From Commitment to Action: Integrating Midwifery into Primary Health Care to End Preventable Maternal and Newborn Deaths

Good afternoon to you all. Prime Minister of Bangladesh, His Excellency Mr. Tarek Rahman, Minister of Foreign Affairs of Sweden, Her Excellency Ms. Maria Malmer Steffensen, ministers from Nepal, Sierra Leone, Slovenia, Thailand, Mexico, Dr. Zubaida Rahman, the Vice President of the Ziaur Rahman Foundation, and the First Spouse of Bangladesh, Excellencies, distinguished guests, delegates, colleagues, ladies and gentlemen, good afternoon and a very warm welcome to this high-level side event on the margins of the 81st session of the United Nations General Assembly. On behalf of the government of Bangladesh, our co-host, the government of Sweden, and our partner, UNFPA, it is my privilege to welcome you all. We are particularly honored by the presence of these distinguished ministers and delegates who have joined us from abroad around the world. We are gathered around a simple but powerful proposition to accelerate progress in maternal and newborn health. Professional midwifery must be firmly integrated within primary health care systems. Today's gathering is an opportunity not only to share Bangladesh's experience, but also to learn from other countries and build a stronger global momentum for this agenda. To set the stage for the discussion that follows, we'll now show a short video from Bangladesh, highlighting the midwifery journey integrated within our primary healthcare system. May I invite you all to turn your attention to the screen. Thank you and once again a very warm welcome to you all.

Prevention is better than cure. This is our motto. We have trained 60,000 health care workers. We have trained 40,000 midwives.

Bangladesh is embarking on a fundamental transformation of its primary health care. From a treatment-centered system to a preventive and promotive-centered system in rural and urban facilities. Now community health and well-being workers based in union health centers will visit women at home and provide a basic health package, including referral to midwives. Midwives will be the critical link between community, primary health care facility and higher level care when needed. 15 years ago, Bangladesh set out to build something new, a professional midwifery workforce. Today, midwives are educated to international standards. licensed, regulated, and deliver quality care to women and newborns across the country. Sweden has stood alongside Bangladesh, investing in education, regulation, leadership, and a profession built to last. A strong primary healthcare system means strong midwifery services. 25,000 midwives mean skilled care closer to home, reaching women in remote and indigenous communities with culturally appropriate care, thousands of professional opportunities for women boosting families and the economy, and a powerful opportunity to make preventable maternal and newborn deaths and morbidities history. Bangladesh shows that long-term partnership can achieve strong institutions, a professional workforce, and better health for women and newborns, and realization of sexual and reproductive health and rights for all. And while Bangladesh is proud to be a leader, it is not walking alone. As a founding champion country of the Midwifery Accelerator, it is helping turn national experience into global momentum. The Midwifery Accelerator brings countries and partners together around a simple ambition: Commit and invest, educate, deploy and retain, advocate and empower. Bangladesh has made its commitment. Now, how far can we go together?

Thank you. Now, it is my honor to invite our first speaker to provide opening remark. Let us welcome his excellency, mister Tariq Rahman, the prime minister of the government of the people's republic of Bangladesh to provide his opening speech.

Thank you, Doctor Zia. Excellencies, Honorable ministers, Madam Executive Director of UNFPA, distinguished guests, ladies and gentlemen, good afternoon and welcome. It gives me great pleasure to open this high-level side event. Bangladesh is proud to co-host it with Sweden in partnership with UNFPA. Political commitment become meaningful when translated into investment, institutions, skilled people, and better lives. This is why today's theme, from commitment to action, is particularly relevant for Bangladesh. My government is transforming our health system, guided by a simple principle, prevention is better than cure. We want to build a healthy Bangladesh, Bangladesh, where health care begins in home and community. Primary health care is at the foundation of our health reform agenda with priority to women and children. Ladies and gentlemen, we intend to recruit 100,000 additional health workers. You will be happy to know 80% of whom will be women. They will connect families with the health system, identify risk early, and support timely care. One professional has a particularly important role in this continuum, the midwife. A professional midwife is much more than a skilled birth attendant, she can become a woman trusted health professional from preconception through the postnatal period. My government has taken the decision to recruit 25,000 professional midwives across Bangladesh, and that process has begun. We want them to become an integral part of the multidisciplinary primary health care terms. They will provide essential reproductive care, support antenatal care, promote safe and respectful childbirth, identify complications early, facilitate referral and care for mothers and newborn support, including breastfeeding, immunization, and health childhood development. Excellencies, ladies and gentlemen, Bangladesh has built an important foundation laid by former Prime Minister Khaleda Zia. We have established professional midwifery education, strengthened regulation, and deployed midwives across districts, subdistricts, and union level facilities. We now have more than 11,000 licensed midwives, with the objective of reaching 25,000 by 2030. Our partnership with Sweden and UNFPA has made an important contribution. With UNFPA's cooperation, Bangladesh expanded midwifery-led care across 22 districts, where skilled midwives supported more than 154,000 births and managed critical maternal cases. These are not merely statistics. They represent mothers returning home safely and newborns beginning life with hope. Distinguished guests, we are also building an integral digital health ecosystem. Our vision is that every citizen will have a health card linked with a digital health record and electronic referral system. For a woman in a rural Bangladesh, her care can be registered close to home, her visit tracked, and her factors recorded. If referred to a high-level hospital, the necessary information should travel with her. Our vision for women's health extends beyond pregnancy and childhood. We must address women's health across the life course, including adolescent health, reproductive health, and family planning. and prevention and early detection of cervical and breast cancer. Midwifery must therefore be part of a broader platform for a woman's health within primary health care. The next phase must be driven by national ownership and sustainable domestic investment. As we open today's discussion, I leave you with an ambition. Every woman should have access to a skilled professional midwife as part of her primary health care team, close to where she lives. For Bangladesh, this means deploying midwives nationwide, strengthening community health services and referral pathways, and connecting citizens through a modern digital health system. Together, these steps will help us build a healthy, thriving Bangladesh. And this is how we move from commitment to action. I look forward to hearing the perspectives of our distinguished ministers, partners, and experts. Thank you very much for your time and participation.

