Strong health systems start with midwives. Credit: Unsplash

By Shreya Komar
UNITED NATIONS, Aug 15 2025 (IPS)

Asia-Pacific’s midwives are a healthcare lifeline capable of delivering nearly 90 percent of essential maternal and newborn services. Yet the region grapples with severe shortages, underinvestment, and systemic neglect.

The newly released State of Asia’s Midwifery 2024 Report, released by the United Nations Population Fund (UNFPA), reveals that despite midwives’ lifesaving potential, many countries lack enough workers, face poor training and support systems, and struggle with weak policy backing. The findings underscore an urgent need to elevate midwives from auxiliary roles to central pillars of health systems across the region.

Drawing on data from 21 countries in the UNFPA Asia-Pacific (AP) region, the report was intended to assist countries in the region to meet the challenges of the health-related SDGs and the Every Woman Every Newborn Everywhere (EWENE) agenda, a global initiative focused on accelerating the reduction of preventable maternal and newborn deaths.

The report shows hundreds of thousands of maternal and newborn deaths in 2023 across the Asia-Pacific that timely midwife interventions could have largely prevented. The region faces a shortage of approximately 200,000 midwives, contributing to an annual toll of roughly 66,000 maternal deaths alone. These stark figures expose both the human cost and the systemic failure to invest in this essential healthcare workforce.

According to the report, at least five Asia-Pacific countries, including Lao PDR, Mongolia, Pakistan, Papua New Guinea (PNG) and Timor-Leste, are estimated to face needs-based midwife shortages, with Pakistan and PNG experiencing the most severe gaps.

The report projects that Pakistan and PNG will still face shortages by 2030, even if they maintain current rates of midwife graduation and full employment. Other countries, such as Afghanistan, Myanmar, and Viet Nam, are also likely to experience ongoing shortages; however, limited data prevents precise estimates of these shortages.

Beyond shortages, the report points to alarming gaps in education quality, regulatory frameworks, and leadership pathways for midwives. Many countries still struggle with limited pre-service training, scarce continuing education opportunities, weak licensing systems, and fragmented governance. Retention suffers as poor pay, inadequate infrastructure, and lack of professional recognition push midwives away, especially from rural and underserved areas.

The report also emphasizes how placing midwives in leadership roles can strengthen decision-making on policies that directly affect maternal and newborn health, improve supervision and mentoring, and ensure midwifery perspectives shape regulation, training, and service delivery.

Countries like Afghanistan, Iran, and Malaysia show how midwife-led governance can integrate professional expertise into national health strategies, ultimately enhancing the quality, reach, and effectiveness of sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) services.

Since 2021, nine countries have increased midwife availability (Bangladesh, Cambodia, Iran, Lao PDR, Maldives, Nepal, PNG, Sri Lanka and Viet Nam), four have seen decreases (Indonesia, Malaysia, Pakistan and the Philippines), and two show no significant change (Mongolia and Timor-Leste). It shows that while some nations are making progress, regional gains are uneven, and shortages can worsen without sustained investment and retention strategies.

The WHO estimates that countries with fewer than 25 doctors, nurses and midwives per 10,000 people will struggle to provide adequate primary healthcare, a threshold that, while general, offers a benchmark for minimum workforce density.

Acting on this information is imperative because midwives are the most cost-effective, accessible answer to achieving safe motherhood and newborn survival goals. As the World Health Organization notes, when well-trained and integrated, midwives can address roughly 90 percent of essential reproductive and newborn health needs. Still, the world faces a global shortfall of nearly 900,000 midwives, and many in Asia endure poor working conditions, low pay, and limited career paths. Thus, saving lives demands investing in midwifery education, fair compensation, regulation, leadership, and full integration into health systems.

Midwife supervisor Arafin Mim, who oversees a team serving over 32,500 Rohingya refugees on the remote island of Bhasan Char in Bangladesh, captures the importance of her work simply.

“I feel this profession from the corner of my heart. It’s about making a connection with a pregnant woman, building a relationship during her pregnancy.”

Mim’s dedication illustrates the commitment and resilience midwives bring to some of the world’s most challenging environments.

In UNFPA’s recent opinion piece, the Regional Director Pio Smith shares a vivid image of midwives delivering in remote Bangladesh during climate crises to describe their resilience.

“When non-stop rain caused flooding in her village, the maternity ward, pharmacy, and storage room were submerged by water. She still continued to deliver babies, without electricity, even supporting emergency cesarean sections as needed with the doctors on call.”

