortages and persistent underinvestment in these essential professions.
References
- World Health Organization. (2024). Nursing. Retrieved from https://www.who.int/health-topics/nursing
- World Health Organization. (2024). Nursing and midwifery – Fact Sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery
- World Health Organization. (2024). Midwifery. Retrieved from https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/maternal-health/about/midwifery
- World Health Organization. (2020). State of the World’s Nursing Report. Retrieved from https://www.who.int/publications/i/item/9789240003279
- World Health Organization. (2021). State of the World’s Midwifery Report. Retrieved from https://www.who.int/publications/i/item/9789240033474
Disclaimer: This article is an adaptation of publicly available information from WHO’s Nursing and Midwifery health topic page (WHO, Geneva. Licence: CC BYNC-SA 3.0 IGO). WHO is not responsible for the content or accuracy of this adaptation. This content is for informational and educational purposes
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