Your Excellency, our honorable Prime Minister, Tarek Rahman, thank you for your inspiring remarks and leadership, which clearly demonstrate Bangladesh's high commitment in institutionalizing and midwifery within health systems. Now, it's my pleasure to introduce our next speaker. Please welcome Her Excellency, Ms. Maria Malmer Stenergard to take the floor and provide her opening speech.

Thank you very much, Prime Minister, Excellencies, distinguished guests, colleagues. Everyone has the right to make decisions about their own body, their own life, and their own future. Every woman, wherever she lives and whatever circumstances she faces, has the right to a safe pregnancy and childbirth. And every newborn deserves the best possible start in life. These are fundamental rights They are at the heart of sexual and reproductive health and rights, and of gender equality. For Sweden, the commitment to advancing these rights remains strong. I am so happy to be here today to highlight the partnership between Bangladesh, Sweden and UNFPA, and to showcase what is possible when we invest in midwives and in the systems that enable them to provide high-quality care. In recent decades, the world has made significant progress on gender equality and sexual and reproductive health and rights. But today, that progress cannot be taken for granted. In many places, progress has stalled, and in some, hard-won rights are being challenged. Conflicts, crises, and growing opposition to sexual and reproductive health and rights are adding further pressure. But we cannot allow progress to be reversed. And one of the most concrete ways to turn our commitments into better health and save lives is by investing in midwives. Midwives play a crucial role in promoting maternal and newborn health. in providing contraception and safe abortion services, and in prevention, support and care related to gender-based violence. Universal access to midwifery services could save millions of lives. Midwives are a critical component of primary health care, the foundation of every strong health system. Support for midwifery is also an excellent investment, generating nine US dollars in social and economic returns for every dollar invested. But the most important return cannot be measured in money. It is measured in healthier women, safer births, and lives saved. There is an urgent need to educate and train more midwives, ensure attractive employment opportunities and decent working conditions, provide them with the resources that they need and enable them to perform their work to the full extent of their expertise. For decades, Sweden has been a steadfast partner in strengthening the midwifery workforce in Bangladesh and around the world. I am pleased to see that these joint efforts contribute to tangible results. I commend the government of Bangladesh for its landmark commitment to train and deploy 25,000 midwives by 2030. I hope this powerful pledge will inspire others to follow suit. Since 2008, UNFPA's Maternal and Newborn Health Fund, with Sweden as its largest donor, has supported over 40 million women in accessing safer delivery care. and our support to initiatives such as UNFPA's new Midwifery Accelerator Initiative help bring quality care to many more women and newborns. Sweden will remain committed to gender equality and sexual and reproductive health and rights, including midwifery. We continue to be a steadfast partner and advocate for women's and girls' full enjoyment of human rights. because when women and girls enjoy their rights and access quality health care, families, communities, and societies benefit. Investing in midwives is not only an investment in health. It is an investment in dignity, equality, opportunity, and our common future. It means safer pregnancies, safer births, more mothers and newborns surviving and thriving. Midwives save lives. Let's continue to invest in them. Thank you.

Your Excellency, Minister Stenberger, thank you for your remarks and highlighting the importance of global partnership towards achieving the Sustainable Development Goals. Before we move to our next session, I would like to once again express our sincere appreciation and thanks to His Excellency, the Prime Minister of Bangladesh, and Her Excellency, the Minister of Foreign Affairs of Sweden, for their inspiring opening remarks and for joining us today. Both Excellencies have pressing commitments elsewhere, and while they will shortly have to leave us, we are deeply grateful for their presence and leadership. We certainly miss having them with us for the remaining of the today's discussions. Please join me thanking them again. Now we can hand over the mic to Farida Yasmin, the Minister here at the Permanent Mission of Bangladesh in New York.

Thank you very much, Dr. Ziauddin Haider, Honorable Advisor on Health Affairs to the Prime Minister, for conducting the opening session and setting the stage so effectively for today's discussion. As we now move to the next segment of our program, it is my great honor to invite Dr. Zubaida Rahman, cardiologist and Vice President, Ziaur Rahman Foundation, to kindly join us and take her seat on the podium. Now, it is my great pleasure to invite Dr. Ziauddin Haider to deliver his presentation. Dr. Haider will share Bangladesh experience and perspectives on strengthening primary health care through the integration and scale-up of professional midwifery services. You have the floor, sir.

