This post originally appeared in the American College of Nurse Midwives’ Quickening, Volume 46, Number 2 (Spring 2015).
Today, May 5, is the International Day of the Midwife. This is an opportunity for the global community to come together to recognize the incredible impact midwives have on maternal and newborn health and decreasing mortality. Want to know more about what global leaders are doing to strengthen midwifery?
On Monday, March 23rd, global leaders in midwifery and maternal, newborn and child health gathered in Washington, DC at the Wilson Center for Call the Midwife: A Conversation About the Rising Global Midwifery Movement. This symposium hosted four panels to discuss current data, country investments, important global initiatives and public private partnerships and innovation in midwifery. Each of the panels was presented in the context of exciting new strides in maternal health with the forthcoming Sustainable Development Goals, an updated strategy for the United Nations’ Every Woman, Every Child initiative and the World Bank’s Global Financing Facility that supports it.
While each speaker’s background and focus varied, the themes of the symposium were consistent:
- Improve management and leaderships skills of midwives
- Improve pre-service and in-service education
- Innovate to keep midwives in rural areas
- Fill the need for well-trained midwifery faculty
- Integrate maternal and newborn healthcare
- Provide respectful maternity care (RMC)
- Build capacity
To kick-off the symposium, His Excellency Björn Lyrvall, Swedish Ambassador to the United States told the story of midwifery in Sweden: in 1751, it was reported to parliament that 400 of 651 maternal deaths could be averted with midwifery. Parliament took this seriously and by training midwives with safe delivery techniques decreased Sweden’s maternal mortality ratio (MMR) from 900 deaths per 100,000 live births (among the highest in Europe at the time) to 230. Sweden’s passion and investment in midwifery can act as an example to countries that are now facing a similar burden of maternal mortality.
The data on midwifery
The first panel on data summarized the State of the World’s Midwifery 2014 (SoWMy 2014), the Lancet Series on Midwifery and the International Confederation of Midwives’ (ICM) vision and programs. In his presentation on SoWMy 2014, Luc de Bernis, Technical Adviser at UNFPA, focused on projections of workforce availability and met need, or the ratio of workforce time available to time needed. Projections identify countries with a low-met need, medium-met need and high-met need in 2030. Interestingly, two countries that are doing well now, Ethiopia and Burkina Faso, will not be able to meet their health workforce needs by 2030 if investment does not accelerate now to keep up with an increasing need for services.
In her review of the Lancet Series on Midwifery, Holly Kennedy, Varney Professor of Midwifery at Yale University, announced two papers that will be added to the series: one on disrespect and abuse and RMC and another that summarizes the top 10 research priorities from the series to improve maternal and newborn health using the QMNC framework.
Frances Day-Stirk, President of the International Confederation of Midwives (ICM), then spoke on her organization’s vision and programs, including “A Promising Future,” a campaign to promote midwifery as the norm and not a novelty. The focus of ICM is to have midwives who are appropriate (well-educated and regulated), accessible (especially in poor geographic areas) and cost-effective. Day-Stirk also outlined the critical pillars of midwifery—education, regulation and association—which stand on a foundation of ICM core competencies. The focus and pillars of ICM were echoed throughout the remainder of the symposium.
At the end of this panel, countries were encouraged to look at long-term plans for strengthening and scaling-up professional midwifery, instead of quick fixes with training auxiliary midwives.
Country investments and lessons learned
Representatives from Cameroon, Afghanistan, Liberia and Ethiopia presented data on current initiatives in their countries to support and scale up midwifery. Ethiopia and Cameroon have both seen improvements in midwifery and maternal health indicators through investing in midwifery education and establishing accreditation of schools and training sites. Although they have seen success in their efforts, challenges still remain with a shortage of midwifery faculty and clinical training sites.
