A Moment for Midwives
Celebrating our Global Midwife Community Amidst the COVID-19 Pandemic
"If we want to continue this world, we have to have life. We need to protect it, and protect the people who help women give birth and create new families. If this pandemic has shown us anything, it is that families matter—our communities matter, and if we want to keep our countries strong we need to protect our people—and this starts with birth and midwives!" - Sally Pairman, ICM Chief Executive
Foreword
“Well, we’ve made it to the end of what has undoubtedly been one of the most challenging years for our global midwife community, and for the world at large. We began 2020 eager to mark the International Year of the Nurse and the Midwife — a historic year when finally, midwives would receive the attention they deserve for their pivotal role in caring for women through pregnancy and childbirth, supporting their reproductive needs, and ensuring their safety, rights and dignity. However, the celebrations had to be significantly scaled back as the COVID-19 pandemic exacerbated existing maternal and newborn health challenges into a crisis.
In the early days of the pandemic, ICM connected with the majority of its 143 Midwives’ Associations and listened to harrowing accounts from their communities. Midwives shared stories of being forgotten when it came to the distribution of Personal Protective Equipment (PPE), of women avoiding hospitals and birthing centres out of fear of contracting the virus, and of midwives being redeployed away from maternity services to COVID-19 screening centres. UNFPA and ICM, with support from a number of our partners, transformed midwives’ concerns into a series of calls to action for governments, decision-makers, donors and health institutions to ensure the continuity of maternity and other sexual and reproductive health services and the protection of midwives, women and newborns during the pandemic. You can read more about these calls to action on page 12.
As we write this message, midwives still need PPE, birthing women are still afraid of contracting COVID-19, and midwives still lack professional autonomy to determine the provision of midwifery services. But despite the challenges, midwives’ resilience has prevented COVID-19 from casting too dark a shadow on our year. Together, ICM and UNFPA have continued to amplify midwives’ voices and advocate for midwife-led care as the optimal care model for pregnant and birthing women, and we’ve observed a substantial rise in the status of midwives and perception of midwifery globally. More than ever before, midwives and their life-saving work are being featured in media stories and prominent online events and conferences. These are small but notable steps toward a world where midwives are well-resourced, adequately compensated and the decision-makers of their own profession.
This leaves us feeling optimistic about the year ahead. In May 2021, UNFPA, ICM, the WHO and a host of other partners will launch the next State of the World’s Midwifery (SoWMy) report – an updated evidence base and detailed analysis of the present progress and future challenges to deliver effective coverage and quality of midwives and midwifery services. This publication will empower our efforts, and those of the global midwife community, in advocating with governments to increase investments in midwife-led continuity of care.
This digital magazine tells the story of 2020 from within the confines of a global pandemic. It is an ode to midwives everywhere, and UNFPA and ICM wish to extend our deepest appreciation to each and every one of you for your resilience, courage and determination. We are honoured to stand shoulder to shoulder with you as we do our part in spearheading efforts toward increased investments in the midwifery workforce. 2021 marks the beginning of the Decade of the Midwife and real, global action towards achieving the Sustainable Development Goals. Together, we can reduce maternal and neonatal mortality and ensure respectful care for all.”
Anneka Knutsson, Chief, Sexual and Reproductive Health Branch, UNFPA
Franka Cadée, President, International Confederation of Midwives
Global leaders deliver salute to Year of the Nurse and the Midwife
When the World Health Assembly (WHO) designated 2020 as the International Year of the Nurse and the Midwife (YONM), no one could have anticipated that a global pandemic would dismantle health systems the world over, placing unprecedented constraint on all health workers, including midwives.
COVID-19 has exemplified what we in our global midwife community observe on a daily basis: midwives are heroes. The stories we continue to hear of midwives sacrificing their own health and safety to care for birthing women, newborns and communities are reminders of why we must continue advocating for increased investments in the midwifery workforce. Over the past year, countries across the world have united in recognition of YONM and the essential role that midwives play in achieving the Sustainable Development Goals and Universal Health. At ICM, we look forward to carrying this momentum into the Decade of the Midwife.
For a final salute to YONM, and to underscore the gratitude owed to midwives and our nursing colleagues, leaders from the ICM, the World Health Organization (WHO), the International Council of Nurses (ICN), Nursing Now and the United Nations Population Fund (UNFPA) have prepared a message of appreciation...
2020 Reflections from our Board Members
Over the past year, ICM’s Board Members have regularly connected with the Midwives’ Associations they represent to determine regional priorities and discuss their triumphs and challenges within the confines of this pandemic and beyond. You’ve heard from ICM President Franka Cadée in the foreword of this magazine — below you’ll find reflective messages from the rest of our Board Members, capturing key moments from their regions and looking ahead to the Decade of the Midwife.
Sandra Oyarzo Torres, Vice President
“I would like to dedicate this message first of all to all the families of our colleagues who lost their lives in the daily practice of midwifery, — they are truly heroines who exemplify love and dedication to midwifery.
I would also like to wish all of our global midwifery family moments of peace, reflection and strength as the year ends. Please remain hopeful for the coming year when we can continue to fight to change the world so that every place where a child is born, or there is a woman in need of care; there is a midwife, protected, supported and valued as the best-suited professional to improve the health care of all women and their families around the world.”
Vitor Varela Treasurer
“During this pandemic, in many countries in the world obstacles occurred that affected the monitoring of women during pregnancy, labour and delivery and postpartum hospitalisation, leading to a violation by many health institutions of the legislation in place to protect maternity and paternity.
In the initial phase of the spread of the disease, restrictive measures were implemented that led to the prohibition in many health institutions of the monitoring of women by a significant person, but with the commitment of health professionals, namely midwives, health institutions were gradually creating conditions for the lifting of the restrictions imposed, again opening the possibility of safe monitoring of the pregnant and puerperal woman by a person of her choice and maintaining the safety of all stakeholders.”
Ann Kinnear, Representing Western Pacific Region
“The impact and value of midwives has been strongly demonstrated, particularly in our ability to flex and respond to the pandemic. In countries like New Zealand, where there is an integrated model of continuity of midwifery care, midwives could readily modify their service so that all women were able to access midwifery or maternity care. Because women knew their midwife, they continued to see them at home, and more women confidently chose homebirth when hospitals were unable to take admissions. In Japan, online call centres were established, and the government was lobbied to increase the financial benefits to mothers and midwives adversely impacted by the pandemic.”
Emi Nurjasmi, Representing South-East Asia Region
“We face this challenge to create innovation in order to celebrate International Day of The Midwife and The Year of the Midwife 2020. In Indonesia, we conducted a Webinar online which can be accessed by all midwives in all provinces in Indonesia. This Webinar is also on Youtube, so the midwives who couldn’t join at the time can still access the recording. Surprisingly, this Webinar was attended by more than 10,000 midwives. In every situation, we must be able to innovate, to keep up with the times and be able to adapt quickly in order to give our best.
So, I would like to say, let’s keep strong!”
Dicko Fatoumata S Maiga, Representing Africa Region (Francophone)
“On the occasion of this end of the Year of the Nurse and the Midwife, I would like to thank the International Confederation of Midwives for the actions planned and undertaken during 2020 despite the presence of the COVID-19 pandemic.
I also thank the midwifery associations for the efforts made within the framework of the SoWMy survey. I encourage midwives to work for better visibility of our organisation, ICM. I ask the almighty God to help us fight against COVID-19 so we can carry out our activities.”
Hilma Shikwambi, Representing Africa Region (Anglophone)
“During this year, we engaged in capacity building workshops aimed at enabling Midwives to provide evidence-based care. I would like to offer my sincere gratitude to all those that supported Midwives during this challenging year. For the first time, we participated in the ICM council meeting, and the regional meeting virtually, which brought us together and allowed us to interact and set the regional agenda for the next Triennium.
As we look forward to the new year, I would like to call on Midwives to remain with women. Our African region is still facing the highest-burden on maternal, neonatal and stillborn deaths. Midwives remain the most appropriate care provider to avert these deaths. The solution lies in the improved quality of education for Midwives to global standards, creations of enabling environment for Midwives to practice in and regulation for Midwifery practice. Our combined effort should be ensuring that Midwives in our region are practising midwifery to the full scope. I wish you all happy holidays!”