Thank you. Excellencies, distinguished ministers, colleagues, and friends. I'll briefly share how Bangladesh is gradually moving from commitment to action by placing professional midwives within a stronger, integrated, and people-centered primary health care system. Next slide. Redesigning primary health care through midwifery-led care. Our starting point is a fundamental shift in philosophy. from a predominantly curative model toward a prevention-focused health system. First, we are making progress, increase in our national investment in health. Second, strengthening the frontline workforce, including the phased recruitment of 100,000 community health and wellbeing workers, with 80% of positions intended for women. and 25,000 midwives. And third, creating a digital ecosystem that connects citizens and providers across different level of care, including through electronic health cards. These are not separate initiatives. Together, they form the architecture of a new primary health care system for Bangladesh. Next slide. This slide captures one of our most important health system challenge. Bangladesh already has multiple frontline gather delivering different services, but they are often operate under different mandates, different supervisory structure, and different service arrangements. The result is fragmentation and weak continuity of care. So the challenge is not simply how many health workers we have, it is how they are organized, connected, supervised, and held accountable for results. Next slide. This diagram illustrates the direction in which we want to move. At the community level, Health and well-being hubs would serve as the entry point into an organized referral pathway. These hubs would connect with primary healthcare facilities, which in turn connect systematically with district and sub-district hospitals, and when necessary, medical colleges and specialized hospitals. The important point is that the patient should no longer have have to navigate the health system alone. We want a system where primary health care coordinates the patient's journey with clear referral pathways, continuity of information, and accountability across levels of care. Next slide. Midwives at the heart of primary health care. This is really the heart of our proposition. We envision the professional midwife as a trusted and continuous point of contact for women throughout the maternal journey, not simply someone who attend a delivery. Before pregnancy, midwives can support reproductive health, family planning, and preconception care. During pregnancy, they can track women, provide antenatal care, identify risks, and provide health education. During childbirth, they can support normal physiological birth and respectful maternity care while recognizing complications early. And after childbirth, they remain connected to the mother and newborn through postnatal care, breastfeeding support, newborn care, and family planning. Next slide. Why should government invest in professional midwives? Because in case of both clinical and economic, the evidence summarized here indicates substantial returns for investment in quality midwifery through lives saved, complications prevented, and more efficient use of health resources. Next slide. This slide tells us important story of progress in Bangladesh. Bangladesh began its three-year diploma in midwifery program in 2013. Since then, we have progressively developed the institutional architecture professional midwifery from establishing posts and standard operating procedure to strengthening regulation through the Nursing and Midwifery Council Act and deploying professional midwives across upazila health complexes and union sub-centers. Our next phase must be about scale and institutionalization. This is where Bangladesh, Sweden, UNFPA partnership has particular significance. The ultimate measure of successful development cooperation is not indefinite dependence on external assistance. It is when partnership helps create national capacity that becomes embedded within a permanent domestically financed health system. Next slide. Midwife-led primary health care advances three goals simultaneously. First, access. It brings pregnancy tracking, antenatal care, postnatal care, and early risk identification closer to women and communities. Second, financial protection, appropriate care at the primary level can reduce unnecessary interventions and dependence on costly private services, and therefore help reduce out-of-pocket expenditure, which is very high in Bangladesh. And third, value-based care, providing the right care at the right place at the right time. That is why our message is that midwifery is not an add-on to the primary health care. Integrating midwife is part of how we redesign primary health care in Bangladesh. Next slide. Our ambition can be expressed very simply. Every woman should have access to a skilled midwife as part of our primary health care team, close to where she lives. This is ultimately what this reform is all about. Our experience is still evolving. We have much to learn, including from our distinguished ministers and countries represented here today. But Bangladesh is committed to moving from pilots to scale, from fragmented service to integration, from development partner-supported initiatives towards sustainable national ownership, and above all, from commitment to action. Thank you, everyone, for passion sharing.

Thank you, Dr. Haider, for your insightful presentation. Excellencies, distinguished delegates, and colleagues, we now move to our ministerial panel, a new era of health workforce scaling. The evidence for investing in professional midwifery is compelling. Yet, the challenge before us is no longer simply making the case for midwifery. It is about achieving scale, institutionalization, sustainable domestic financing, and effective integration within primary health care. We are privileged to have distinguished ministerial representatives from Sierra Leone, Slovenia, Thailand, and Mexico, bringing experience from diverse health systems and country context. To lead this important conversation, it is my honor to invite Dr. Ziauddin Haider, Special Assistant to the Prime Minister of Bangladesh on Health Affairs, to moderate the panel discussion. Dr. Haider, the floor is yours.

Thank you, Farida. Distinguished panelists and excellencies, please limit interventions to three to four minutes to ensure full cross-regional dialogue. I think we are missing two countries. Honorable Minister from Sierra Leone, I think he's yet to come. And also, honorable Minister from Thailand is yet to come. Perhaps I can start with His Excellency, Dr. Tadej Strejc, the Minister of Health in Slovenia. Dr. Strejc is a specialist clinician and public policy expert. appointed Minister of Health in June 2026 after serving as a state secretary responsible for health management. Your Excellency, in Slovenia, primary care structure, primary care obstetricians and gynecologists serve as the entry point, while midwives are integrated into municipal health centers for outpatient and postnatal care. What governance lessons can other nations draw from your model regarding multidisciplinary coordination between doctors and community midwives?

