By Elizabeth Bailey, EBN’s Associate Editor for Midwifery and Women’s Health

The 5^th May marks International Day of the Midwife. This is an opportunity to reflect on the contribution the profession of midwifery makes to the global community. For midwives, it is an opportunity to celebrate the work of colleagues and contemporaries around the world and reflect on ongoing challenges and opportunities for the impacts of midwifery.

Each year International Day of the Midwife has a theme to provide a focus for awareness and debate and this theme is set by the International Confederation of Midwives. This year’s theme is ‘Midwives: a vital climate solution’ which seeks to explore debate around midwifery’s interactions with climate change which is recognised in the campaign as ‘the greatest health challenge of our time’.

Climate change is high on many political agendas, and we are all familiar with the high-level global climate summits such as the UN COP28 and the various commitments being requested from member countries to work towards avoiding climate disaster. In addition, as individuals, we are becoming more aware of how climate change is linked to our lifestyles and how much it is contributing to local environmental issues.

However, why should midwifery take a profession-wide position on climate change?

There are notable direct impacts of climate change on midwifery work. Significant environmental events, such as flooding, typhoons and wildfires have adversely impacted maternal morbidity and mortality rates [1, 2, 3]. Every time I hear about these kinds of environmental disasters, I think about the midwives working in those areas and how they might be able to continue with their work and ensure safe outcomes for women and babies. I think of families with babes-in-arms and consider how stressful it must be to need to urgently re-locate or become displaced.

There is emerging scientific evidence that also raises concerns for the impact of climate change on perinatal well-being. Research suggests that maternal exposures to both extremely high and low temperatures, particularly during late gestation are associated with increased risks of preterm birth, stillbirth, and reduced fetal growth [4]. In the last few years, we have seen scientific papers emerge that demonstrate microplastics are detectable in placentas and in breastmilk [5, 6, 7]. One small study of faecal samples from the USA found more that infants were exposed to higher levels of microplastics than adults [8].

World Earth Day was only a few weeks ago and the theme for 2024 was Planet vs. Plastics following a previously published special report titled ‘Babies vs. Plastics’ which included a call for more research into the health implication of microplastics on unborn babies, neonates and infants [9].

These issues are rightly the concern of us all as a global population, but for midwives the communities we serve will share concerns about environmental impacts on health for themselves and their families and will expect well-informed advice. Midwives are likely to find that planning for environmental disruption and unexpected events might become a larger part of their professional responsibilities [10]. As such climate change and environmental issues may play an increasingly significant part of midwifery work. This is by no means the only new demands that midwives face. In many countries there is also increasing conflict, widening health inequalities, poorer population health, increasing pressures on the maternity workforce and continued debate on the role and autonomy of midwives within health systems. Maternity care in many countries is also struggling to reduce poor outcomes for increasingly marginalised populations and with a widening gender gap in human rights and wellbeing [11].

It can feel difficult to find the priority on which to focus our efforts and attention. However, climate change has been described as a ‘threat multiplier’ and an issue that is not gender-neutral with its impacts affecting women and girls disproportionately as well as other minoritised groups who may be ‘less visible’. In an upcoming blog series with a focus on maternal inequalities, EBN will hear more from those working in this important area.

For now, as we take the time on 5^th May to celebrate midwives and midwifery and the reflect on the potential the profession has to improve the health and the wellbeing of families globally, midwives must consider how we can not only stay informed in order to advocate, but also be the drivers of knowledge and awareness of the specific risks to perinatal wellbeing within climate change debates.

1. Sato M, Nakamura Y, Atogami F, Horiguchi R, Tamaki R, Yoshizawa T, Oshitani H. Immediate Needs and Concerns among Pregnant Women During and after Typhoon Haiyan (Yolanda). PLoS Curr. 2016 Jan 25;8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743840/
2. Davis D, Roberts C, Williamson R, Kurz E, Barnes K, Behie A, Aroni R, Nolan CJ, Phillips C, Opportunities for primary health care: a qualitative study of perinatal health and wellbeing during bushfire crises, Family Practice, Volume 40, Issue 3, June 2023, Pages 458–464,https://doi.org/10.1093/fampra/cmac133
3. Agency authors (art of a cross-border reporting workshop organised by the U.S.-based East-West Center in Kathmandu, Nepal) Climate change compounds maternal health crisis in flood-prone areas of Indo-Pak Act on Climate Change – Earth Day The Shillong Times 24^th March 2024 https://theshillongtimes.com/2024/03/24/climate-change-compounds-maternal-health-crisis-in-flood-prone-areas-of-indo-pak/
4. Nyadanu S, Dunne J, Tessema GA, Mullins B, Kumi-Boateng B, Bell ML, Duko B, Pereira G, Maternal exposure to ambient air temperature and adverse birth outcomes: An umbrella review of systematic reviews and meta-analyses, Science of The Total Environment, Volume 917,2024, https://www.sciencedirect.com/science/article/pii/S0048969724003711
5. Ragusa A, Notarstefano V, Svelato A, Belloni A, Gioacchini G, Blondeel C, Zucchelli E, De Luca C, D’Avino S, Gulotta A, Carnevali O, Giorgini E. Raman Microspectroscopy Detection and Characterisation of Microplastics in Human Breastmilk. Polymers (Basel). 2022 Jun 30;14(13):2700 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9269371/
6. Ragusa A, Lelli V, Fanelli G, Svelato A, D’Avino S, Gevi F, Santacroce C, Catalano P, Rongioletti MCA, De Luca C, et al. Plastic and Placenta: Identification of Polyethylene Glycol (PEG) Compounds in the Human Placenta by HPLC-MS/MS System. International Journal of Molecular Sciences. 2022; 23(21):12743. https://www.mdpi.com/1422-0067/23/21/12743
7. Garcia MA, Liu R, Nihart A, El Hayek E, Castillo E, Barrozo ER, Suter MA, Bleske B, Scott J, Forsythe K, Gonzalez-Estrella J, Aagaard KM, Campen MJ, Quantitation and identification of microplastics accumulation in human placental specimens using pyrolysis gas chromatography mass spectrometry, Toxicological Sciences, Volume 199, Issue 1, May 2024, Pages 81–88, https://doi.org/10.1093/toxsci/kfae021
8. Zhang J, Wang L, Trasande L, Kannan K, Occurrence of Polyethylene Terephthalate and Polycarbonate Microplastics in Infant and Adult Feces, Environmental Science & Technology Letters 2021 8 (11), 989-994 https://pubs.acs.org/doi/abs/10.1021/acs.estlett.1c00559
9. Charron A, Wunsh J (Eds.) Babies vs Plastics Earthday.org November 21, 2023 https://www.earthday.org/wp-content/uploads/2023/11/BVP-Report.pdf
10. Kumari U, Sharma RK, Keshari JR, Sinha A. Environmental Exposure: Effect on Maternal Morbidity and Mortality and Neonatal Health. Cureus. 2023 May 4;15(5):e38548. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10239284/#REF27
11. WHO Factsheet Maternal mortality 26 April 2024 https://www.who.int/news-room/fact-sheets/detail/maternal-mortality