Lisa Apini-Welcland, Representing Europe Region (Central Europe)
“Working together, learning from each other and strengthening the regional midwife community will lead us through the upcoming years. We are strong and can work the pathway forward together — a path where midwife-led care is present and accessible in every maternity health care system within the region. These are exciting times, and the global community is looking forward to promoting these models, providing guidance on educational standards and advocating for more leadership opportunities for midwives in order to build toward strengthened midwifery care in the Central European Region.
So, let’s move forward together.”
María Florencia Francisconi, Representing Americas Region (Latin America)
“Dear Colleagues: What a year! As the regional representative for Latin America, a member of the College of Midwives of the Province of Buenos Aires, I would like to take this opportunity to say THANK YOU. Thank you for not giving up, even facing the most adverse situations, thank you for being such an active and committed region and, above all, thank you for enhancing our profession by providing quality care to women and newborns. I am proud of the unity that you Midwives’ Associations are achieving in the region, and thanks to this, we speak with one voice for the midwife profession.”
Pandora Hardtman, Representing Americas Region (North America and the Caribbean)
“When I look back on 2020, it will be remembered as a year that changed everything and everyone forev
For those of us who love sci-fi, it seemed that prior best-selling novels were coming true. Fact followed fiction as surely as a variable deceleration might follow cord compression in an altered universe complete with sweltering space suit coverings, dehydration (because masking does not lead to high fluid intake) and new vocabulary as I, like many of you, became Zoomed out!
With this ever-evolving reality, came unforeseen ethical dilemmas as midwives followed the call of their career path and passion, sometimes at great risk. I will never forget the hard choice of running for PPE or letting a rapid delivery in triage hit the floor, then the onslaught of emotion from the joy of the birth, mixed with guilt at exposing my family to the virus.”
Roa Altaweli, Representing Eastern Mediterranean Region
“Midwives play an essential role in ensuring that women have a safe and positive experience during their pregnancy, childbirth, and the postnatal period. I am really proud of the midwives in the Eastern Mediterranean Region for their hard work during COVID-19 crisis to support women and their newborns through childbirth. Midwives save lives. They help women to have a positive experience, even during pandemic situations.”
Trude Thommesen Representing Europe Region (Northern Europe)
“I am proud of the midwives in my region who have continued to give women the best midwifery care, some with fewer resources in already difficult and scarce health care settings, some with little personal protection equipment available. Midwives did what they always have done: taken good care of pregnant and birthing women and their families in the most vulnerable time in life.
I know many midwives in my region had expected a different 2020. However, when Corona hit, we stood together with women and did what a MIDWIFE should always do: be there for them. In that way, this has been the Year of the Midwife.”
Victoria Vivilaki, Representing Europe Region (Southern Europe)
“Who could have imagined the critical importance of midwives in our society would be brought into focus so clearly by the COVID-19 pandemic? Every day, the media highlights the threatening conditions midwives and other care providers are facing in their clinical practice. Moreover, midwifery staff shortages have demonstrated the healthcare system’s ability to provide homecare, virtual antenatal and postnatal sessions in this time of social distancing, and pandemic fear. However, midwives are still providing the human connection and supporting mothers and their families as they adapt to changes in society.”
The State of the World’s Midwifery (SoWMy) 2021 is coming!
The SoWMy report will provide an updated evidence base and detailed analysis of the progress and challenges in delivering effective coverage and quality of midwives and midwifery services worldwide. Together with UNFPA and the WHO, ICM will launch the report at the Virtual Triennial Congress in June.
Most of the quantitative data used to compile the report has come from two sources: (1) country submissions to WHO’s National Health Workforce Accounts (NHWA) data platform and (2) responses to ICM’s Map survey of its 140+ member associations. Staff in UN country and regional offices have supported national NHWA focal points and midwives’ associations to locate, validate and submit the requested data to NHWA and the ICM survey platform.
The newly released ‘Impact of Midwives’ study, conducted by ICM, UNFPA and the WHO, provides the latest estimates on the potential impact of midwives on reducing maternal and neonatal mortality and stillbirths and acts as an important precursor to the release of SoWMy. You can find the study here.
This year, ICM together with UNFPA, PMNCH and WHO will release the Humanitarian and Fragile Settings paper —an analysis on midwives’ and women’s experiences across a range of humanitarian and fragile settings.
UNFPA mourns loss of Henriette Eke Mbula, Country Midwife Advisor DRC
UNFPA is deeply saddened by the loss of its Country Midwife Advisor, Henriette Eke Mbula, an inspirational midwifery leader and an icon in her country, the Democratic Republic of Congo (DRC). Henriette passed away on Friday the 27th of November after fighting a brave battle with breast cancer.
Henriette’s efforts led to the recognition of midwifery as a separate profession from nursing and a cornerstone for the improvement of maternal and newborn health in the country. She provided strategic, policy, technical and operational support to UNFPA and the national authorities and counterparts on all aspects related to the promotion of the midwifery profession-education, association and regulation. Henriette contributed to the pre-and in-service training of more than 5,000 midwives working all across the country, including in humanitarian settings.
Henriette became a midwife because of the exceptional joy on the face of a mother when she held her baby for the first time. In her own words “I chose this profession to contribute to making childbirth a happy event”. To Henriette, skilling up and making midwives competent was very important. In addition, she felt the important qualities that a midwife should demonstrate are patience, kindness, efficiency and discretion. Anyone aspiring to be a midwife must first love the profession and have a total commitment to advance and improve RMNCAH. Else, you cannot make one a good midwife. Henriette portrayed and modelled all these qualities in her daily life.
In 2011, the midwifery association in DRC was hardly active with but a few members. Through Henriette’s hard work and dedication and UNFPA’s support, the association today has more than 1,000 active members, numerous provincial committees and enjoys great visibility both inside and outside the country. From strengthening the regulatory framework, to strongly advocating for the profession among parliamentarians and policymakers, Henriette worked tirelessly for strengthening the midwifery profession in DRC.
Let us all pledge to continue Henriette’s legacy. May her soul rest in eternal peace.
“Henriette became a midwife because of the exceptional joy on the face of a mother when she held her baby for the first time. In her own words “I chose this profession to contribute to making childbirth a happy event”.”
Record number of midwives attend 8th Triad Meeting
On 16-18 June 2020, over 600 participants from more than 145 countries gathered virtually for the 8th ICN-ICM-WHO Triad Meeting. Participants included government midwifery and nursing staff, leaders and representatives of national midwifery and nursing associations, ICM, the International Council of Nurses (ICN), the World Health Organization (WHO) and partners such as WHO Collaborating Centers for Nursing and Midwifery, regulators, and the Nursing Now campaign. As a result of the digital nature of this meeting, many midwives were able to attend and advocate for the unique challenges facing their profession.
The resulting Triad Statement focuses on actions that participants in their respective roles agree to take. These actions will support WHO Member States in strengthening midwifery and nursing towards priority health targets, including responding to COVID-19 and achieving universal health coverage.
On the heels of the 8th Triad Meeting, ICM hosted a post-triad midwifery forum to discuss the establishment of Chief Midwife positions within Ministries of Health, after The State of the World’s Nursing Report 2020 shows that there is a direct correlation between the presence of Chief Nursing Officers and improved status and position of the nursing profession.
The Year of the Nurse and the Midwife 2020: The Wilson Center and UNFPA partnership
In celebration of 2020 being the first historic Year of the Nurse and the Midwife, UNFPA in collaboration with the Wilson Center’s Maternal Health Initiative Advancing Dialogue on Maternal Health Series, organised four global advocacy events, in addition to other articles and podcasts - all centred around the role midwives play in promoting maternal and newborn health and saving lives at birth. The year began with two back to back dialogues: first, a private roundtable on creating an enabling environment for midwives followed by a second public event on the importance of midwives to achieving universal health coverage. However, following these two events in early spring, COVID-19 shutdowns began, and all meetings were moved to the virtual space. Two highly successful virtual public events were conducted in the second half of the year, one on Indigenous midwifery and the final event was the launch of the Impact of Midwives study published in The Lancet Global Health. More details of the events are below:
March 5: Private roundtable event on Creating an Enabling Environment for Midwives to Transform Maternal and Newborn Health Outcomes. Attended by 25 leading SRHR experts from 16 different organisations to discuss key components of an enabling environment for midwives, successful interventions, remaining challenges for midwives, and possible solutions. Roundtable was led by Anneka Knutsson (UNFPA) and Sarah Barnes (Wilson Center).
