It is late morning in a field outside Atiak, northern Uganda, and Achen’s head is pounding. She is seven months pregnant and has been working since daybreak. She totals up the cost of visiting a clinic: a day’s work lost, transport she cannot afford, and children left unsupervised. On almost any other day, the cost would be too high.

But Achen has been receiving prenatal care through a mobile clinic. Her community health worker lives close by and comes to her. She takes Achen’s blood pressure and sees that it is rising. A severe headache combined with high blood pressure can signal preeclampsia. The health worker contacts the midwife overseeing Achen’s care, who arranges transport. By nightfall, Achen is being monitored and treated by a registered midwife.

The blood pressure monitor was important. But the system around it saved Achen’s life: a community health worker who came to her, and a midwife who could act on what the reading revealed.

That distinction should inform how the EU approaches global health. In her recent State of the Union address, European Commission President Ursula von der Leyen spoke about the potential for artificial intelligence to support doctors rather than replace them. It is an important principle, with implications well beyond EU borders.

The same principle was put into practice at this year’s United Nations General Assembly in New York. At an EU-hosted event, the Commission announced €60 million to strengthen primary healthcare in Ethiopia through investment in facilities, skills, digital services, and supply chains. WHO Director-General Tedros Adhanom Ghebreyesus offered a simple test: whether health workers have the “supplies, support and systems” to provide care.

Midwifery was also on the agenda. Sweden, Bangladesh, and the United Nations Population Fund (UNFPA) highlighted Bangladesh’s commitment to create 25,000 professional midwifery posts. Sweden is backing UNFPA’s Midwifery Accelerator with $6 million to strengthen the global midwifery workforce. Innovation in maternal health cannot mean technology alone. It must also mean investing in the people and systems that make technology useful.

The EU has committed to the global target of reducing maternal mortality to fewer than 70 deaths per 100,000 live births by 2030. The world remains far from that goal. Midwife-delivered care could prevent a substantial share of maternal and newborn deaths and stillbirths, yet the world faces a shortfall of roughly 980,000 midwives. In many places where mortality is highest, the immediate problem is not a lack of artificial intelligence. It is a lack of skilled health workers.

Those who are there often work without the training, equipment, mentorship, transport, and referral networks they need.

Technological innovation, much of it being developed in Europe, can help. Portable ultrasound, better fetal monitoring, and AI-assisted diagnostics can put information into the hands of frontline health workers that once required a specialist or a trip to a distant hospital. But these tools cannot close the gap on their own.

Midwives and community health workers build relationships with the women in their care. They may recognize that something has changed since a woman’s last visit because they know her history and have kept a record of it.

A functioning midwife-led system can arrange transport, administer medication, manage labour, and identify when a woman needs urgent referral. Global efforts have long focused on getting women into facilities and increasing skilled birth attendance. Both matter. But putting a midwife, or an ultrasound machine, inside a building does not automatically create good maternity care.

This is the thinking behind the Quality Maternal and Newborn Care framework published in The Lancet’s 2014 Series on Midwifery. It helped establish a principle that should shape global health investment: outcomes depend on a whole system of care organized around women’s needs. In 2024, the World Health Organization called on countries to transition toward Midwifery Models of Care. In these systems, midwives coordinate continuous, person-centred care throughout pregnancy, childbirth, and the postnatal period. WHO followed that call with detailed implementation guidance in 2025.

Yet the transition has barely begun. Research cited by WHO suggests that universal access to skilled midwives could prevent more than 60% of maternal and newborn deaths and stillbirths, potentially saving 4.3 million lives each year by 2035.

That makes the sharp decline in development assistance particularly consequential. The question is not simply how much the EU spends on health, but what kind of health systems its investments leave behind. If the EU wants those investments to build resilience and greater health sovereignty, strengthening national midwifery workforces should be central to its strategy. That means educating more midwives, improving working conditions and retention, strengthening community-based care, and ensuring that midwives have the tools, autonomy, and referral systems necessary to do their jobs.

Von der Leyen and EU Commissioner Jozef Síkela should recognize that investment in new technology must be matched by investment in the workforce and systems that allow it to save lives.

In rural areas, midwives connected to community health workers can reach women earlier. Give a midwife a reliable referral route and specialist backup, and a reading from a device can lead to timely treatment.

Achen ultimately gave birth prematurely, but she was already in the right clinical setting when it happened. She survived, as did her baby.

Her blood pressure monitor was valuable because it was in the right hands, within a functioning system. That is what the EU should back as it enters a new era of health innovation: the people and systems that let a reading taken in a field in rural Uganda end with a mother and baby who survive.