Midlevel providers and the Fifth Millennium Goal of reducing maternal mortality

The implementation of community midwifery, characterized by a health system approach, political commitment, task-shifting, close supervision and complimentary roles of midwives and doctors, was a major contributor to the decline in maternal and neonatal mortality in Sweden during the late 19th century. In respect of the MDG5 a causal inference between skill birth attendants and decline in maternal mortality might not be straight forward but more a matter of skilled birth attendance, i.e. obstetricians, professional midwives, other midlevel providers and nurse-aides working in an enabling environment. A health system approach, commitment and mobilization, is a necessity to achieve safe abortions and safe deliveries by full coverage and equity.