March 6: Public event on The Importance of Midwives in Achieving Universal Health Coverage was held in person at the Wilson Center in Washington, D.C. The event highlighted the barriers to UHC, the contribution of midwives to sexual, reproductive, maternal, and newborn health, and strategies to fill the service gaps worldwide. Welcome by Sarah Barnes. Moderated by Anneka Knutsson with discussants Elena Ateva (White Ribbon Alliance); Franka Cadée (International Confederation of Midwives); and Marie Klingberg-Allvin (Karolinska Institutet in Sweden). See Event Summary and Podcast.
September 22: A Virtual public event on Indigenous Midwives - conducted together with ICM, included Indigenous midwives from New Zealand, Mexico, and Canada. A highly engaged panel comprising mostly of indigenous midwives and indigenous midwifery leaders discussed the varying impacts of past and present maternal health service policies and health systems on Indigenous mothers and families. Examples of successful policy changes and existing barriers towards improving Indigenous maternity care, including country-specific strategies used to enhance Indigenous midwifery care and the Indigenous midwifery workforce were also dwelt on. The discussion was moderated by Sandra Oyarzo Torres (International Confederation of Midwives) with discussants Claire Dion Fletcher (Indigenous Potawatomi-Lenape Registered Midwife and co-chair of the National Aboriginal Council of Midwives in Canada); Nicole Pihema (Māori Registered Midwife and President of the New Zealand College of Midwives); and Ofelia Pérez Ruiz (Indigenous Registered Midwife and Spokesperson for the Chiapas Nich Ixim Movement of Traditional Midwives). Please see: Event summary and podcast.
December 2: The year was wrapped up with the virtual global public launch of an important study, Impact of Midwives done by UNFPA, ICM, and WHO and published in The Lancet Global Health—which provides new estimates on the potential impact of midwives on reducing maternal and neonatal mortality and stillbirths. Anneka Knutsson moderated the event with discussants included Andrea Nove (Novametrics); Franka Cadée (International Confederation of Midwives); Elizabeth Iro (World Health Organization); Petra ten Hoope-Bender (UNFPA, Geneva); and Jihan Salad (UNFPA, Jordan). Closing remarks were provided by Chunmei Li (Johnson & Johnson). Please see: Event summary and podcast (to be published on 12/11).
Podcasts series:
UNFPA and ICM will continue to collaborate in 2021 with further Wilson Centre live events and podcasts planned around midwifery education and continuity of care. Look out for details on the ICM and UNFPA social media pages!
Did you hear the news? The ICM 32rd Triennial Congress is going virtual!
The ICM Board has decided to transfer the 2021 32nd Triennial Congress to a virtual format instead of continuing with plans for a face-to-face Congress in Bali. The ICM Board reached this decision after consideration of all available information regarding the progression of the COVID-19 pandemic from the WHO, the Indonesian government, the Indonesia Midwives Association, our members and our partners.
We are excited by the opportunity provided by the virtual format to increase participation, and we look forward to what will surely be the largest gathering of midwives ever!
We’ve refreshed our Congress website with the new look and feel of our virtual event - check out these updates.
Preterm Births and Midwifery
Geeta Lal, Senior Technical Advisor, Global Midwifery Programme Coordinator, United Nations Population Fund and Sarah Bar-Zeev, Technical Specialist - Midwifery, Sexual and Reproductive Health Branch, United Nations Population Fund
The day of birth should be among the happiest days for a family. However, this joy may turn into sorrow and anguish when the baby is born preterm (before 37 completed weeks of pregnancy) and struggles for survival. Worldwide, an estimated 15 million babies are born preterm, which is more than 1 in 10 [1]. Complications due to preterm birth are the single leading cause of neonatal deaths, accounting for 35% of the 3.1 million neonatal deaths every year [2]. Among the babies who survive, some may face life-long health issues related to pre-term birth such as hearing, visual and learning disabilities.
Preventing preterm birth starts with a healthy pregnancy. The United Nations Population Fund, UNFPA, as the lead United Nations agency on sexual and reproductive health is committed to ensuring that women have a safe and healthy pregnancy and childbirth, thereby also reducing newborn lives lost due to prematurity.
UNFPA addresses the issue of preterm births through initiatives such as:
- Access to quality family planning information; a steady, reliable supply of quality contraceptives; and strengthening national health systems to provide quality contraceptive services.
- Youth sensitive, gender responsive programmes on adolescent sexual and reproductive health, comprehensive sexuality education and ending child marriage. Young pregnant teenage girls are at higher risk of several adverse pregnancy related outcomes including low birth weight, preterm delivery, and infections compared with mothers aged 20–24 years. These programmes contribute towards prevention of preterm births.
- Health system strengthening ensuring quality maternal and newborn health programmes with particular focus on continuity of quality midwifery care through its global midwifery programme. Robust midwifery led continuity of care services have been shown to reduce the risk of prematurity by around 24% [3].
UNFPA continues to invest significantly in educating and training midwives to deliver quality maternal and newborn health care, globally in over 125 countries. Midwives are key caregivers and providers of a safe, positive and respectful pregnancy experience to all women. This includes provision of quality antenatal care which is essential to detect any danger signs that could potentially lead to preterm birth, so that all at-risk mothers can be properly monitored and managed. Midwives can also help save the lives of preterm babies with essential care during birth and in the postnatal period such as kangaroo mother care and antibiotics to treat newborn infections. In addition to the immediate pregnancy and child birth related care, midwives provide family planning counseling and services and culturally sensitive counseling on health and nutrition that directly or indirectly will influence the outcome of a full-term and preterm birth.
UNFPA has helped train over 150,000 midwives since 2009 and has equipped hundreds of midwifery schools, updated curricula and trained midwifery tutors. In 2021, UNFPA in collaboration with Johnson &Johnson will launch a global initiative to strengthen and scale up quality pre-service education of midwives using a standardized package of evidence based approaches and teaching and training modules that focus on the competencies of midwives. A well-educated midwifery workforce can help stem the tide of babies born too soon. UNFPA and J&J call upon all global partners to engage in this important endeavor of training midwives that could help avert millions of maternal and newborn deaths, including pre-term births and stillbirths each year.
COVID-19 guidelines from ICM and partners: tailored resources for midwives and birthing women
ICM is concerned about the effects of the COVID-19 pandemic on midwifery care, midwives and the health and wellbeing of women and newborns. Since the beginning of the pandemic, we’ve been closely monitoring the developments of this virus and sharing information to support midwives and other maternity care on our COVID-19 Resource page.
These resources form a selection of the many resources available. We aim to ensure they are from reputable sources and help midwives and others in providing care during these difficult and unprecedented times. We encourage our global community of midwives to review the selection of resources we’ve compiled and reach out to us with suggestions of regionally specific content to share on this page.
Earlier this year, ICM connected with her Member Associations in all regions. Accounts from the midwives working in communities during this pandemic were harrowing, unveiling an increase in gender discrimination, domestic violence, human rights abuses, the over-medicalisation of birth, and fear and misinformation, all culminating in growing distress among women and midwives.
ICM, in partnership with UNFPA, united in solidarity to launch a series of calls to action for governments, decision makers, donors and health institutions to ensure the protection of midwives, women and newborns during the COVID-19 pandemic.
Months after the original publication of these calls to action, they are still entirely relevant.
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A digital response to help ensure safer childbirths during COVID-19
On April 8th, UNFPA and ICM together with the Maternity Foundation, University of Copenhagen and Laerdal Global Health, and the UN sexual and reproductive health agency, launched the COVID 19 module under the Safe Delivery App. This digital tool equips midwives in low-resource settings to protect themselves, mothers and newborns from the Coronavirus and to ensure that women continue to receive respectful quality of care during pregnancy and childbirth.