In Afghanistan, the Community Midwifery Education (CME) program, supported by USAID, Jhpiego, WHO and UNFPA, provides quality, sustainable midwifery education. The 2-year program supports women with at least a 10th grade education, chosen by their communities to participate. After training is complete, women return to their communities where child care and transportation is provided to enable them to use their skills and also to incentivize them to stay in their community. Other initiatives include leadership training, accreditation and mobile programs.
Marion Subah, a senior nurse midwife and Jhpiego’s country representative in Liberia, reported that since Ebola, antenatal care (ANC) coverage, skilled birth attendance and institutional delivery have all had an absolute decrease of about 10%, reversing recent advances in maternal health in Liberia. She recounted the difficulties of delivering maternal health care in the context of Ebola: six midwives have died from Ebola and women who need post abortion care are especially at risk because of the fears associated with contracting Ebola through bodily fluids. Moving forward, the ministry of health (MOH) has created a 10-year plan that focuses on increasing the number and quality of midwives, faculty development and establishing well-working computer and science labs and clinical sites.
Global midwifery initiatives
All over the world, organizations of all types are banning together to improve maternal and newborn health by investing in midwifery. With initiatives by the World Bank, USAID, GE Foundation and global policy experts, there was a lot to be excited about.
These initiatives are focused on creating a sustainable midwifery workforce, strengthening professional associations, improving workplace conditions for midwives, promoting RMC, building leadership and management skills, implementing global policies for ending maternal and newborn deaths and a new ICM Midwifery Services Framework. Many of the initiatives presented have overlapping goals, all to the end of creating a healthy, well-educated, accessible midwifery workforce.
At the close of this panel, Laura Laski, Chief of the Sexual and Reproductive Health Branch at UNFPA, noted three upcoming critical turning points for midwifery:
- The Global Maternal Newborn Health Conference in Mexico City: timed right after the agreement of countries on the SDGs, this conference in October 2015, provides an opportunity to emphasize the need to invest in midwives to accomplish the SDGs
- The World Health Assembly: provides a forum in May to discuss the new version of Every Woman, Every Child
- The Women Deliver Conference in 2016
Innovation and Public-Private Partnerships for Midwifery
To end the day, we looked forward to the future with a focus on innovation and pioneering public-private partnerships (PPPs). Greeta Lal of UNFPA shared recently developed e-learning modules that were created in partnership with Jhpiego, UNFPA, Intel and WHO. With topics ranging from family planning to essential newborn care, these e-learning modules can be conducted almost anywhere with a battery-operated projector, solar powered charger and a cheap tablet, these modules can be used in almost any part of the world.
In addition, Survive & Thrive and Nurses Investing in Maternal Child Health both seek to strengthen young professionals to become leaders in the field to create sustainable change. Both programs work internationally, but with different strategies. Survive & Thrive, supported by ACNM and other partners, works to strengthen professional associations and host master training of trainer courses for the management of maternal and newborn complications, from Malawi to Afghanistan. Nurses Investing in Maternal Child Health is an 18-month program supported by Johnson & Johnson and Sigma Theta Tau for nurse fellows to work with a mentor in order to gain leadership and technical skills in order to improve maternal and child health through evidence-based practice, health systems improvements and program evaluation.
Lastly, the NGO Direct Relief, with technical support from ICM, creates midwife kits for facility-based deliveries. With essential commodities, these kits have the potential to decrease MMR and the neonatal mortality rate by 63%. Thus far, these kits have been distributed in the Phillipines after Typhoon Haiyan and in Sierra Leone in the wake of Ebola.
The symposium was a full day of reviewing the incredible impact midwifery can have and what we need to do as a global community to realize that impact.
Resources discussed at this symposium:
- Call the Midwife: A Conversation About the Rising Global Midwifery Movement
- Ending Preventable Maternal Mortality
- EPMM: USAID maternal health vision for action, evidence for strategic approaches
- Every Newborn Action Plan
- ICM Midwifery Services Framework (Pilot)
- Updated Global Strategy for Every Woman, Every Child
- State of the World’s Midwifery 2014
- Lancet Series on Midwifery