Thank you very much for the word. Excellencies, distinguished colleagues, let me thank the governments of Bangladesh and Sweden, together with the UNFPA, for bringing us together around this important issue, around this important topic. Well, Slovenia has a well-established tradition of accessible maternal and child health care, grounded in universal access to preventive services and a strong primary health care system. In 2024, 91% of pregnant women had a first antenatal checkup within the first 12 weeks of pregnancy. We approach maternal and newborn health as a continuum, extending from pregnancy and childbirth through the postpartum period and early parenthood. Midwives play an essential role throughout this pathway. Beyond attending births, They provide health promotion and counseling, support healthy pregnancy and physiological childbirth, promote breastfeeding, recognize risks and complications at an early stage, and ensure timely referral when specialist care is required. Let me briefly highlight six key lessons from Slovenia's experience, drawing on examples of good practice. Firstly, successful coordination starts with clearly defined responsibilities across the continuum of care. Women in Slovenia can choose their own gynecologists within primary health care and preventive reproductive health services cover pregnancy, childbirth and the postpartum period. Midwives already contribute the antenatal education, maternity care and breastfeeding support. And at the same time, it is important to clarify that postnatal home visiting is currently provided largely through our community nursing service, known in Slovenia as patronage nursing, rather than through a nationwide community midwifery model. This distinction is important because it shows both where our system is strong and where integration can still be improved. Secondly, National programs and common standards help different professionals work as one system. With Slovenia's national preventive program, Health Today for Tomorrow, managed by the National Institute of Public Health, we implement the nationally standardized preparation for childbirth and parenthood program. It consists of seven structured sessions covering pregnancy, childbirth, the postpartum period, breastfeeding, newborn care, and the transition to parenthood. The third point I would like to stress is the importance of strengthening professional autonomy and competencies. Professional autonomy and multidisciplinary cooperation need to develop together. Slovenia has a strategy for healthcare workforce management and development 2026 to 2036, who provides a clear direction from further development of midwifery. It explicitly foresees a stronger role for midwives. The aim of this measure is to ensure that the greater professional autonomy is accompanied with appropriate competencies, clear professional standards and reliable mechanisms for quality and safety. The fourth key lesson is the long-term development of midwives and specializations. As part of this long-term approach, to the development of the midwifery profession and the continuous advancement of midwives' competencies, the strategy also recognized the potential for development of specializations in midwifery. As the fifth point of this success story, let me highlight the universal health coverage, public health and outcomes. Slovenia's experience also shows why this coordinated approach matters in practice. We have universal health coverage supported by a strong primary health care and a long-standing focus on prevention and public health provides the foundation for continuous care for women, newborns, and families. Together, these features of our health system contribute to very good health outcomes. In 2025, infant mortality in Slovenia was 2.1 deaths per 1,000 live births and it remained below 3 per 1,000 live births for the past 18 years. Such outcomes are the result of the health system as a whole. Midwives work alongside gynecologists, pediatricians, nurses, community nursing services, and other health professionals across the continuum of care. For Slovenia, this underlines an important lesson. Good outcomes depend not only on the expertise of individual professions, but also how effectively they work together in accessible, prevention-oriented and well-coordinated teams and within the health system as a whole. Finally, for Slovenia, the key policy lesson is to build one coordinated system rather than the parallel pathways. The long-term direction is therefore not simply to expand the role of one professional group, but to strengthen cooperation across the whole health system. It is also important to ensure that each professional can contribute in line with their competencies, supported by clear standards and effective coordination. Let me conclude. Our aim is to strengthen midwifery as an integral part of coordinated care, supported by clear professional standards, multidisciplinary cooperation, and safe referral pathways. By investing in education, competencies, and appropriate workforce development, we can ensure that midwives are well-prepared to take on an increasingly important role in primary health care. In this way, midwives can contribute both to preventing avoidable maternal and newborn deaths and to build stronger and more resilient health systems. Thank you very much for your attention.

Thank you, Excellency, Dr. Tadej Ostric, for sharing your insights and experience from Slovenia. Now, our next panel discussion is His Excellency, Dr. Rafael Valdez Vasquez, Vice Minister of Health Policy and Public Welfare in Mexico. Dr. Valdez is an infectious disease specialist and public health official who formerly led CANPRESS and directed national public health emergency response. Your Excellency, Mexico utilizes community-based innovators like maternal health houses to bridge rural indigenous communities with primary health centers. How have these midwife-staffed facilities helped overcome cultural and economic barriers, and what lessons does this offer for global health equity? Thank you. Thank you.

Dr. Hayre, excellencies, distinguished ministers, colleagues, dear friends for UNFPA, let me start with the question behind this panel. What is a commitment worth if there is no past behind it? No job description, no salary scale, no budget line that survives the next fiscal cycle. For too long, my wife already has lived in the space between applause and payroll, and Mexico has decided to close the gap. New research commissioned by the International Confederation of Midwife tell us the world is missing nearly 1 million midwife, and in the Americas, the sort of succeeds 80% of what our population need. Yet, in many countries, midwives are trained but not absorbed into the workforce or not enabled to practice fully. That bottleneck is ours as government to open. UNFPA, WHO and ICM have already built the evidence and the guidance. And at a time when international financing for health is contracting, the only posts that will last are the ones that live inside our own national budgets. Between 2002 and 2024, Mexico's maternal mortality ratio fell from 54.6 to 34.7 per 100,000 live births, well below the global SDG threshold of 70. But 21 of our 32 states remain about 30, the target the region set for 2030. One in six maternal deaths happens outside the health facility. Cesareans have reached 40% in Ministry of Health facilities. And fewer than one in every 100 births is attended by midwife. For us, Midwifery is not a cultural gesture. It's essential to preventing the deaths we still have. First, we made midwife visible to the state because no government can create a path for a profession the law does not see. In 24 months, we recognized midwifery in our constitution, performing the general health law, brought a new official Mexican standard into force and install a national midwifery committee convened by the Secretary of Health. Second, we are creating the post. Our National Midwifery Strategy 2026-2030 sets the goal of 5,161 standardized midwifery posts and midwifery profiles are being incorporated into the Ministry of Health official job catalogue and a salary scale. A midwife with a code in the catalogue is no longer a project. She is part of the permanent structure of the health system. By 2030, we aim to graduate 600 new midwife expand labor delivery recovery rooms from 98 to 397 and have one in four births attended by a midwife. I will be candid. Today we have identified 231 professional midwife. The gap is not a political will, is a training pipeline, and that is where we must invest. Third, we found it with evidence. Modeling published in the Lancet Global Health estimates that universal coverage of midwife-delivered interventions could avert around two-thirds of maternal deaths, newborn deaths, and stillbirths. In a system with 40% cesareans, midwifery models of care are not added cost. They are an invest in efficiency. And with UNFPA, we are building a municipal prioritization index so that every new post goes first where it can save the most lives. Fourth, we protect. More than 9,000 traditional midwives are voluntarily registered in our national midwifery registry. They are not substitute of for professional midwives. They are valued partners who connect women and communities with skilled care. Protection also means clinical safety, including obstetric emergency training developed by UNFPA. And it means counting. Our information system now records the midwife who attends each birth, because what we do not measure, we cannot defend in a budget negotiation. Allow me to close with three proposals. Measure absorption, not just training. Treat my wife imposed as a protected health infrastructure and strengthen South-South cooperation, which Mexico is ready to offer, including through our 2026-2030 framework agreement with UNFPA. From commitment to action, in Mexico, that action has a name, a job code, and a budget line. Thank you. Thank you very much.