During the current COVID-19 pandemic, women everywhere will continue to get pregnant and give birth. In low-resource countries and in humanitarian settings affected by conflict, pregnant women, new mothers, newborns and the health personnel providing them care face great risks in the new reality brought by the virus. Health systems are facing enormous pressure with lack of staff, resources and training to take necessary preventative measures against the virus. Midwives and other skilled health personnel providing care during childbirth need immediate support and tools to be able to still provide quality maternal care in the light of the pandemic. A new digital tool launched today aims to do just that.
In response to the global COVID-19 pandemic, Maternity Foundation, University of Copenhagen, and Laerdal Global Health in collaboration with International Confederation of Midwives (ICM) and UNFPA have partnered up to develop and disseminate an immediate and digital response for healthcare personnel – particularly midwives – to protect themselves, women and newborns from COVID-19.
The coalition is launching tools for capacity building and training for midwives through the Safe Delivery App, a mobile application developed by Maternity Foundation and the University of Copenhagen, which provides visual, clinical and practical guidance on how to handle the most common childbirth complications. Through the Safe Delivery App, midwives can now get key information, animated video instructions, and checklists as well as guided training to support them to limit the spread of COVID-19 in the health facilities, including information on infection prevention, breastfeeding and vertical transmission.
The Safe Delivery App is a free application that is already being used by midwives and other skilled health personnel providing care during childbirth in over 40 countries worldwide. Thereby, the partners are leveraging an existing platform that is already reaching thousands of frontline health workers. All current users of the App will receive a pop-up message creating awareness about the new module and the importance of taking precautions during COVID-19. It works offline once downloaded, making it easy to use in remote settings without a stable internet connection. The new COVID-19 content in the App is available in English as of today and will be available in French in the near future. The content of the Safe Delivery App is updated according to WHO standards and guidelines.
Laerdal Global Health has 10 years of experience of simulation-based training for midwives and other health care providers in low resource settings through the Helping Mothers Survive and Helping Babies Survive training programmes, implemented in over 80 countries. The current collaboration on merging scenarios for simulation into the Safe Delivery App will expand use of the App and support training in an efficient way, supporting the midwives where they are working.
In Moshi in northern Tanzania, senior nurse-midwife at Mawenzi Regional Hospital Anne Shuma and her colleagues have just been introduced to the new COVID-19 module in the Safe Delivery App. The hospital is one of the hospitals in the country selected for receiving COVID-19 patients, and preparations are in full motion to prepare isolation centers, so they are ready when the first cases arrive. In the first week of April alone, they had 50 deliveries in the hospital.
“Going through the Safe Delivery App and the COVID-19 module made us realise that we were not prepared to receive pregnant women with suspected COVID-19. Immediately, we prepared a delivery kit and brought it to the isolation center and prepared a cube where suspected cases can give birth. We have now developed checklists based on the content in the App, so we are ready for when suspected cases come. It’s a very helpful tool for us midwives in an outbreak like this. It takes a concrete case and gives guidelines that are aligned with our national guidelines; procedures for handwashing and how to handle personal protective equipment. The App has opened our minds, we’re prepared now”, says Anne Shuma, who will spend the next weeks training fellow midwives and nurses in nearby clinics and hospitals to use the Safe Delivery App in their preparations for the COVID-19 response.
Case Study
UNFPA Papua New Guinea, through a DFAT- supported regional initiative across the Asia Pacific, also embarked on a roll-out of the Safe Delivery App and conducted a training of 18 midwives and health workers in the Western Province in collaboration with the Maternity Foundation and the UNFPA Asia Pacific Regional Office. The training was conducted virtually through Zoom with in-person support and facilitation from UNFPA Papua New Guinea country office staff. Less than 24 hours after completing the training, Polycard Iwik, a Resident Medical Officer from the Rumginae Rural Hospital, went back to his workplace and received a woman who presented with an incomplete miscarriage and had developed sepsis. Polycard immediately referred to what had been covered in the training and cared for the woman step by step using the guidance on the Safe Delivery App - saving the woman’s life!
Dr. Natalia Kanem, Executive Director UNFPA:
“The enormity of the COVID-19 crisis and its consequences is testing us all. As essential frontline health care workers, midwives must be protected and prioritized so that they can continue providing quality care to women and their newborns during the pandemic. UNFPA is pleased to collaborate with the Maternity Foundation, Laerdal, ICM and University of Copenhagen in developing innovative online resources to support midwives and other maternity care providers working in the field. These new digital tools will enable them to access the latest evidence-based approaches to care delivery in the context of COVID-19.
Dr. Sally Pairman, CEO of the International Confederation of Midwives:
“Midwives everywhere are frontline health care professionals in the face of the coronavirus, providing essential care to pregnant women and their babies during the childbirth continuum, despite the risk this presents to their own health. Many midwives have never had to work in pandemic situations before, and for everyone, the coronavirus is new. In speaking with our Midwives’ Association members, we've been saddened by news of midwives dying from COVID-19, simply because they were not adequately protected from the virus or did not have proper information on how to protect themselves. It’s essential that midwives and all other health professionals providing maternity care can access up-to-date and evidence-based advice on the changes they need to incorporate into their practice to keep women and their babies, and themselves, as safe as possible. The new modules in the Safe Delivery App will help guide midwives everywhere with advice they can count on.”
Chairman of Laerdal Global Health, Tore Laerdal:
"Our mission has always been helping save lives, and now it has come even closer. During these extraordinary days, we work even harder towards our mission. There are hundreds of thousands of health workers who heroically continue to work through challenging situations and are in need of all the support we can offer. We hope our manikins and simulation solutions will be the helping hand that will support them in providing safe and respectful care."
CEO of Maternity Foundation, Anna Frellsen:
“The direct and indirect consequences caused by the covid-19 pandemic can be fatal for mothers and newborns in many parts of the world. The Ebola outbreak in West Africa in 2013-16 showed a dramatic increase in maternal deaths because the health system was under too much pressure to fight the pandemic to also provide quality care. In a situation like this, we need to respond fast, and we need to do it together. By building on an existing digital platform and our global partners’ strong channels, we are now availing essential clinical guidelines instantly to midwives, even in some of the most vulnerable settings.”
How to download the Safe Delivery App:
- Search for Safe Delivery App in Google Play or App store
- Click Download – the App is free of charge
- Open the App and select language version – the COVID-19 content is in the global English version
- If you already have the Safe Delivery App on your phone: Update the App, and the COVID-19 module will appear in the global English version
ICM’s Stronger Together series listens to midwives and women from around the globe
"Students Learn about Birth Process during Training" by USAID_IMAGES
Over the past three months, ICM, together with leading international partners in global development and health, have been conducting a series of virtual conversations with midwives and the women they support. These conversations have taken place on webinars and podcast episodes.
Early on in the series, we facilitated a panel discussion with New & Student Midwives on improving recruitment and retention within the profession. This discussion brought together pre- and in-services midwives from a range of backgrounds, each highlighting their hopes for the future of midwifery and underscoring the challenges of learning within the context of COVID-19. In the below video, we’ve featured thoughts from each panelist to give you a sense of how new and student midwives are managing during this pandemic.
The stories shared during our Stronger Together webinar series will inform our Decade of the Midwife campaign. As mentioned by Franka and Anneka in the foreword of this magazine, the Decade of the Midwife centers midwives as the key to achieving a drastic reduction in maternal and newborn death by the year 2030. Together with a committed coalition of partners, this campaign aims to inspire a pathway toward strengthened and empowered maternal and newborn health sectors.
The webinar series informing this campaign will continue into 2021, but before we close out the year, we’re excited to bring you the stories of two Maori midwives from New Zealand.
In partnership with UNFPA and the Wilson Center’s Maternal Health Initiative, this podcast episode features an interview with Camille Harris and Waimarie Onekawa. Both midwives have dedicated their careers to providing culturally specific, midwife-led care to birthing women in their communities. This episode is one of three conversations highlighting the experiences of indigenous midwives and the women they care for. We look forward to bringing you the remaining conversations at the beginning of next year.
How to provide short- and long-term protection for women affected by COVID-19
Franka Cadée President, International Confederation of Midwives, Toyin Ojora-Saraki founder-president of The Wellbeing Foundation Africa & Neha Mankani, Young Midwife Leader, International Confederation of Midwives.