The report urges governments and partners to close needs-based midwife shortages by expanding education in line with ICM standards, improving faculty and curricula, and ensuring equitable deployment. It recommends updating policies so midwives can work to their full scope, using data-driven workforce planning to create sanctioned posts, and adopting fair recruitment, deployment, and retention strategies.

Finally, it calls for empowering midwives with leadership roles in SRMNAH governance, regulation, and service improvement.

UNFPA’s Executive Director, Dr. Natalia Kanem, reminds us in a statement that “midwives are instrumental to navigating these challenges: They can provide up to 90 percent of essential services for sexual and reproductive health and bring their expertise and counsel to women wherever they are.”

Country examples such as Bangladesh, Nepal, and Cambodia offer hopeful signs. Bangladesh’s midwife-led birthing centers, Nepal’s rural midwifery deployments, and Cambodia’s regulatory reforms are exemplary, but much more action and investment are needed.

Midwives must be valued and supported as key professionals with quality education, fair pay, robust licensing, leadership opportunities, and a seat at health policymaking tables. This will result in fewer maternal and infant deaths, stronger newborn health, and more resilient healthcare systems.

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The origin of COVID-19 remains a mystery, hampered by secrecy, stalled research and global inaction.

By Shreya Komar
UNITED NATIONS, Aug 14 2025 (IPS)

More than four years since Covid-19 upended the world, the question of how it began remains unanswered. Did SARS-CoV-2 originate from animals to humans naturally, or did it accidentally escape from a laboratory? The World Health Organization’s latest report offers little new clarity and raises serious concerns about international cooperation and scientific transparency. On June 27, 2025, the WHO Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) released its second report examining how the virus emerged. Despite years of work and renewed international focus, the findings have been widely criticized for failing to break new ground. Much of the blame lies in what wasn’t included. Critical data requested from China was never provided, leaving glaring holes in the investigation.

“The report adds almost nothing to what a few talented independent investigators found several years ago,” said Viscount Ridley, co-author of Viral: The Search for the Origin of Covid-19.

“That it has taken five years and 23 people to produce this ‘all but useless’ addition to the literature on the origin of Covid-19 is frankly a disgrace.”

The search for COVID-19’s origin is not simply an academic exercise. Understanding how this virus entered the human population is crucial for preventing the next pandemic. Scientists agree that future coronavirus outbreaks are not only possible but also likely. Knowing whether SARS-CoV-2 came from a wildlife market or a laboratory accident informs how humanity prepares for the next spillover.

While the SAGO report acknowledges both the zoonotic spillover and lab-leak theories as plausible, it stresses the need for further evidence. That evidence remains frustratingly out of reach.

“If China had been transparent all along, we would have been able to pinpoint what happened,” said Dr. Deborah Birx, who served as the White House Coronavirus Response Coordinator from 2020 to 2021.

Most virologists continue to believe that the virus has a natural origin, a view reinforced in a new documentary titled “Unmasking COVID-19’s True Origins” released by Real Stories on July 15. “The vast majority of virologists understand the virus had a natural origin,” one expert says in the film. Still, without access to early samples and full records, both theories remain scientifically viable, and political tensions continue to cloud the inquiry.

This latest WHO report comes just weeks after a major development in global health policy. On May 20, 2025, the World Health Assembly adopted the long-anticipated WHO Pandemic Agreement, a legally binding treaty intended to strengthen preparedness for future outbreaks. The agreement aims to fix the deep weaknesses revealed by the COVID-19 pandemic: sluggish coordination, delayed data sharing, and unequal access to vaccines and treatments.

The treaty commits countries to share information on emerging pathogens faster, to improve cooperation on disease surveillance, and to distribute medical tools like vaccines more equitably. It also respects national sovereignty, meaning that countries will not be forced to relinquish control of their public health decisions. Still, some provisions, particularly those concerning the sharing of pathogen samples and related benefits, remain under negotiation and are expected to be finalized in 2026.

The WHO’s first SAGO report, released on June 9, 2022, also found that both leading origin theories were possible and called for further data from Chinese authorities. The absence of transparency since then has only hardened frustration among scientists. The call for cooperation is not just about this virus but about preparing for what comes next.

Meanwhile, research vital to fighting COVID-19 and future respiratory diseases has quietly stalled. In 2024, Ohio State University was awarded USD 15 million to study new treatments for SARS-CoV-2 and long COVID. One promising clinical trial focused on a drug to treat hypoxemic respiratory failure, a leading cause of death among hospitalized patients. But halfway through, the National Institutes of Health abruptly terminated the funding.

