PURPOSE:
Despite decades of global evidence that midwifery improves outcomes and reduces costs, governments continue to undervalue and underfund midwives. This presentation uses a behavioral economics lens to examine why international midwifery remains politically and financially sidelined and offers strategies to reframe its value.

DISCUSSION:
Behavioral economics explains systemic inertia around midwifery investment through cognitive and institutional biases. For example,“status quo bias” favors physician-centered models, and “loss aversion” deters shifting power and budgets. Framing deeply matters: midwifery framed as “alternative” rather than essential weakens its policy standing. Fragmented professional identity and low visibility worsen disparities and create an “effort-reward imbalance,” a driver of burnout. Reimbursement may be delayed or absent, while midwives face limited scope and exclusion from decision-making. These dynamics reinforce “social identity bias,” casting midwives as peripheral rather than central.

EVIDENCE WHERE RELEVANT:
Reports from The Lancet Midwifery Series (2014), WHO (2016, 2021), UNFPA (2014, 2021), and ICM (2021, 2023) show that investing in midwives can lower maternal and newborn deaths, improve patient satisfaction, and reduce costs. This presentation applies behavioral concepts including “prospect theory,” “loss aversion,” and “present bias,” drawing on research by Kahneman, Thaler, OECD (2017), and World Bank (2015) to show how behavioral patterns stall investment even when evidence is strong.

KEY MESSAGE:
Data alone won’t create one million more midwives. Decision-makers must also be influenced emotionally and behaviorally. Policymakers may avoid investing in midwives not because of lack of data, but because midwifery is not the “default” in care models. By applying behavioral insights, we can reframe midwifery as essential and design advocacy aligned with real decision-making. This research offers a framework that advocates can use to shift narratives, influence policy and funding, and grow the midwifery workforce. Policy - strategy (including three-minute presentation competition)