The current COVID-19 outbreak continues to cripple health services worldwide. As the World Health Organization has widely publicised, an estimated shortage of 350,000 midwives globally meant midwives were already under pressure even before the pandemic kicked in. Midwives now strive to balance disease prevention with the continuation of midwife-led continuity of care for women and their babies.
The challenges presented by this balancing act were evident during the recent Global Nursing & Midwifery Triad Meetings, where Sally Pairman, chief executive of the International Confederation of Midwives, discussed how midwives are eager for increased involvement in global conversations pertaining to maternal health.
In our respective roles as ICM president, global goodwill ambassador, and young midwife leader, we have listened to midwives carefully to understand their current challenges and continue to advocate on their behalf within regional, national, and international circles. We have drawn on experiences from Nigeria and Pakistan — the respective home countries of Toyin and Neha — to highlight the current state of midwifery.
These front-line experiences are reflected in ICM’s global calls to action for governments, decision-makers, donors, and health institutions to ensure the protection of midwives, women, and newborns during the COVID-19 pandemic and beyond.
The following calls to action emerged:
1. Recognize midwives as essential workers and give them PPE
Many midwives in countries around the world are not recognised as essential health workers and are denied access to personal protective equipment as a result. This reality is playing out in Nigeria, where unprotected midwives have been infected, while in Pakistan our fellow midwives are having to turn away women who are coronavirus-positive or presumed positive, out of understandable concern for their own health and safety.
Comparably, Nigerian and Pakistani women have been terrified of the threat of the virus, resulting in skipped antenatal and postnatal appointments and home deliveries aided by untrained birth attendants who lack adequate information to make informed decisions about their care.
2. Protect women’s rights to a positive birthing experience
As a predominantly female workforce, midwives face the same gender inequalities that put women and girls at the highest risk during any crisis, with increases in gender-based violence, deprioritisation and defunding of essential health and social services, and inherent biases within institutions and systems that see the female workforce operating in unpaid, unsafe environments.
3. Support midwives in continuing to help women — even during pandemics
When staff and services are under extreme stress, there is a real risk of increasing avoidable harm, including a heightened risk of infection, disrespect, morbidity, and mortality — all indicators of a reduction in quality of care. As we already face the reality that at least 800 women per day are dying from preventable causes related to pregnancy and childbirth globally, the continuation of near-normal care for women should be prioritised to ensure we do not reverse progress made in lowering maternal death rates in the past decade.
4. Stop the redeployment of midwives and ensure the quality of midwifery
In countries around the world, midwives are being redeployed outside of their scope of practice to care for coronavirus-positive patients. Midwives in Pakistan, for example, have reduced their maternal health responsibilities in favour of performing COVID-19 testing and other pandemic-related tasks.
5. Include midwives in policy, decision-making, planning, and response to COVID-19
The redeployment of midwives typifies the broader issue of midwives being excluded from decision-making processes around maternal health services. This is a long-standing trend that has been exacerbated by the current pandemic. If midwives had been included in policy, decision-making, planning, and response to COVID-19 early on, they might not have been deployed to other sectors, and the provision of male PPE for a female workforce would have been avoided — fostering safer, more effective care.
6. Prioritize women’s sexual health and reproductive services
It is equally important to centre women’s voices during this time when their sexual and reproductive rights are being ignored. Around the world, midwives are noting that a shortage of healthcare workers, a reduction in pharmaceutical supplies, and depleting health finances have contributed to a disruption or stoppage of essential health services. In Pakistan, for example, many women haven’t been able to access basic reproductive services such as family planning support and post-abortion care, resulting in an increase in unwanted pregnancies.
We must come together to collectively call on governments to invest more in midwives globally and include midwives and women in global health leadership and decision-making. ICM’s calls to action seek to spell out how governments and decision-makers can make this a reality. Resilience is a common characteristic of midwives, but we must still ensure this is the last time the world is caught unprepared for a global health crisis such as this one.
“Resilience is a common characteristic of midwives, but we must still ensure this is the last time the world is caught unprepared for a global health crisis such as this one.”
Midwives on the front lines working to reverse Afghanistan’s high maternal death rate
“It was midnight on 6 August when there was a loud knocking at my front door. My husband answered. Standing in the dark was a person asking for my help – a baby was being born,” Shirin described to UNFPA.
It was the start of the greatest challenge she had ever faced as a midwife.
Shirin, 31, manages a family health house in Usho Golaka Village, in Daikundi Province. Family health houses are community-based facilities that provide a host of basic reproductive health services in remote communities, including family planning, antenatal care, safe delivery services, newborn care and immunizations.
She knew the man. He was a relative of Fatima, one of her patients. “Tonight her situation was critical,” Shirin said.
Fatima, already a mother of six children, was in labour with her seventh. Shirin was immediately alarmed – an earlier examination had shown that the delivery would be dangerous.
“Fatima’s baby was found to be in the wrong position and the delivery was to be a breach birth,” Shirin explained. “I'd provided information and counselling on her condition, but advised her to refer the case to the provincial hospital in Nili, the center of Daikundi, for further management of her delivery.”
But Fatima’s family couldn’t afford to seek care so far from home. “We’re a poor family and the economy and unavailability of transport was a big problem for us,” Fatima said. “We would have had to pay 13,000 afghanis [$170] for transport to reach the provincial hospital in Nili. This was not possible.”
Midwives to the rescue
Afghanistan has one of the highest maternal mortality rates in the world, according to United Nations data. Some 638 women die per 100,000 live births. Poverty, lack of access to health services and gender inequality all contribute to these tragically high numbers; fewer than 60 per cent of births are overseen by skilled health professionals.
To address these concerns, UNFPA supports Afghanistan’s community midwifery education programme, a training programme funded by the Canadian Government, which equips midwives to provide essential basic maternal health services and other midwifery care. These midwives then operate from UNFPA-established family health houses, which provide the only medical services available in Afghanistan’s remotest and most difficult-to-reach areas.
Shirin graduated from the community midwifery education programme in 2015. She has since worked in the family health house in Usho Gholaka, where she has served hundreds of women.
Her husband is supportive of her work. That night, he took her by motorbike to the village where Fatima and her family live.
“The intent was to save a mother and her baby,” her husband said. “I’ve pledged to support my wife in this work, even if it’s midnight.”
Thinking on her feet
Shirin found Fatima suffering in terrible pain, shouting for help. She tried to find a way for the family to urgently transport Fatima to the provincial hospital, but the family felt it was impossible.
Although Shirin is an experienced midwife, she is not equipped to managing serious complications like breach delivery. But in that situation, she was forced to improvise.
“I called an expert gynaecologist who was working in the provincial hospital and asked for instructions. This was the only solution I could come up with that might save their lives. I was instructed to use different manoeuvres to shift the position of the baby in the womb. I followed the gynaecologist’s guidance carefully.”
It was a tense labour – but in the end, her efforts paid off.
“Finally, the uterine contraction began and a baby boy was born after one hour and 45 minutes of labour. He was safe and healthy,” Shirin recalled.
Fatima’s family was greatly relieved.
“When I heard that Fatima and her baby were alive, I can’t tell you how happy I was,” Fatima’s mother-in-law told UNFPA. “I am so grateful to Shirin for being there and helping women in need.”
Fatima later brought her newborn to the family health house for postnatal services. “I’m grateful to Shirin,” she said. “She saved not only my life but also the life of my child.”
And Shirin, too, is grateful. Though the experience was harrowing, she feels she has grown as a midwife.
“I was very proud of what I did,” she said.
“Shirin graduated from the community midwifery education programme in 2015. She has since worked in the family health house in Usho Gholaka, where she has served hundreds of women.”
COVID-19 has disproportionately affected black mothers in America
Franka Cadée President, International Confederation of Midwives & Pandora Hardtman Board Member, North America and the Caribbean, International Confederation of Midwives.
Today, black American women are three to four times more likely to experience a pregnancy-related death than white women, regardless of education, income, or other socioeconomic factors. This dismal truth is a brutal indicator of the pervasive inequalities in our systems.
During the Black Lives Matter movement, inside the confines of the global COVID-19 pandemic, we’ve been painfully reminded of the distressing maternal health outcomes for black American women highlighted in media reports, political speeches, and within the communities impacted by their real-life consequences.