Excellencies, guests, ladies and gentlemen, now we'll listen from Nepal, Nepal's representative from the Ministry of Foreign Affairs. Nepal's primary healthcare model connects local birthing centers with over 50,000 female community health volunteers. As your government skills up professional midwifery qualifications to international standards, How are you ensuring that professional midwives and frontline community volunteers work seamlessly together without displacing local trust? Over to you.

Thank you, dear moderator, excellencies, distinguished delegates. It's a pleasure to join this important discussion today. I thank Bangladesh and Sweden, together with UNFPA, for convening us together. This may appear to be a specialized health discussion, but ending maternal and newborn deaths is not for health ministries alone. It's a matter of national political commitment, public investment, capable institutions, and international cooperation. That is why 2030 Agenda placed maternal and newborn health at the heart of our shared development goals. And the Pact for the Future renewed our resolve to build resilient, equitable health systems. The task remains urgent. Globally, around 260,000 women died from pregnancy and childbirth-related causes in 2023, and 2.3 million newborns died in their first month of life in 2024. In Nepal alone, 622 mothers died from pregnancy and childbirth-related causes in the year before our 2021 national census, and more than 12,000 newborns die every year before reaching one month of age. Midwives are central to changing this reality. Evidence shows that educated, licensed, and well-supported midwives can deliver around 90% of essential maternal and newborn health services. Nepal's experience shows that sustained investment can achieve. Since 1996, our maternal mortality has fallen by more than 70%. and institutional deliveries have risen sharply, even in our mountainous terrain and dispersed settlements. However, that progress has slowed in recent years. Our maternal and newborn mortality rates are not declining as rapidly. This is a matter of urgency. Our public health colleagues tell me that expanding access alone is no longer enough. We now need deeper investment in the quality of frontline care and in the skilled health workers, including midwives who deliver it. Nepal also trains health professionals who go on to serve communities abroad. This gives us a direct track in ensuring that global health worker migration is fair, ethical, and mutually beneficial, in line with WHO Global Code of Practice on the International Recruitment of Health Personnel. Excellencies, let me offer three commitments from Nepal. First, sustained investment in our health workforce, including midwives, as a foundation of national development. Second, stronger pathways from education to deployment, retention, and literacy for midwives. Third, active partnership with the international community on ethical health workforce mobility and on extending the quality of care that will determine whether these hard-won gains continue. As you look ahead to 2027 high level meeting on universal health coverage, Nepal remains committed to this agenda through national ownership, domestic investment and genuine international partnership. Let me conclude by expressing our aspiration, which is very simple, that every mother gives birth safely, every newborn is given a healthy start and quality health care reaches every community. Thank you for this opportunity.

Thank you, Excellency. Now, the next we have is Excellency, Mr. Patanapong Patt, the Minister of Public Health from Thailand. Mr. Patt has spearheaded major public health initiatives, including domestic vaccine production capacity and international health diplomacy. since taking office in late 2025. Your Excellency, Thailand has achieved skilled birth attendance rates exceeding 97% nationwide through a unified model where registered nurses complete dual licensing in nursing and midwifery. How does this integrated workforce model strengthen primary care delivery, and what advice would you offer? to countries seeking to streamline their health cadres. Over to you, Excellency.

