Toward a Sustainable Maternity Care System

Strengthening primary maternity care is not an optional reform. It is the only path to a sustainable, equitable maternity system. When continuity, comprehensiveness, and coordinated teams form the foundation, every other part of the system becomes safer, more efficient, and more humane.

A strong primary care system is the quiet engine of a healthy population. When it works well, we barely notice it as people stay well, problems are caught early, care is coordinated, and hospitals are reserved for those who truly need them. But the features that make primary care effective – continuity, comprehensiveness, and trusted relationships – are rarely measured or rewarded. As a consequence, short‑term fixes often crowd out the long‑term reforms that would actually strengthen the system.

Maternity care makes this challenge especially visible. Pregnancy, birth, and the postnatal period rely on relationship‑based care. Continuity of carer; being supported by the same midwife or small team; is associated with better outcomes for mothers and babies, including improved satisfaction, fewer interventions, and culturally safer care for priority populations. 1

Yet investment continues to flow into standalone programs and narrow services rather than into integrated, community‑based care. Australia’s own maternity models of care data show wide variation in continuity, with many women still receiving fragmented, episodic care. 2

This fragmentation has consequences. 5 Women bounce between providers who don’t share information. Follow‑up becomes inconsistent. Each initiative may look helpful on its own, but together they create a system that is harder to navigate, more expensive to run, and less effective at preventing complications. Research on implementing continuity models in regional Australia highlights how system design—not individual effort—is the main barrier to sustainable, relationship‑based care. 3

The path forward is well understood, and countries with high‑performing maternity systems are already following it. A sustainable maternity care system requires a whole‑of‑system approach that:

·       sets clear investment targets for primary maternity care

·       aligns funding, workforce planning, and service delivery

·       builds true multidisciplinary teams rather than piecemeal roles

·       rewards continuity and comprehensiveness

·       and establishes long‑term accountability that outlasts election cycles

The evidence is consistent: midwifery continuity of care is one of the most effective, evidence‑based models available, improving outcomes while reducing unnecessary interventions and costs. 4 Countries that invest in strong primary maternity care spend less overall, achieve better outcomes for mothers and babies, and reduce inequities.

Those that neglect it pay for it many times over—in hospital pressures, workforce burnout, and widening gaps in care.

Strengthening primary maternity care is not just another reform. It is the only path to a sustainable, equitable maternity system. The countries that recognise this are building healthier futures for families. Those that don’t are already feeling the strain.