As midwives, one black, and one white, and both with extensive experience working within high, middle and low-resource countries, we’ve come together to highlight the realities facing birthing and pregnant women navigating maternal and newborn care in the United States. It’s through this lens we provide our thoughts on a pathway forward amidst unprecedented social and economic upheaval.
How has this global pandemic aggravated the issue?
As midwife leaders, we’re frequently contacted by members of our global midwife community with alarming anecdotes regarding this pandemic’s impact on the health outcomes of pregnant and birthing women.
Emerging research indicates low and middle-income countries could see an additional 28,000 maternal deaths and 168,000 newborn deaths resulting from the impacts of COVID-19. The United States, despite its high-income country status, is already documenting compromised sexual and reproductive health services, disproportionately impacting low-income and minority communities.
Now, pair this new reality with the knowledge that, prior to “Rona”, black Americans were experiencing substantially higher rates of maternal and neonatal mortality, preterm birth, low birth weight and a culture of disrespect compared to their white counterparts. Comments like the one shared below by a practicing midwife indicate COVID-19 could worsen this disparity: as black midwives, we’re worried that if we get sick, no one will be left to care for our black patients.
What is the role of white women within this issue?
As women, we understand the emotional, social, and economic impacts of sexism, and can transfer this knowledge to our understanding of racism. True allyship is grounded in action: calling out friends’ behaviours and searching for authentic opportunities to connect with women of colour.
Perhaps most importantly, as white women, we need to sit with our discomfort and acknowledge that comfort is complicity – this is especially true in our hyper-connected digital era where entire movements are accessible on our devices.
A comment made to us by one black midwife on the frontlines of this pandemic, does a good job underscoring this topic: “Women of colour are tired of doing the emotional labour that comes with calling out offensive behaviours on the part of white people – start calling each other out!”
So, where do we go from here?
Maternal morbidity and mortality among black American women are complex issues made more complex by the reality that every system, and every individual plays a role in combating racism. For this reason, confronting the institutions preventing true health equality requires concerted effort from governments, civil society, academia, media, and the private sector.
At a policy level, we know women of colour must have proportional representation in decision-making roles, and appointments such as a Chief Midwife Officer and a Minister of Gender Equality go a long way toward improving health outcomes for marginalised communities.
Investing in midwives and the sexual and reproductive health services we provide will lead to improved health outcomes for black American women. Within this knowledge is the need to grow and diversify the United States’ largely white maternity care workforce. It’s midwives, practicing within a supportive team providing the continuity of midwifery care based on skill and trust, who are uniquely equipped to respond to the culturally specific needs of minority women. This is not new – we know what works, now let’s make it happen!
“As black midwives, we’re worried that if we get sick, no one will be left to care for our black patients.”
On the Black Lives Matter protests and other mass demonstrations against systemic racism and police brutality
Joint reflections by United Nations Senior African Officials (*)
A desperate yearning for a long-departed mother. Reaching deep from the bowels of fragile humanity. Grasping for breath. Begging for mercy. The entire world heard the tragic cry. The family of nations saw his face pounded against the harsh tarmac. Unbearable pain in broad daylight. A neck buckling under the knee and weight of history. A gentle giant, desperately clinging to life. Yearning to breathe free. Till his last breath.
As senior African leaders in the United Nations, the last few weeks of protests at the killing of George Floyd in the hands of police, have left us all outraged at the injustice of racism that continues to be pervasive in our host country and across the world.
Not enough can ever be said about the deep trauma and inter-generational suffering that has resulted from the racial injustice perpetrated through centuries, particularly against people of African descent. To merely condemn expressions and acts of racism is not enough.
We must go beyond and do more.
United Nations Secretary-General António Guterres stated that “we need to raise our voices against all expressions of racism and instances of racist behaviour”. Following the killing of Mr. George Floyd, the cry ‘Black Lives Matter’ resounding across the United States and throughout the world is more than a slogan. In fact, they do not only matter, they are quintessential to the fulfillment of our common human dignity.
Now is the time to move from words to deeds.
We owe it to George Floyd and to all victims of racial discrimination and police brutality to dismantle racist institutions. As leaders in the multilateral system, we believe it is incumbent upon us to speak for those whose voices have been silenced, and advocate for effective responses that would contribute to fight systemic racism, a global scourge that has been perpetuated over centuries.
The shocking killing of George Floyd is rooted in a wider and intractable set of issues that will not disappear if we ignore them. It is time for the United Nations to step up and act decisively to help end systemic racism against people of African descent and other minority groups “in promoting and encouraging respect for human rights and for fundamental freedoms for all, without distinction as to race, sex, language, or religion” as stipulated in Article 1 of the UN Charter. Indeed, the foundation of the United Nations is the conviction that all human beings are equal and entitled to live without fear of persecution.
It was at the height of the civil rights movement in the United States and during the emergence of post-colonial independent African nations joining the United Nations, that the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) came into force in 1969.
This was a pivotal time in history. The collapse of apartheid in South Africa, driven in part by the United Nations, was one of the Organization’s proudest achievements.
The human rights and dignity of black people in Africa as well as across the African diaspora resonated as a powerful signal to future generations, that the United Nations would neither turn a blind eye on racial discrimination nor tolerate injustice and bigotry under the cover of unjust laws. In this new era, the United Nations must in the same vein use its influence to once again remind us of the unfinished business of eradicating racism and urge the community of nations to remove the stain of racism on humanity.
We welcome the initiatives by the Secretary-General to strengthen the global anti-racism discourse, which would address systemic racism at all levels, as well as its impact wherever it exists, including in the United Nations Organization itself.
If we are to lead, we must do so by example. To initiate and sustain real change, we also must have an honest assessment of how we uphold the UN Charter within our institution.
Our expression of solidarity is well in keeping with our responsibilities and obligations as international civil servants to stand up and speak out against oppression. As leaders we share the core beliefs and the values and principles enshrined in the Charter of the United Nations that do not leave us the option to keep silent.
We commit to harnessing our expertise, leadership and mandates to address the root causes and structural changes that must be implemented if we are to bring an end to racism.
Almost 500 years after the revolting Transatlantic trade of Africans began, we have arrived at a critical point in the arc of the moral universe as we approach in 2024 the end of the International Decade for People of African Descent, a mere four years away. Let us use our collective voice to fulfill the aspirations of our communities that the United Nations will wield its moral power as an institution to effect global change. Let us use our voice to contribute towards the realization of Africa’s own transformative vision contained in Agenda 2063 which is consistent with the world’s Agenda 2030.
Africa is the cradle of humanity and the forerunner of human civilizations. Africa as a continent must play a definitive role if the world is to achieve sustainable development and peace. That was the dream of the founders of the Organization of African Unity, that was also the strong belief of prominent leaders such as Kwame Nkrumah and eminent intellectuals such as Cheikh Anta Diop.
Let us never forget the words of President Nelson Mandela: "To deny people their human rights is to challenge their very humanity."
Let us ever bear in mind the admonition of civil rights leader Fannie Lou Hamer: “Nobody’s free until everybody’s free”, who was echoed by Dr. Martin Luther King Jr., “Injustice anywhere is a threat to justice everywhere”.
Their words were later embodied into the rainbow of the diverse nation of South Africa, as spelled by the peacemaker Archbishop Desmond Tutu when he stated that ``Black liberation is an absolutely indispensable prerequisite to white liberation - nobody will be free until we all are free.”
(*) All signatories listed below are senior UN officials who hold the rank of Under Secretary-General. They signed this Op Ed in their personal capacity:
- Tedros ADHANOM GHEBREYESUS
- Mahamat Saleh ANNADIF
- Zainab BANGURA
- Winnie BYANYIMA
- Mohamed Ibn CHAMBAS
- Adama DIENG
- François Lounceny FALL
- Bience GAWANAS
- Gilbert HOUNGBO
- Bishar A. HUSSEIN
- Natalia KANEM
- Mukhisa KITUYI
- Kingsley MAMABOLO
- Phumzile MLAMBO-NGCUKA
- Mankeur NDIAYE
- Parfait ONANGA-ANYANGA
- Moussa D. OUMAROU
- Pramila PATTEN
- Vera SONGWE
- Hanna TETTEH
- Ibrahim THIAW
- Leila ZERROUGUI
“We commit to harnessing our expertise, leadership and mandates to address the root causes and structural changes that must be implemented if we are to bring an end to racism.”
