Male Midwives? Lesotho’s High-Stakes Bet

Lesotho is betting on an unlikely ally to save mothers’ lives: male midwives.

Story Snapshot

Lesotho’s maternal deaths remain among the world’s highest at 478 per 100,000 live births.
Health leaders are adding male midwives to reach more mothers faster and earlier.
Tradition still frames birth as women’s work, which can fuel patient hesitation.
Policy fights are about workforce gaps and access, not gender alone.

Maternal Mortality Stays High Despite Skilled Attendance

Lesotho ended 2023 with an estimated maternal mortality ratio of 478 deaths per 100,000 live births, with about 267 maternal deaths that year, according to the World Health Organization. That level remains far above global targets and the world average. Researchers note that most births in Lesotho already have a skilled attendant, yet deaths still run high. That tension points to weak referral systems, delayed care, transport barriers, and thin staffing in rural areas, more than a single factor like provider gender.

Policy teams in Maseru have responded by widening the front line of care. The World Health Organization and partners backed national training and quality tools to cut preventable maternal and newborn deaths. The move focuses on faster triage, cleaner handoffs, and reliable emergency response. Leaders see this as a whole-system task: more eyes, more hands, and earlier action in every clinic and district hospital, especially before crises need operating rooms or blood banks.

Why Male Midwives Are Entering Delivery Rooms

Lesotho faces the same math as many countries: too few midwives, too many emergencies, and long distances for mothers. Global analyses report a shortage of about 900,000 midwives, with the gap worst in low-income countries and across Africa. When lives depend on speed, expanding the pool of trained professionals is common sense. Bringing men into midwifery opens one more pipeline for skills, especially in remote posts that struggle to recruit and keep staff.

Evidence from international reviews says male midwives contribute to reducing maternal deaths when integrated and supported. The key is not who holds the hand, but who holds the skills—and whether backup is close, supplies are stocked, and transport is ready. Countries that align midwife training with referral networks see fewer fatal delays. Lesotho’s strategy mirrors that playbook: train, deploy, and connect every provider to a working chain of care.

Culture Clashes With Urgent Need

Some women in Lesotho prefer female midwives. The Associated Press reported that midwifery has long been seen as women’s work there, and that men in such intimate roles can make some patients uneasy. A government story acknowledged that nursing began as a female-only profession and remains female-dominated, with men still a minority in midwifery roles. Those views deserve respect and practical answers, like offering choice when possible and ensuring privacy and consent at every step.

In Lesotho, about 300 male midwives are challenging gender norms as they help tackle one of the world’s highest maternal death rates. Some women still prefer female staff, but others say the quality of care matters more than gender.

Al Jazeera’s Cara Legg reports. pic.twitter.com/7dMU452e73

— Al Jazeera English (@AJEnglish) September 1, 2026

Regional research shows stronger objections in some communities, where male assistance in labor conflicts with norms. A scoping review recorded cases in which most men opposed male midwives, citing tradition and modesty concerns. These concerns are sincere, but they coexist with a stubborn death toll. When a hemorrhage starts, families want the fastest path to skilled hands and blood. That is where values like personal responsibility, community trust, and family protection favor a bigger, better-trained team.

What Works: Choice, Competence, and Clear Chains of Care

Lesotho can square culture with safety by setting three standards. First, choice whenever staffing allows: honor requests for a female midwife, and make chaperones easy to ask for. Second, competence proven by skills drills and audits, not by gender. Third, clear chains of care: if a clinic cannot stabilize eclampsia or manage obstructed labor, the referral must be automatic and fast. These steps match common sense and uphold dignity while saving time and lives.

Leaders should keep one line bright and firm: let qualified midwives serve, male or female, and judge them by outcomes. Parents and grandparents carry the memory of mothers lost on long roads to care. They do not ask who started the IV. They ask why help took so long. Lesotho’s push to widen its midwifery ranks confronts that delay head-on—and that is the standard any serious plan must meet.