Excellency, distinguished panels and participants, it is a great honor to address you today on behalf of the Royal Thai Government, Thailand. Highly value this opportunity to share our experience and perspective on strengthening the health workforce, particularly within primary healthcare. to improve maternal and newborn health and help end preventable maternal and newborn death through inclusive health system and community-based support. Today, Thailand's maternal mortality ratio is estimated between 28 and 34 deaths per 100,000 live births, remaining below the SDG goal target of fewer than 70 deaths per 100,000 live births. This progress reflect Thailand's sustainable commit, sustained commitment to improving maternal health and ensuring equitable access to quality health services. As countries work to advance universal health coverage and response to changing demographic needs, we are reminded that the health system depend on fundamentally on the people who deliver care infrastructures technology and financings are essential, but their impact ultimately depends on the competent, well-supported and equitably distributed health workforce. Thailand's progress is underpinned by five key factors. First, Thailand has a strong public healthcare network and universal health coverage, a nationwide network of more than 9,000 primary care facilities and hospital across all 77 provinces help ensure broad geographically access to essential health services. Under Thailand's universal health coverage scheme, comprehensive antenatal, childbirth, and postnatal services are covered, helping to reduce financial barriers for mother and their families. Second, Thailand's promote high standard of care for hospital birth through national clinical safety guidelines. These guidelines support the attendance of skilled health professionals, including doctors, nurses, and midwives, to safeguard the health and well-being of both mother and newborns. Third, Thailand continues to strengthen health workforce capacity through a nationwide network of nursing education institute that prepares thousands of qualified nurses. and midwifery each year. Our integrated education and competency-based training system supports flexible workforce planning while maintaining essential maternal and midwifery services. Advanced practice nurses also play an important role in the primary care unit and nurse-led clinics under Thailand's national health security system. providing home-based care and mobile outreach services to mother, infants, and vulnerable populations. Fourth, sustainable financings and institutional support are essential to achieving an equitable distribution of the health workforce. National health financing mechanisms, public sector incentives for personnel serving an underserved rural area, and well-defined career pathway all contribute to a long-term health system resilient. At the same time, we recognize that the fair remuneration, heavy workloads, and workforce shortage remain significant challenges. Our doctors, nurses, midwives, and other health professionals continue to serve with dedication while we pursue sustainable solution to support and retain the health workforce. Fifth, community and family engagement are integral to safe motherhood, which requires a whole of society approach. Partner families and more than 1 million trained village health volunteers serve communities across Thailand. Nurses work alongside these volunteers as case managers to provide health education, identify early warning signs during pregnancy and the postpartum period. and facilitate timely referrals to hospital. Together, they help create a seamless continuum of care from the home and community to health facilities. Looking ahead, Thailand prioritise three key areas: developing a flexible, multi-skilled health workforce that can respond to evolving demographic needs; strengthening community partnerships; with health volunteers to support early detection and timely referrals, and securing sustainable domestic financings, complemented by international cooperation to advance long-term capacity building and innovation. Through South-South and triangular cooperation, and in close partnership with UNFPA, Thailand actively engaged in technical exchanges and capacity building initiatives in midwifery and maternal health with partner countries, including Lao PDR, Timor-Leste, Vietnam, Nepal, Bhutan, Indonesia, and the Philippines. We stand ready to deepen these partnerships and further share Thailand's experience and expertise through this cooperative framework. Finally, Thailand remains firmly committed to expanding this knowledge exchange and work alongside member states, international organizations, and development partners to build a health workforce that is equitable, resilient, responsive, and fit for the future. Together, we can advance towards our shared goal of ending preventable maternal and newborn death worldwide. Thank you.

Thank you, Excellency, Mr. Prampet. Hopefully, will be able to build a multilateral partnership, maybe a platform for us to have more South-South collaboration and learn from each other. With this, I would like to conclude the ministerial panel discussion and for a few question and answer session and for the remaining session, let me hand it over to Ms. Farideh Aspin.

Thank you, Dr. Haider. Before beginning the opening discussion segment, I would like to kindly request all speakers to limit their interventions to two to three minutes to ensure that we can hear from everyone. Now, I would like to give the floor to Ms. Kemi Williams, Head of Women and Girls Department, Foreign, Commonwealth and Development Office, United Kingdom. Madam, you have the floor.

Thank you and good afternoon, everybody, Excellencies, colleagues, midwives, and friends, I'd like to thank the governments of Bangladesh, Sweden, the EDF, UNFPA for convening this really important discussion. It's a real privilege to join so many committed partners here today. On this, I know we are united. Around the world, far too many women and newborns continue to die, and they are dying from causes we know how to prevent. These deaths are not inevitable. We have the know-how, the evidence, and the tools to save lives. and one of the most effective investments we can make is in midwifery. I have to admit a personal bias, my mother is a midwife. Educated and regulated midwives can deliver up to 90% of essential sexual reproductive, maternal, newborn, and adolescent health services, including family planning, enabling women to make informed choices about their health and futures. When integrated into primary healthcare systems, they bring quality healthcare closer to communities, reach those most left behind, and build more resilient systems. Yet midwives make up just a fraction of the global healthcare workforce. With universal coverage of midwife-delivered interventions, we can prevent around two-thirds of maternal deaths and newborn deaths, saving an estimated 3.4 million lives by 2035. With quality care before, during and after pregnancy, more women would complete their education, take up better economic opportunities and fulfil their potential. But we must not make the mistake of viewing this as only about improving health and development outcomes. This is also about rights. It's about advancing gender equality and it's about dignity. And it is about ensuring that every woman has access to safe, respectful care throughout pregnancy, childhood, and beyond. This is why today's focus on integrating midwifery into primary healthcare is so important. We have seen what is possible when governments make midwifery a national priority. And Bangladesh's success in establishing a respected, professionalized midwifery service demonstrates the power of national leadership, long-term investment, and strong partnership. Through the UK's strategic partnership with the government of Bangladesh, UNFPA, BRAC University, and professional bodies over the past decade, Bangladesh has developed more than 7,000 licensed midwives and strengthened national systems for midwifery education, regulation, and deployment. And today, Bangladesh's midwives provide care to the country's most underserved, including remote communities and Rohingya refugees and host communities. The results have been transformative. WHO recently recognized Bangladesh as achieving the SDG maternal mortality target ahead of schedule. This offers an inspiring example for countries seeking to strengthen their health workforce and accelerate progress towards universal health coverage. But no single country can achieve this agenda alone. We need sustained political commitment, we need domestic leadership, and we need continued partnership across governments, multilateral organizations, professional associations, and civil society. Because ultimately, this is not only about health systems. It's about a woman surviving childbirth. It's about a baby getting the chance to celebrate a first birthday. And it's about ensuring that every family everywhere can look to the future with hope. I thank you.