What we learned from the 50,000 Happy Birthdays project
Mugirente Angelique, Tachawet Salilih Zeleke, Lucy Mabada
Improving maternal and newborn health remains at the heart of many of the issues we face as a global health community, and here in Ethiopia, Rwanda, and Tanzania, this issue is especially relevant.
Maternal deaths in our region accounted for approximately two-thirds of the global maternal deaths in 2017, and a child in sub-Saharan Africa is 10 times more likely to die in their first month compared to a child born in the global north. The majority of maternal deaths due to difficulties during pregnancy and giving birth could be prevented according to the latest “State of World’s Midwifery” report.
Between 2018 and 2020, the 50,000 Happy Birthdays project aimed to save the lives of thousands of mothers and newborns in Ethiopia, Rwanda, and Tanzania. Throughout this project, we have seen how competent midwives can help reverse preventable mortality rates.
In our three countries, more than 18,500 midwives and other health care providers have been trained to improve management of birth asphyxia, newborn prematurity, post-partum hemorrhage, and eclampsia. Across the project implementation sites, internal project data indicated a 26% reduction in stillbirth rates in Ethiopia, a 57% reduction in newborn deaths in Rwanda, and a 33% reduction in maternal deaths in Tanzania.
We have come together as midwives and project managers to draw on our experiences and outline ways in which maternal and newborn health care can be strengthened in our respective countries as COVID-19 continues to further compromise efforts to improve maternal and newborn health.
Provide frequent, simulated training to student midwives
The 50,000 Happy Birthdays project addressed both preservice and in-service health providers, aligning the knowledge and skills of students with experienced clinicians, ultimately decreasing the disparity between theory and practice.
Through the project, life-like maternal and newborn mannequins were provided to universities and colleges, allowing students to practice and feel confident performing simulated obstetric emergency skills prior to entering a health facility and caring for patients.
We saw that students who were trained during this project had confidence to resuscitate a newborn, call for help to manage bleeding after birth, and could identify signs of life-threatening complications. These findings showed that parallel training of midwifery students and practicing midwives improves communication and collaboration between health care providers and improves quality of care for women and newborns.
In 2019, Rukia Ramadhani Shaban, a midwife of seven years from Tanzania’s Pwani Region, attended a 50,000 Happy Birthdays training where she learned core midwifery skills. Recently, she was able to put her training to use during a delivery where a mother was experiencing rapid blood loss. Rukia recognized the symptoms of a postpartum hemorrhage and administered a dose of oxytocin, helping the mother to deliver the placenta and ultimately saving her life.
Increase the competencies of in-service midwives
Midwives are integral to the childbirth continuum — they support women and their communities with prenatal and newborn care, breastfeeding, family planning, and screening for HIV, among many other responsibilities.
There is a global shortage of midwives which may contribute to high death rates of mothers and babies across the continent, and the death rates of birthing women and newborns may be on the rise as a result of diverted attention from maternal health sectors to the management of COVID-19.
Through the 50,000 Happy Birthdays project, we’ve managed to increase the number of competent in-service midwives significantly in all three regions. In Ethiopia alone, the project has trained 12,000 midwives and other health care professionals to effectively manage the most frequent complications that arise during birth. But much more needs to be done to ensure young people in underresourced countries and around the world are pursuing a career in midwifery.
Bring greater awareness and autonomy to the profession of midwifery
Around the world, we see midwifery continually conflated with nursing, and our three countries are no exception. The necessity and value of each profession is undisputed. However, in conflating the two, we risk negatively impacting midwives, women, and newborns. Nurses sometimes end up representing midwives in policy- and decision-making conversations pertaining to maternal and newborn health. Nurses typically focus on the treatment of the sick and injured, whereas midwives see pregnancy and birth as normal life events that usually don’t require medical intervention.
Rwandan facilitators of the 50,000 Happy Birthdays regularly worked with women and communities who were unaware of the differences between nurses and midwives. As a result, they lacked adequate or correct information about how birthing experiences can be improved with the care provided by a well-trained midwife. An unintended but positive outcome of this project was the opportunity to correct these common misconceptions.
Perhaps more significantly, we see firsthand that the limited availability of competent midwives is a significant impediment to achieving Sustainable Development Goal 3.
To increase the number and status of midwives, advocacy is essential, not only through highlighting the achievements of initiatives such as the 50,000 Happy Birthdays project but also through the strengthening of midwives' associations, positioning these organizations to collaborate with ministries of health and inform policies that impact mothers and newborns.
From 2018 – 2020, the 50,000 Happy Birthdays Project contributed substantially to quality maternal and newborn care in Ethiopia, Tanzania, and Rwanda by strengthening midwives' competencies in saving lives at birth. Ultimately, this project enabled midwives to save thousands of mothers and babies across all three countries.
Across the project implementation sites, a 26% reduction in stillbirth rates was seen in Ethiopia, a 57% reduction in newborn deaths in Rwanda and a 33% reduction in maternal deaths in Tanzania.
In partnership with Laerdal Global Health, we’re thrilled to be launching the 50,000 Happy Birthdays report — a comprehensive look into the driving forces behind the success of this project, and a resource for funders, Midwives’ Associations and other groups aiming to implement similar initiatives in their respective contexts.
Young Midwife Leaders fight for women, newborns and communities amidst pandemic
Like all midwives, ICM’s Young Midwife Leaders (YMLs) have had to adapt during these extraordinary times, finding creative ways to uphold care for newborns and pregnant and birthing women while continuing to advocate for healthcare reform within their respective contexts.
Explore the page below to learn how our YMLs are supporting their communities during the fight against COVID-19.
About the YML programme: The YML programme is a 2-year programme created by ICM with support from Johnson & Johnson Foundation. The program provides selected young midwives with a unique opportunity to learn how to develop as leaders in their professional lives and the communities they work in. The programme challenges young midwives to broaden their knowledge of key policy areas in maternal and newborn health and create innovative projects to address some of the biggest global health challenges of today. Our current cohort of YMLs will complete the programme in June of 2021. For more information, visit the project page on the ICM website.
Sylvia Hamata - Namibia
In her role as a SheDecide Champion and ICM YML, Sylvia published a joint op-ed in May with a colleague from Marie Stopes International on the role midwives play in providing safe abortion and post-abortion care.
Harriet Nayiga - Uganda
This past August, Harriet was interviewed by Seed Global Health on her work to prevent teenage and unplanned pregnancies in Uganda.
Tekla Mbidi - Namibia
Earlier this fall, Tekla wrote an op-ed for Namibia’s New Era paper on the far-reaching benefits of respectful maternity care.
Bartholomew Kamlewe - Zambia
In October, Bartholomew opened a hospital cafeteria in rural Zambia. Part of proceeds from the cafeteria will go towards the sustainable renovation of the mother's shelter.
Bounmy Inthavong - Canada/Laos
In July, Bounmy appeared on the Good Birth For All podcast with ICM CE, Sally Pairman to call on governments and decision-makers to protect midwives and sustain care for women and birthing people, newborns + their families during COVID-19 pandemic.
Luseshelo Fanny Simwinga - Malawi
In the spring, Luseshelo wrote an op-ed for White Ribbon Alliance on providing respectful maternity care amidst the COVID-19 pandemic.
Neha Mankani - Pakistan
June 25, 2020 - Neha appeared on the BBC to discuss the challenges birthing women in Pakistan are facing during this pandemic.
Samson Udho - Uganda
In an ICM blog post published earlier this year, Samson discusses his efforts to prevent maternity wards from being transformed into quarantine treatment centres.
Sebabatso Makafane - South Africa
Throughout the past year, Sebabatso conducted advocacy initiatives through her organisation, Black Woman Arise Women’s Health Foundation — a registered NPO aimed at promoting the sexual and reproductive health and rights of all women, regardless of their background.
Olajumoke Adebayo - Nigeria
In September, Olajumoke was interviewed about her career as a midwife by Devex. In the interview, Olajumoke advocates for pursuing a career in midwifery.
