Dubbed the “heroes in pink,” Souksavanh Paserthsak has witnessed first-hand how midwives have evolved to save lives and support rights in Laos.
As deputy director of the Health Science College in central Khammouane Province, Paserthsak is proud to have played a part in the evolution of professional midwifery during her nearly 35-year career.
“We have made so much progress. When I started, most people didn’t know what midwives were—they thought we were nurses. Now, when our students intern in communities, people recognize their pink uniforms and marvel at the critical work they do,” said Paserthsak.
Paserthsak’s contributions are part of a long legacy of Laotian women who have shaped the country’s 100-year journey in developing the midwifery profession.
This list includes Madame Soikeo Sibounheuang, considered one of the doyens of midwifery in Laos. Known as the “second mother of midwives,” she is credited with helping to give birth to the country’s midwifery profession during a 34-year career at Mahosot Hospital until her retirement in 1999, while also teaching medical students at university.
First studying midwifery in 1960 at Touyou School in the southern Vietnamese city of Saigon, Soikeo gave an interview in 2014 before her passing said: “my decision to learn midwifery was driven by my deep passion for supporting women and was influenced by Madame Maniso, considered the first midwife of Laos. When my father asked me what I wanted to study, I told him I wanted to be like her.”
Soikeo studied in Vietnam and Cambodia before returning to lead the profession in her homeland at Mahosot Hospital.
Like Soikeo, Paserthsak remembers a time when maternal mortality was alarmingly high. In the early 1990s, Laos had one of the highest maternal mortality ratios (MMR) in Southeast Asia. Having first worked at Khammouane province’s hospital in the early 1990s, “there was a lot of work to do to reduce the maternal death rate. By 2005, the shortage of trained midwives had contributed to the region’s highest maternal mortality ratio (MMR),” said Paserthsak.
Great strides have since been taken towards protecting the lives of Lao mothers during pregnancy and childbirth. Between 2000 and 2020, the country’s maternal mortality ratio fell from 579 to 126 deaths per 100,000 live births, according to the World Bank, – one of the largest percentage reductions in the world.
Similarly, downward trends in both neonatal and infant mortality have been witnessed to sit at 12 and 25 deaths per 1,000 live births (LSIS III 2023), respectively, in 2023 compared to 32 and 68 deaths per 1,000 live births in 2012.
Paserthsak is quick to highlight the key factor behind this dramatic turnaround: the revival and professionalization of midwifery in Laos.
The country’s midwifery journey has a long history, beginning in 1924 with the introduction of the first lower diploma in midwifery. However, this progress stalled for decades. Midwifery training was discontinued for 23 years from 1990 until 2010 due to insufficient funding, leaving just 100 midwives in the country by 2008. This critical shortage significantly contributed to the country’s alarmingly high maternal mortality ratio (MMR) at the time.
Recognizing the urgency of the situation, UNFPA and the Lao Government partnered with Luxembourg and the Thai International Cooperation Agency (TICA) to revive the midwifery program in 2009.
This effort was further supported by the launch of the Skilled Birth Attendance Development Plan in 2008, which aimed to strengthen the health sector’s capacity to provide culturally appropriate and nationally accessible services for pregnancy, childbirth, and postnatal care.
Key interventions included re-establishing midwifery training programs, capacity building for health providers, scholarships for ethnic midwives, and investments in outreach initiatives. These comprehensive efforts laid the foundation for a national commitment to rebuilding midwifery and improving maternal and newborn health outcomes across the country.
Since 2010, role models like Paserthsak have trained more than 3,000 midwives and 91 midwifery students, including 21 from ethnic communities receiving scholarships from UNFPA to successfully complete their midwifery training. Upon graduation, these midwives return to their villages to deliver essential Maternal Health services, contributing to health system strengthening at the community level and addressing gaps in access to quality care.
“We have also strengthened our students’ capacity to work in provincial and central hospitals. Our midwives can also provide training courses to students in various disciplines at community hospitals and village clinics, as well as various services such as counseling and family training and how to use the contraceptive tools,” said Paserthsak.
To further professionalize midwifery in the country, the Lao Association of Midwives was officially launched in 2022 as an advocacy and oversight agency, now also an implementing partner of UNFPA.
Symbolizing the rebirth of the midwifery profession in Laos, in 2023 three colleges graduating 200 students every year became the first in the Asia-Pacific region to receive international accreditation from the International Confederation of Midwives with support from UNFPA.
“I can’t wait to graduate and become a practicing midwife. I am passionate about deliveries and I love babies a lot,” said 22-year-old midwifery student Aspy Kamsing, currently training at Xieng Khouang Health Sciences College, one of the three accredited colleges in Laos.
While progress has been significant, there is still much work to be done.
In many remote and rural areas, the shortage of trained health providers continues to endanger the lives of women and girls due to complications from pregnancy and childbirth. Midwives play a critical role in saving lives—not just through essential sexual and reproductive health interventions, but also by providing comprehensive support to their patients.
They are there every step of the way, offering antenatal care, ensuring safe deliveries, providing postpartum support, assisting with family planning decisions, and empowering women and girls to exercise their rights and make informed choices. This life-changing guidance reduces the risk of preventable maternal deaths, enabling women to live healthier lives and thrive with their families and loved ones.
This challenge is not unique to Laos but reflects a global trend. Around the world, the demand for midwives far exceeds the supply. UNFPA estimates a global shortage of nearly one million midwives, underscoring the critical need for continued investment in this profession.
In response, UNFPA remains steadfast in its commitment to advancing midwifery in Laos, as it does in more than 125 countries worldwide. Efforts focus on strengthening quality education, establishing robust regulations and workforce policies, and fostering strong national midwifery associations to advocate for and support the profession.
Building on this foundation, the upcoming Lao Midwifery Strategy aligns with the UNFPA Global Midwifery Strategy 2018-2030, which is structured around six core pillars. These include recognizing midwifery as an essential component of achieving universal access to sexual and reproductive health care.
To sustain and build on the progress made, all stakeholders must deepen their commitment. This means securing adequate funding, creating more midwifery positions, and ensuring adherence to rigorous training requirements for continued accreditation.
“We must keep going. Every midwife needs the skills and knowledge to support communities and save lives. Together, let’s aim to bring the maternal death rate down to zero,” urged Souksavanh Paserthsak, encapsulating the urgency and hope driving this vital work.