The cancellation saved USD 500,000 but came after USD 1.5 million had already been spent. As a result, researchers were forced to abandon the trial entirely, delaying possible treatments that could have helped the nearly one million people hospitalized annually for respiratory failure caused by COVID, flu, and other infections. “This is a disaster for all of us,” said a veteran scientist at Ohio State.

“We’re all depressed and living on a knife-edge, because we know we could lose the rest of our grants any day. These people really hate us, yet all we’ve done is work hard to make people’s health better. A flu pandemic is coming for us; what’s happening in cattle is truly scary and all we have is oxygen and hope for people.”

Scientific leaders argue that the world must do the opposite of what is currently happening: invest more, not less, in pandemic-related science. Research that has languished or been underfunded must be revived and expanded. More international partnerships are needed, especially with researchers in hotspot regions such as China, to ensure the global community is better equipped to face the next threat.

As the WHO itself notes, “The work to understand the origins of SARS-CoV-2 remains unfinished.”

But without transparency, funding, and political will, it may remain that way for years to come. And if that happens, the world could be left just as vulnerable when the next pandemic emerges.
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Leaders, policymakers, and partners unite at Africa Day 2025. Credit: Shreya Komar/IPS

By Shreya Komar
UNITED NATIONS, Jul 30 2025 (IPS)

Africa is making progress on over two-thirds of the Sustainable Development Goals (SDGs), but the pace remains far too slow to meet the 2030 targets, especially in areas like decent employment, gender equality, and access to social protection.

This was the central warning of the newly released Africa Sustainable Development Report (ASDR), launched during the 2025 Africa Day session at the UN’s High-Level Political Forum.

The report, which tracks alignment between the African Union’s Agenda 2063 and the UN’s 2030 Agenda, offers a sobering yet actionable picture: Africa’s development efforts are gaining traction, but deep structural barriers, ranging from inadequate financing and data gaps to high youth unemployment and gender-based exclusion, continue to stall momentum.

Despite being home to several of the world’s fastest-growing economies, the continent faces an annual sustainable development financing gap of up to USD 762 billion, according to the report. Social protection coverage remains alarmingly low, with only 19 percent of vulnerable populations benefiting from any form of safety net. Public investment in social protection across most African countries is below 3 percent of GDP, significantly under the global average.

“The current pace of progress is insufficient to achieve the SDGs by 2030,” the report warns, prompting leaders to explore actionable strategies for scaling up inclusive growth, regional integration, and institutional capacity building across the continent.

Health outcomes have improved in areas like life expectancy and disease control, but maternal mortality and unequal access to care persist. Gender equality remains constrained by legal barriers, high rates of violence, and the burden of unpaid care work.

On SDG 8, the continent struggles with low productivity, informality, and youth unemployment, emphasizing the need for inclusive job creation and economic transformation. While the continent has seen some recovery in sectors like tourism, key indicators such as GDP growth per capita (down from 2.7 percent in 2021 to 0.7 percent in 2023) and youth employment remain weak. Over 23 percent of African youth are not in education, employment, or training (NEET), with women disproportionately affected. Despite its potential, tourism contributed just 6.8 percent to GDP in 2023.

Economic shocks, climate change, and geopolitical instability continue to undermine job creation and sustainable growth. The report calls for data-driven strategies, innovative financing, and integrated policies to bridge development gaps and build resilient, equitable systems aligned with both global and continental agendas.

“It is not enough to just create jobs, but we must ensure safe working conditions,” said H.E. Amb. Selma Malika Haddadi, Deputy Chairperson of the African Union Commission.

UN Deputy Secretary-General Amina Mohammed acknowledged the uneven starting point for African countries, stating, “too often, Africa isn’t at the table where decisions are made but is the first to feel the impact.” She added, “Our young people deserve more than we give them,” highlighting the pressing need for inclusive investment in youth education.

Central to the discussion was the need to mobilize greater technical and financial support, scale up climate financing, tackle illicit financial flows, and reduce social and economic inequalities. Participants emphasized stronger partnerships (SDG 17), inclusive social protection systems, and youth- and women-led innovation as key enablers for transformational change. The launch of the ASDR marked a major milestone, offering data-driven insights to support national strategies.