UNFPA celebrates Nairobi Summit anniversary
In November 2019, more than 8000 delegates from 170 countries descended on Nairobi to recommit to the goals set forth at the International Conference on Population and Development (ICPD) held in Cairo in 1994. The landmark conference declared reproductive and sexual health as a fundamental right and affirmed empowering women and girls is the bedrock to a just, safe, and equitable world.
The 2019 Nairobi Summit advanced the Cairo agenda. Governments, corporations, organizations, and individuals pledged more than $8 billion and 1,300 commitments toward meeting three zeros by 2030, the same deadline for accomplishing the Sustainable Development Goals: zero unmet need for family planning; zero preventable maternal deaths; and zero gender-based violence and harmful practices, including child marriage and female genital mutilation.
The ICM advocacy toolkit and video: a midwife's guide to delivering sustainable change
What do you think of when you hear the word advocacy? How can midwives use this concept to bring about small and large-scale change?
ICM has developed an advocacy toolkit to empower Midwives’ Associations and individual midwives with the skills they need to address the range of issues impacting midwives and the women, newborns and communities they care for. Additionally, we have launched a COVID-19 specific advocacy video to help midwives continue the fight against the virus.
The Maternal and Newborn Health Thematic Fund Annual Report 2019
The latest 2019 annual report of the UNFPA Maternal and Newborn Health Thematic Fund (MHTF), which marks the first year of implementation of MHTF Phase III, highlights UNFPA's key strategies and achievements to end preventable maternal and newborn mortality and morbidity and accelerate the progress towards universal health coverage.
The MHTF continued to build on its strength to offer a unique platform for delivering on the United Nations Secretary-General’s Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), using an integrated, holistic, rights-based, person-centred, life-course approach to the delivery of comprehensive sexual, reproductive, maternal and newborn health services. Using strategically designed, high-impact, catalytic programmes with multi-stakeholder engagement, and numerous global and national partners, the MHTF continued to roll out and operationalize the six pillars of UNFPA’s Global Midwifery Strategy (2018-2030); build, strengthen and monitor EmONC networks; strengthen MPDSR systems; and support the implementation of the 2018 Secretary-General’s resolution on intensification of efforts to end fistula within a decade (by 2030).
Respect Toolkit: addressing disrespect and abuse in antenatal or childbirth care
In 2018, ICM began developing a series of workshops on Respectful Maternity Care to present at our regional conferences in Dubai, Paraguay and Namibia. At each workshop, there was an overwhelming call for more education and support to change the behaviour of health workers caring for women during pregnancy and birth. Many recent studies show that disrespect and abuse of women are common, ranging from verbal abuse and physical violence to stigma and discrimination. This occurs in low and high-income countries at an alarming rate and is contributing to women declining to access essential antenatal or childbirth care.
Supported by UNFPA, ICM has continued to work on developing resources and materials to be openly available and widely disseminated for midwifery educators, hospital managers, in-service teachers, country midwife advisors, and development partners. The RESPECT toolkit provides step by step guidance on why and how to run a workshop on Respectful Maternity Care. In addition, we have added many videos, lesson plans, PowerPoint slides, and reference documents with a facilitator guide on how to go through each step of a workshop. It is intended these materials are adapted for local use, and are available in English, French and Spanish.
At a time in a woman’s life when she is the most vulnerable, she is in the hands of those who are meant to protect and provide her with safety and care. As midwives, we need to reflect on the voices of women who have unequivocally told us that what they want is respectful care. Please join ICM in its strategy to create zero tolerance for disrespect and abuse.
ICM launches new mentoring resources, empowering midwives to deliver high-quality leadership.
Mentoring is a powerful leadership skill that ICM believes can support and encourage reflective practice, quality improvement, life-long learning and teamwork amongst midwives. After consultation with member associations in 2018, ICM adopted the following definition of mentoring: A reciprocal learning relationship in which a mentor and mentee agree to a partnership where they work together toward achievement of mutually defined goals that will develop a mentee’s skills, abilities, knowledge and/or thinking.
Mentoring is a process that aligns well with midwifery practice and approaches to care, and the mentoring relationship reflects principles found in ICM’s Philosophy and Model of Midwifery Care and International Code of Ethics: respect, trust, equity, shared control, self-determination, participation and partnership. The same principles are found in all of ICM’s Core Documents – Global Standards for Midwifery Education and Regulation, Essential Competencies for Midwifery Practice, Bill of Rights for Women and Midwives and various Position Statements.
ICM, with the support of UNFPA, developed a mentoring guide in 2019, and this year, we have created an online mentoring programme on ICM’s eLearning platform. The programme has been designed for midwives who wish to become mentors, and can be used by Midwives Associations, midwifery schools and institutions, and in the workplaces of midwives. Together, the mentoring guide and programme will empower midwives to create a nurturing environment for others to learn and be confident in their midwifery practice and to role model respectful, high quality leadership.
Coming soon: new e-learning tools for midwives' associations, midwifery education institutions, educators and midwives in clinical practice
ICM is committed to providing its Member Associations with educational resources, workshops, and other professional learning activities. This year, we have been developing eLearning courses on Moodle, our new learning management system.
These eLearning modules have been designed for use by Midwives Associations, Midwifery Education Institutions, Educators and midwives in clinical practice, and cover topics such as Respectful Maternity Care, Mentoring, and ICM’s core philosophies, principles and values.
While these modules are not intended to replace face-to-face workshops, conferences and congresses, they will complement the resources already available on ICM’s website. Each module will be available in English, French and Spanish and suitable for mobile device use with easy to follow navigation instructions and downloadable content.
We look forward to sharing these modules with you in 2021.
Acknowledgements
Publication
January 2021
Copyright 2020
The International Confederation of Midwives (ICM)
The United Nations Population Fund (UNFPA)
Special thanks to
Ann Yates
Anneka Ternald Knutsson
Charlotte Renard
Florence West
Franka Cadée
Global Office Consulting
Martha Bokosi
Morgane Schmidt
Sally Pairman
Sigrid Engström
UNFPA Asia Pacific Regional Office
Supported by
The United Nations Population Fund (UNFPA)
Content compiled by
Eleanor Gall
Geeta Lal
Molly Karp
Ony Anukem
Paula Owino
Sarah Bar-Zeev
Translations by
Camila Negrón-Rodriguez (Spanish)
Carole Chatelet-Hing (French)
Lina Andrea Preciado de Novak (Spanish)
Polly Lorelli (French)
Roxanna Azimy (French)
Published by
RedOrange Media and Communications
/27
1
Cover
2
Foreword
3
Index
4
Global leaders deliver salute to Year of the Nurse and the Midwife
5
2020 Reflections from our Board Members
6
The State of the World’s Midwifery (SoWMy) 2021 is coming!
7
UNFPA mourns loss of Henriette Eke Mbula, Country Midwife Advisor DRC
8
Record number of midwives attend 8th Triad Meeting
9
The Year of the Nurse and the Midwife 2020: The Wilson Center and UNFPA partnership
10
Did you hear the news? The ICM 32rd Triennial Congress is going virtual!
11
Preterm Births and Midwifery
12
COVID-19 guidelines from ICM and partners: tailored resources for midwives and birthing women
13
A digital response to help ensure safer childbirths during COVID-19
14
ICM’s Stronger Together series listens to midwives and women from around the globe
15
How to provide short- and long-term protection for women affected by COVID-19
16
Midwives on the front lines working to reverse Afghanistan’s high maternal death rate
17
COVID-19 has disproportionately affected black mothers in America
18
On the Black Lives Matter protests and other mass demonstrations against systemic racism and police brutality
19
What we learned from the 50,000 Happy Birthdays project
20
Young Midwife Leaders fight for women, newborns and communities amidst pandemic
21
UNFPA celebrates Nairobi Summit anniversary
22
The ICM advocacy toolkit and video: a midwife's guide to delivering sustainable change
23
The Maternal and Newborn Health Thematic Fund Annual Report 2019
24
Respect Toolkit: addressing disrespect and abuse in antenatal or childbirth care
25
ICM launches new mentoring resources, empowering midwife educators to deliver high-quality leadership
26
Coming soon: new e-learning tools for midwives' associations, midwifery education institutions, educators and midwives in clinical practice
27
Acknowledgements
