Nutrition education for midwives. A comparison between the UK and Brazil. By J.C. Abayomi1, A. K. Azevedo-Martins2. G. Nonato2 L. Newson3, 1Applied Health & Social Care, Edge Hill University, Ormskirk L39 4QP. 2Univerisity of São Paulo, São Paulo, Brazil, 3Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF.
Introduction:
Optimal maternal nutrition and Gestational Weight Gain (GWG) are key to tackling dual burden malnutrition and preventing non-communicable disease, and advising women of both is a key midwifery role (1). The aim of this study was to explore the approaches to nutrition education of under graduate midwives in Brazil in comparison to the UK.
Methods:
We collected published online demographic data and data on pregnancy outcomes, access to antenatal care and resources available for maternity care from the World Health Organisation (2) regarding UK and Brazil. We also reviewed the midwifery taught curriculum from two universities in the UK and in Brazil and discussed the delivery of nutrition education with staff from both institutions.
Results:
Both countries have sizeable populations [UK = 65.789 million; Brazil = 207.653 million] with life expectancy of [Brazil = 71 years (men) and 78 years (women); UK = 79 years (men) 83 years (women)]. Expenditure of health as a % of GDP is similar [Brazil = 8.32%; UK = 9.12%]. However the maternal mortality ratio in Brazil is much higher at 60 per 100,000 live births, where as it is 7 per 100,000 live births in the UK. Furthermore, Brazil has the highest caesarean section rate in the world at 55.5%; whereas it is 20-25% in the UK.
There are only 433 registered midwives for the whole of Brazil but they receive comprehensive nutrition training designed and delivered by a nutritionist throughout their undergraduate course. They also monitor GWG throughout pregnancy, intervening when GWG is insufficient or excessive. Arguably, the UK has sufficient midwives in comparison, (26,778 in England alone), but they report a lack of knowledge, skills and confidence regarding maternal nutrition (3). Weight is measured at booking-in, though not routinely monitored throughout, and there are no UK guidelines regarding optimal GWG. The UK has limited access to dietitians (9,469), compared to Brazil (with 132,000); most pregnant women will not routinely see a dietitian, so advice from midwives is crucial.
Conclusion:
There is a shortage of midwives in Brazil compared to the UK and this impacts maternal mortality ratios and caesarean section rates. However, unlike the UK, midwives in Brazil experience consistent nutrition education throughout their training, empowering them to communicate and translate key messages regarding nutrition and GWG to pregnant women.
National Institute for Health      and Care Excellence (NICE) Antenatal care for uncomplicated pregnancies.      2017 Available at: https://www.nice.org.uk/guidance/cg62     . Accessed 28/03/2018
World Health Organization. The      Global Health Observatory. 2017 Available at: https://www.who.int/data/gho/data/countries/country-details/GHO/brazil?countryProfileId=4cb28d44-b963-4b91-a607-83e3d282291d.      [Accessed 28/09/2021]
3. McCann MT, Newson L, Burden C, Rooney JS, Charnley MS, Abayomi JC. A qualitative study exploring midwives' perceptions and knowledge of maternal obesity: Reflecting on their experiences of providing healthy eating and weight management advice to pregnant women. Maternal & child nutrition. 2018 Apr; 14(2):e12520.

**Nutrition education for midwives. A comparison between the UK and Brazil.** By J.C. Abayomi1, A. K. Azevedo-Martins2. G. Nonato2 L. Newson3, _1Applied Health & Social Care, Edge Hill University, Ormskirk L39 4QP. 2_Univerisity of São Paulo, São Paulo, Brazil, _3Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF._
**Introduction:**
Optimal maternal nutrition and Gestational Weight Gain (GWG) are key to tackling dual burden malnutrition and preventing non-communicable disease, and advising women of both is a key midwifery role (1). The aim of this study was to explore the approaches to nutrition education of under graduate midwives in Brazil in comparison to the UK.
**Methods:**
We collected published online demographic data and data on pregnancy outcomes, access to antenatal care and resources available for maternity care from the World Health Organisation (2) regarding UK and Brazil. We also reviewed the midwifery taught curriculum from two universities in the UK and in Brazil and discussed the delivery of nutrition education with staff from both institutions.
**Results:**
Both countries have sizeable populations [UK = 65.789 million; Brazil = 207.653 million] with life expectancy of [Brazil = 71 years (men) and 78 years (women); UK = 79 years (men) 83 years (women)]. Expenditure of health as a % of GDP is similar [Brazil = 8.32%; UK = 9.12%]. However the maternal mortality ratio in Brazil is much higher at 60 per 100,000 live births, where as it is 7 per 100,000 live births in the UK. Furthermore, Brazil has the highest caesarean section rate in the world at 55.5%; whereas it is 20-25% in the UK.
There are only 433 registered midwives for the whole of Brazil but they receive comprehensive nutrition training designed and delivered by a nutritionist throughout their undergraduate course. They also monitor GWG throughout pregnancy, intervening when GWG is insufficient or excessive. Arguably, the UK has sufficient midwives in comparison, (26,778 in England alone), but they report a lack of knowledge, skills and confidence regarding maternal nutrition (3). Weight is measured at booking-in, though not routinely monitored throughout, and there are no UK guidelines regarding optimal GWG. The UK has limited access to dietitians (9,469), compared to Brazil (with 132,000); most pregnant women will not routinely see a dietitian, so advice from midwives is crucial.
**Conclusion:**
There is a shortage of midwives in Brazil compared to the UK and this impacts maternal mortality ratios and caesarean section rates. However, unlike the UK, midwives in Brazil experience consistent nutrition education throughout their training, empowering them to communicate and translate key messages regarding nutrition and GWG to pregnant women.
1. National Institute for Health      and Care Excellence (NICE) Antenatal care for uncomplicated pregnancies.      2017 Available at: [https://www.nice.org.uk/guidance/cg62](https://www.nice.org.uk/guidance/cg62)     . Accessed 28/03/2018
2. World Health Organization. The      Global Health Observatory. 2017 Available at: [https://www.who.int/data/gho/data/countries/country-details/GHO/brazil?countryProfileId=4cb28d44-b963-4b91-a607-83e3d282291d](https://www.who.int/data/gho/data/countries/country-details/GHO/brazil?countryProfileId=4cb28d44-b963-4b91-a607-83e3d282291d).      [Accessed 28/09/2021]

3. McCann MT, Newson L, Burden C, Rooney JS, Charnley MS, Abayomi JC. A qualitative study exploring midwives' perceptions and knowledge of maternal obesity: Reflecting on their experiences of providing healthy eating and weight management advice to pregnant women. Maternal & child nutrition. 2018 Apr; 14(2):e12520.

Nutrition education for midwives. A comparison between the UK and Brazil

Modern nutrition science is young: It is less than one century since the first vitamin was isolated in 1926. Nutrition science stands upon research conducted by academia, the private sector, and nongovernmental organisations, often in collaboration across these sectors. Its evidence base is of fundamental importance to the solving of current challenges and complexities, optimising outcomes, and the prevention of harm.

In order to remain relevant, nutrition science must address the global challenges, including ensuring nutrition security for all, in line with the UN Sustainable Development Goals and in the context of the post-COVID era. It is timely to take stock and consider how nutrition science must move forward.

The conference is designed integrate three symposium sessions which will commence with reflection on historical exemplars of nutrition achievements, then moving the discussion to current challenges which face the discipline and will culminate in scoping the outlook for nutrition science going forward.