Madrid, April 6 – The Community of Madrid’s primary care midwives are facing an unsustainable workload, with fewer than 300 professionals serving patient lists that can reach over 20,000 in health centers. This alarming situation, denounced by the SATSE nursing union in the region, is severely impacting women’s sexual and reproductive health services, a problem that has plagued the healthcare system for years.
Midwives Overwhelmed by Increasing Demands
As primary care tasks continue to expand, these professionals report being unable to cover all their responsibilities, despite their training. They are increasingly relegated to the reproductive sphere, struggling to provide the desired quality of care for other crucial areas such as lactation support, postpartum care, infertility, sex education, and the detection of gender-based violence.
SATSE emphasizes that the scarcity of these specialists limits the implementation of projects designed by the Ministry of Health. “Many workers believe that the regional government wants to eliminate the role of midwives in health centers,” the union states. Despite their limited numbers, midwives are indispensable for numerous screening programs in Primary Care, forming the core of these initiatives. “The lack of coverage during holidays, sick leave, or even a single day off means many women are left without necessary assistance, as consultations close or, at best, another colleague has to take on the additional workload,” SATSE reports.
Critical Role in Screening Programs Undermined
Midwives play a vital role in early detection programs for breast and cervical cancer, as well as the ‘Tarde Joven’ (Youth Afternoon) initiative, which provides information on sexual and reproductive health to young people aged 14 to 25. However, the union points out, “the policy of the Ministry of Health, and therefore of the government of Isabel Díaz Ayuso, is to limit the hiring of these professionals.” They explain that increasing the workforce directly affects the remuneration of existing midwives; if a new professional is hired, the salaries of their colleagues are reduced.
María Sanz, a primary care midwife, explains the financial disincentive: “What happens when they hire a new colleague in health centers so that instead of attending to 30,000 patients, we attend to 15,000? Well, the salary is reduced by between 180 and 250 euros because we are paid by assigned population.” The Ministry of Health states that this condition applies to all health center professionals who receive a rurality supplement.
Unmanageable Patient Loads and Long Waiting Lists
“Some midwives have more than 20,000 assigned patient cards, while doctors rarely reach 2,000,” the union highlights, expressing concern that “obstetrics and gynecology specialists are unwilling to work in the Madrid Health Service.” They denounce the high pressure, waiting lists that can extend up to two months, and a lack of salary benefits commensurate with the responsibility.
Sanz describes the system as perverse: “We have a huge population that we cannot attend to, they bring in a reinforcement person, and the waiting list goes down, but the care is still not good, and on top of that, the salary decreases.” They need more support but do not believe it should come with a pay cut. The Ministry of Health believes the union’s complaints do not reflect the reality “of the great professional consideration that the Community of Madrid grants to midwives or the very important role they play in the sexual health of women in the region’s primary care centers.”
According to the Ministry, since 2023, their care activity in this area has increased by 14%, as has their role in pregnancy and postpartum follow-up. They assure that the early detection screening programs involving these professionals are not at risk. “The Ministry of Health itself recognizes that the Community of Madrid is above the Spanish average in terms of the number of midwives in the public health system,” they argue.
Government Initiatives and Continued Shortages
The Ministry boasts of launching Obstetric Psychoprophylaxis Units with more midwife positions since 2023, in addition to reinstating their theoretical in-person training in 2025. The Minister of Health, Fátima Matute, told the media on Tuesday that the staff has increased by more than 100 workers since 2010, with 18 joining in the last year. As she did last Thursday with the nursing profession, she announced that midwives will also be designated as a shortage category to apply specific measures to continue filling positions, in addition to “the existing salary improvements.”
Sanz emphasizes that in the last quarter, births in the Community of Madrid have increased by 4% to 5%. If the population grows, so does their care pressure. “The patients we attend to are more complex, and we not only focus on pregnancy but also on newborns and menopause, where there is now a significant volume of women in that period,” she says, referring to the increase in life expectancy and population aging. She reports that she and her colleagues feel overwhelmed by the implementation of the cervical cancer prevention plan.
“It is not uncommon, then, for us to have to say ‘no’ to young people who report symptoms compatible with sexually transmitted diseases, as their follow-up would be impossible,” explains a midwife who prefers to remain anonymous. She states that she has over 14,000 assigned patient cards and appointments available only from mid-May. “In these cases, we refer them to other care resources to resolve the issue, although we should really be doing it ourselves,” she clarifies.
Professional Abandonment and Historical Context
The scheduled appointments and actions are difficult to manage in many health centers with the available staff. “We not only attend to women in a specific age range but also to breastfeeding children, parents in childbirth preparation workshops, or adolescents in sex education, but we are not paid for assisting that population,” Sanz protests. Many of her colleagues are leaving the profession. “They believe it is more economically profitable to work as nurses without a specialization,” the union states.
The shortage of these specialists is a nationwide problem that has persisted for decades, dating back to 1987 when Midwifery Schools were closed as Spain adapted its training to European standards, deeming some obsolete. However, until 1992, when it became mandatory to complete a specialization after nursing to practice the profession, there was a hiatus. In 1994, they returned to the labor market, after seven years without new graduates.
The 2024 report on the inequality of midwife competency development in Spain, published by the Federation of Midwife Associations of Spain (FAME), indicates that the Community of Madrid is characterized by limited autonomy and unequal development of professional competencies. It highlights the insufficient presence of these specialists in sexual and reproductive health facilities and notes that their work is concentrated in delivery rooms, obstetric wards, and emergencies, while their involvement in family planning consultations, climacteric care, fertility, or specialized sexual health is more deficient. Overall, the region shows partial progress and strong internal heterogeneity between health areas.
Source: El País