Thank you, Ms. Kemi Williams. Our next speaker is Dr. Ariani Dewi Widodo, Director of Human Resources, Education and Research at Harapan Kita Women and Children Hospital, Indonesia. Madam, you have the floor.

Thank you. Excellencies, distinguished colleagues, ladies and gentlemen, first allow us to congratulate the government of Bangladesh, Sweden, UNFPA, and all countries that have demonstrated what strong investment in midwifery can achieve. Indonesia comes to this conversation with a particular challenge. We are a vast archipelago of more than 17,000 islands and 280 million people. In some of our most remote communities, reaching the next level of care can mean 12 hours by boat, small boat. So for us, the question is, how close can we bring the health system to every mother? Our answer has been to build an increasingly layered and interconnected primary healthcare system. Across Indonesia, we have more than 10,000 primary health care, and below them are health units at village level, and further into the community, more than 300,000 posyandu. It is a small office health supported by caters. And throughout the system, the midwife is crucial, because very often she is the beginning of this interconnected system. So Indonesia now has approximately 222,000 midwives within this primary care network. And we are really seeing progress. Between 2015 and 2025, Indonesia's maternal mortality ratio declined from 346 to 144 deaths per 100,000 live births. So it's more than... 50% decline. And the infant mortality also declined from 16.85 to 14.12 per 1,000 live births. Are these numbers low enough? Certainly not. But this is not a competition between countries. The competition is against ourselves. Can we do better tomorrow than we are doing today? And this is where midwives matter enormously. So we have four pillars for strengthening our midwifery system. First to deploy, bring the midwife closer to every mother. We embed midwives throughout a layered primary health care network. And under this integrated model, the village level unit is expected to have at least one midwife and one nurse or two midwives, because not all of our areas have doctors. And then number two is connect. Never leave the midwife working alone. What happens 30 minutes after they face a problem in remote areas? So the key reform is that integration of primary care. We connect her vertically from community to village to primary health care, referral care, and horizontally as well with doctors, nurses, and other health workers. And as of July 2026, we have 9,000 primary health care implemented this integrated program. Number three is empower. We strengthen competence, standards, and tools for them, and standardizing equipment, SOPs, and clinical capabilities across facilities. Number four is reach. When a mother does not come to us, our system must find its way to her. So the midwives go to the community and to the mothers who cannot come to the health centers. So today we celebrate midwives, but I hope we do more than praising them. Because if the midwives are expected to reach the last mile, then our health system must travel that last mile with them. Give them training, give them the tools, connect them to primary care, referral systems and hospitals. Never leave them alone with responsibility of saving two lives. Because perhaps the great recognition that we can give a midwife is not simply to call her essential, but to build a health system that treats her as they are essential. Thank you.

Thank you, Dr. Ariani, for your very inspiring remarks. Before giving the floor to our last speaker in the open discussion, I'd like to request again to kindly limit your intervention to two to three minutes to ensure that we are on time. Now, I have the pleasure to give the floor to Ms. Caroline Micklebast-Linde, Chief Executive Officer, Lordel Global Health. You have the floor, madam.

Thank you very much. Excellency, distinguished guests, colleagues and friends. Thank you so much for this occasion to express why strengthening midwifery is such a high priority for a private sector company like Laerdal. Laerdal has for the past 60 years worked on developing tools for ensuring that healthcare workers are trained, equipped, confident and competent. And I was very happy to see in the video earlier that our tools have found its way to the midwifery schools in Bangladesh. I would like to congratulate Bangladesh and all of the other countries here because investing in midwifery is one of the best investments that a country can do. I come from a country where we have a long midwifery tradition, Norway, and I know firsthand what that can mean for me, for my child, and for my family. For a midwife to do a good job, she needs to be confident and competent. A newborn not breathing or a mother bleeding should not be the first time a newly educated midwife gets to practice their skills. This is why midwifery education is so crucial, and this is why ensuring competency-based midwifery education is crucial. In LADAL, our mission is helping save life, with an emphasis on helping. And this is where partnership plays an imperative role. That's why we have for more than 15 years partnered with UNFPA, with ICM globally to ensure that countries has access to tools to train their health workforce. We've had the pleasure of working in Nepal together with partners when Nepal started their first midwifery education program. And we are so proud that this week we've signed an extension of that agreement so that for every maternal simulator that we sell in a high income country, we will give one to training midwives in the global south. And let me finish by bringing back the words of the honorable prime minister of Bangladesh. Every woman should have the access to a skilled, confident, competent and supported midwife everywhere.

Thank you.

Thank you, Ms. Carolyn, and thank you all for your impactful remarks. It is clear that by working together, we can collectively move closer to ensuring that midwifery is an integral part of primary healthcare in all countries around the world. It is now my distinct pleasure to introduce our speakers for the closing segment. I first invite Her Excellency, Dr. Zubaida Rahman, cardiologist and vice president of the Ziaur Rahman Foundation. A former civil service physician, Dr. Rahman actively advocates for universal health access and primary health care facility expansion across Bangladesh. Madam, you have the floor.

