The present crisis in midwifery and the seriousness of maternal mortality and morbidity demands a rethink about the background and training requirements of each level of midwifery worker. This paper describes the background of the present shortage and mal-distribution of midwives. The reduction of maternal mortality by 50% at the turn of this century requires the development of a maternal health care team in which the midwife functions as the linchpin. In order to equip the midwife for the leadership functions in this team, the present educational system needs to be fundamentally improved. The rationale for the acquisition of epidemiological, managerial specialised technical and teaching skills by midwives is discussed. Implications for further education are high-lighted. Collaborative actions taken by the WHO, ICM, UNICEF and other governmental and non-governmental agencies to address the issue of midwifery are outlined. This paper was given at the 1990 ICM, WHO, UNICEF Pre-Congress Workshop on Midwifery Education--Action for Safe Motherhood in Kobe, Japan.