This paper discusses the implications of shortages of midwives, nurses and doctors for maternal health and health services in sub-Saharan Africa, and inequitable distribution of maternal health professionals between geographic areas and health facilities. Shortages of health professionals reduce the number of facilities equipped to offer emergency obstetric care 24 hours a day, and are significantly related to quality of care and maternal mortality rates. Some countries are experiencing depletion of their workforces due to emigration and HIV-related illness. Another feature is the movement from public to private health facilities, and to international health and development organisations. The availability of skilled birth attendants and emergency obstetric care may be reduced due to understaffing, particularly in rural, poor areas. The existing workforce may experience increased workloads and job dissatisfaction, and may have to undertake tasks for which they are not trained. If governments and development partners are serious about reaching the Millennium Development Goal on maternal health, substantial numbers of professionals with midwifery skills will be needed. Shortages of maternal health professionals should be addressed within overall human resources policy. A rethink of health sector reforms and macro-economic development policies is called for, to focus on equity and strengthening the role of the state.