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Gila Zarbiv
Advancing Women's Health, One Policy at a Time

The Hidden Key to Transforming Women’s Health in Israel

Israel has earned its reputation as a global leader in innovation, from life-saving medical technologies to groundbreaking research. Yet when it comes to access to maternal health services, Israel falls behind. Despite having the highest fertility rate among OECD countries, Israel struggles to provide accessible care for its women. Long wait times for gynecological and maternal healthcare are the norm. Women in the periphery can wait months for appointments, while even in central Israel, delays can stretch into weeks. Research shows that many, especially in religious communities, prefer female physicians. This creates a bottleneck so severe that some kupot cholim (Israel’s healthcare insurance system) have reportedly offered over 1,000 shekels an hour to attract female OB-GYNs. This is not merely an inconvenience; it is a national crisis with far-reaching consequences for women, families, and Israel’s medical infrastructure.

Perhaps most astounding of all is that the solution already exists. It is evidence-based, cost-effective, and deeply embedded in Israel’s healthcare system: midwives.

Midwives are independent, autonomous, and highly trained healthcare professionals. According to the World Health Organization (WHO), midwives are equipped to meet 90 percent of women’s healthcare needs. The WHO recently issued a policy brief urging nations worldwide to implement midwifery models of care, recognizing their ability to transform maternal health systems and save lives.

Globally, the evidence is overwhelming. A landmark study in The Lancet found that universal access to midwives could save 4.3 million lives annually by 2035. Midwifery-led continuity of care, a model where the midwife serves as the lead medical professional responsible for planning, organizing, and delivering care throughout pregnancy, birth, and the postnatal period, has been shown to reduce unnecessary interventions, lower cesarean section rates, increase vaginal births and breastfeeding rates, reduce patient anxiety, and improve access to care, among other benefits. While midwives collaborate with other healthcare professionals when necessary, they retain primary responsibility for assessing needs, diagnosing, treating, admitting, discharging, referring, prescribing, and ensuring access to maternity services. Although traditionally focused on low-risk pregnancies, recent studies have demonstrated that midwifery-led care is equally invaluable for women with high-risk pregnancies as well.

Around the world, midwives are leaders in maternal and neonatal care, offering a wide range of services, including prenatal and postnatal care, family planning, routine gynecological exams, ultrasounds and imaging, medical and surgical abortion care, menopause management, and much more. Countries that fully integrate midwives into their healthcare systems consistently report healthier mothers and babies, safer births, and significantly lower costs. In short: midwives save lives.

Israel, however, continues to restrict midwives to a narrow scope of practice. Limiting midwives to labor and delivery wards wastes their potential and exacerbates inefficiencies in the healthcare network. By empowering midwives to practice to their full capacity as independent and autonomous healthcare professionals, Israel could revolutionize its maternal health system. Midwives could manage low-risk pregnancies, routine gynecological care, and family planning, enabling OB-GYNs to focus on high-risk and complex cases where their expertise is most needed. This reallocation would reduce wait times, alleviate pressure on overburdened physicians, and save the healthcare system millions of shekels annually.

But this is about more than logistics or economics. Midwifery-led care improves outcomes that truly matter. Midwives provide woman-centered care that ensures better outcomes for mothers and babies alike. In rural and underserved areas, where access to healthcare is often limited, midwives can be the difference between life and death.

As Israel and the rest of the world mark Maternal Health Awareness Day today, on January 23, it is time to ask difficult but essential questions. How can we claim to be a global leader in medical innovation while leaving our women behind? Why are we ignoring a proven, evidence-based solution that could transform care for mothers and babies?

The answer is clear: Israel must integrate midwifery-led care into its healthcare system. This begins with investing in midwifery education, removing outdated and non-evidence-based regulatory barriers, and empowering midwives to practice independently and autonomously. Insurance companies must embrace midwives as essential healthcare providers who can reduce costs while improving care. Most importantly, Israeli women must be empowered to make informed decisions about their healthcare, with access to care that respects their autonomy and their right to choose their providers. Anything less infringes on a woman’s basic right to choose and denies her access to the highest standard of care.

Israel is known for its innovation, resilience, and leadership. By embracing midwifery-led care, we can transform maternal health in Israel and set a global example of progress rooted in evidence-based policies. This is our opportunity to lead the world not just in birth rates, but in achieving meaningful maternal health outcomes. The health of our mothers, our babies, and our nation depends on it.

About the Author
Gila Zarbiv is a certified nurse midwife with a master’s in women’s health and a PhD candidate at Ben-Gurion University of the Negev, specializing in Global Health Systems Management and Implementation Science. A dedicated advocate for midwifery models of care, she has held leadership roles with the Israel Midwives Association and the International Confederation of Midwives. As a doctoral fellow at the Israel Implementation Science and Policy Engagement Centre (IS-PEC), her work bridges research and policy to transform maternal health systems globally.
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