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A child receives treatment at a cholera clinic in the DRC, where clean water is scarce and healthcare even scarcer. Credit: UNICEF

By Shreya Komar
UNITED NATIONS, Jul 14 2025 (IPS)

The Democratic Republic of Congo (DRC) is grappling with one of its worst cholera outbreaks in recent history, exposing deep systemic cracks in public health, water infrastructure, and humanitarian response, leaving its youngest citizens in peril.

On April 3, 2025, the United Nations released a stark warning: a fast-spreading cholera outbreak in the southern province of Tanganyika was placing thousands at grave risk. As of that date, 9 out of 11 health zones in the province were affected, with over 1,450 confirmed cases and 27 deaths, marking a six-fold increase compared to the previous year.

By early June, the outbreak had exploded far beyond Tanganyika. The World Health Organization (WHO) reported 29,392 suspected cholera cases and 620 deaths nationwide, making this the worst outbreak in the country in six years. Most alarmingly, children, especially those under five, are dying in disproportionate numbers due to weakened immune systems, chronic malnutrition, and an almost total collapse of access to clean water and sanitation in many areas.

A recent Instagram post from the WHO underscored the scale of response efforts: “To tackle the rise in #cholera cases & deaths in #DRCongo, WHO is mobilizing resources for the hardest-hit areas: emergency beds, free medical care, and deployment of over 7,000 community health workers.”

Cholera is an acute diarrheal infection caused by ingesting food or water contaminated with the Vibrio cholerae bacterium. It is entirely preventable and highly treatable. So why is it still killing hundreds in a single outbreak?

“The reason cholera has persisted is that we have not addressed poverty to the level that we should,” said Dr. Anita Zaidi, director of the Enteric and Diarrheal Diseases program at the Gates Foundation.

The answer lies not in the biology of the disease, but in the fragile reality of life in the eastern DRC. In provinces like Tanganyika, North Kivu, and South Kivu already scarred by decades of armed conflict, mass displacement, and collapsing infrastructure the cholera bacterium finds ideal conditions to spread.

A 2024 study on cholera risk in Goma found that the lack of water infrastructure forced communities to rely on unsafe sources like Lake Kivu, the small Lake Vert, and the Mubambiro River, which are often contaminated with human waste.

In the most affected areas, only 20 percent of residents have access to safe drinking water. Healthcare infrastructure is threadbare, with limited beds, medicine, or trained personnel to handle waves of acute cases. Years of humanitarian funding cuts have only made the situation worse especially for women and children.

Between July 2024 and June 2025, nearly 4.5 million children under five are expected to suffer from acute malnutrition in the DRC, 1.4 million of whom are experiencing severe acute malnutrition. Cholera, which causes rapid dehydration and can be fatal within hours, is especially deadly in malnourished children. With their immune systems already compromised, even the smallest lapse in hydration or care can become fatal.

Still, field efforts are outpaced by the scale of the emergency. In 2017, the Global Task Force on Cholera Control (GTFCC) launched the “Ending Cholera: A Global Roadmap to 2030”, which aimed to eliminate the disease from 20 countries, including the DRC.

The strategy emphasized early detection, integrated prevention (clean water, sanitation, vaccination), and international coordination. But with only five years left before 2030, the roadmap’s vision is faltering in the DRC. In 2023, the DRC recommitted to cholera elimination, as documented by the WHO, but outbreaks have only worsened.

A Doctors Without Borders emergency response in Lomera, South Kivu, highlights the impact of unmanaged gold rushes, poor sanitation, and overburdened clinics creating a perfect storm for cholera transmission.

Efforts by the UN and NGOs have ramped up in recent months. Oral Cholera Vaccines (OCVs) are being deployed in hotspots. Emergency treatment centers are being established. Supplies are arriving, albeit slowly. But a true resolution requires structural investments in safe water infrastructure, consistent access to healthcare, and conflict stabilization.

More importantly, child-focused solutions must be prioritized. In a recent peer-reviewed article, Congolese researcher Aymar Akilimali called for dedicated pediatric cholera wards in eastern DRC, noting that most children have no access to tailored emergency care even during active outbreaks.

He also stated that “a community-based and multisectoral response must be implemented, including an anti cholera vaccination campaign, a budgeted response plan with involved partners, as well as the development of national cholera control plans, epidemiological surveillance, risk communication on cholera, community awareness, and social mobilization.”

The cholera outbreak in the DRC is not just a public health crisis; it is a humanitarian failure. It is a warning signal of what happens when decades of conflict, poverty, and weak governance go unaddressed. As 2030 approaches, the question isn’t whether we can end cholera, it’s whether we’re willing to invest in the lives of those most at risk of it.

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