Excellencies, distinguished guests, ladies and gentlemen, good afternoon. As we come to the close of this important discussion, let me thank you all who have joined us today. I particularly thank the honorable health ministers and senior representatives from Slovenia, Mexico, Nepal, UK, Thailand, Indonesia, and other participating countries for sharing their experiences. Your presence reminds us that preventing maternal and newborn deaths is a shared global responsibility. I also thank the government of Sweden and UNFPA for partnering with us and all United Nations agencies, development partners, professional organizations, civil society, and the global health community who have contributed to today's dialogue. Our exchanges reinforce one clear message: professional midwives save lives. Our task now is to build health systems that enable them to do so effectively, equitably, and sustainably. For Bangladesh, this discussion comes at an important moment. We are redesigning our primary health care system around a simple principle, prevention is better than cure. Our vision of a healthy Bangladesh, Bangladesh, is to move from a treatment-centered system to one that emphasizes prevention, early identification, and continuity of care with services closer to people's homes. This reflects a long-standing commitment to putting people at the center of development. Shahid President Ziaur Rahman and Deshnetri, former Prime Minister Begum Khaleda Zia, emphasized reaching ordinary people, strengthening communities, and expanding access to essential services. We seek to carry that people-centered spirit forward through a modern health system built around prevention, dignity, and access. Women and children are at the center of this transformation. We are working towards an integrated primary healthcare network extending to rural unions and urban wards, supported by a stronger frontline workforce and digital health. Importantly, recruitment of 25,000 professional midwives has already begun. Our objective is not simply to increase their numbers. We want to integrate them into multidisciplinary primary health care teams and provide continuity of care from preconception and pregnancy through childbirth, postnatal and newborn care. The primary health care model presented today places midwives at the center of this maternal journey and moves our health system from fragmented services to an integrated and accountable platform. This platform will connect households and communities with primary facilities and, when necessary, with secondary, tertiary, and specialized care through a functioning referral system. midwife-led primary health care can advance three priorities for Bangladesh: better access, stronger financial protection, and better value in health care. It can bring essential care closer to women, reduce unnecessary interventions and out-of-pocket expenditure, and ensure respectful care at the right place and at the right time. Let me therefore draw the ambition that has guided our discussion. Every woman should have access to a skilled professional midwife as part of her primary healthcare team, close to where she lives. This is relevant not only to Bangladesh. The experiences shared today show the value of countries learning from one another while developing solutions suited to their own health systems. Bangladesh looks forward to continuing this exchange and working with governments, United Nations agencies, development partners, and the global health community to turn today's dialogue into practical action. On behalf of Bangladesh, I thank all the honorable ministers, distinguished delegates, and our partners and colleagues for joining us. Thank you all.

Thank you, Madam. Thank you for your very inspiring closing remarks. Distinguished guests, finally, I invite Dr. Diane Kaye, United Nations Under Secretary General and Executive Director of UNFPA. Dr. Kaye brings more than three decades of distinguished international diplomacy and governance dedicated to saving lives and protecting the rights of women and youth worldwide. You have the floor, Madam.

Thank you, Madam Chair. Excellency Dr. Zubaeda Rahman, First Lady, cardiologist, and vice president of the Rahman Foundation. My esteemed Dr. Haider, special assistant to the honorable prime minister of Bangladesh. Excellencies, ministers from Slovenia, Thailand, Mexico, Nepal, thank you so much for coming here. and distinguished guests, all protocol observes. In following the journey of a midwife, we see how strong health systems are built, from the heroic determination to reach a mother-to-be, no matter where she lives, to the comprehensive care delivered before and after a healthy newborn's cry. It is a journey that reminds us that primary health care is built on the front line, one dedicated, skilled, and supported midwife at a time. Ending preventable maternal death is not a technical challenge. It is a political choice that needs to be backed by smart investment in the health workforce. At the top of that list of political and economic priority, we need to see midwives. Make no mistake, the infrastructure needs to be there. The right equipment needs to be in place. Quality commodities need to be available, but if we are serious about ensuring that no woman dies while giving life, an educated, supported, and motivated midwifery workforce is the closest thing we have to a magic bullet. Midwives can deliver up to 90% of essential reproductive and maternal health care. Investing in in them, empowers a predominantly female workforce, and more broadly, can yield up to tenfold in socioeconomic returns. I applaud Bangladesh's landmark commitment to recruit and deploy 25,000 midwives. You lead the way. One more million midwives needed. Bravo to Bangladesh. That is political leadership and courage in action. And your presence here today, Your Excellency, Dr. Zubaida Rahman, cardiologist, Vice President of Foundation and First Lady, shows us that it comes from the very highest level. I also welcome the effort of Nepal, Sierra Leone, and other countries leading the way and joining the movement towards midwifery models of care. Allow me also to recognize the government of Mexico, muchisima gracias, Slovenia, Thailand for their important contribution and commitment. And few words to Sweden, a wavering champion of sexual reproductive health and right. We are at UNFPA ever grateful for your sustained commitment to midwifery. Thank you for your long standing support to UNFPA Maternal and Newborn Health Fund. and for the $6.2 million investment you made in 2026 to the midwifery accelerator to help close the global midwifery workforce gap. I welcome all partners coming on board and moving us forward. Distinguished partners, Excellencies, we have a roadmap and our path for progress is clear. First, let's commit to dedicate a national budget line for midwifery, aligning global funding behind national priority. Second, let's focus on educating all midwives to global standards, then deploying them where needs are greatest. We heard about the Indonesian islands. Third, let's empower them and recognize the leadership. Their insights need to be part of policy and financing discussion. This is how we save life and build resilience and thriving societies. Ending preventable maternal death is within our grasp. We have heard from so many high level representatives today. The political will is in this room and speaks volume. We have a shared ambition, zero preventable maternal death and newborn death. And midwives are the keystone to make it happen. Let's invest in them. Let's support them. Let's make them the backbone of primary care. I thank you.

Thank you, Madam Executive Director, for your very powerful remarks. Excellencies, distinguished guests and colleagues, thank you for your presence today and your commitment to scaling the global midwifery workforce. We have come to conclusion to our program, so the session is now officially closed. Thank you.