Preserving professional distinction: The risk of merging nurses and midwives and the imperative to strengthen both professions – A commentary

Nurses and midwives are foundational to resilient health systems and achieving Universal Health Coverage, yet global policies often fail to reflect their distinct competencies, regulatory frameworks, and contributions. As the International Standard Classification of Occupations (ISCO) undergoes revision, a proposed sub-category-"nurse-midwives" under Midwifery Professionals-risks conflating these two professions. This commentary argues that such a classification threatens the integrity of health workforce data, undermines midwifery-led models of care, and compromises efforts to meet global targets for sexual, reproductive, maternal, newborn, and adolescent health. Drawing on the latest State of the World's Nursing and Midwifery reports, we demonstrate how misclassification inflates midwifery coverage estimates and obscures persistent shortages. Furthermore, merging professions risks diminishing the autonomy and unique philosophy of midwifery, promoting over-medicalised care and diverting critical resources. We call for the preservation of nursing and midwifery as distinct, equally essential professions-each deserving of separate investment, regulation, and recognition. Only through accurate classification can we ensure accountable workforce planning, protect midwifery's unique contributions, and advance person-centered, gender-equitable health systems worldwide.