Results

The impact on women’s ability and confidence to access services was significant. Three quarters (75%) of the associations who responded said that women had expressed being afraid to attend maternity facilities and this was reflected in the dramatic (73%) reduction in attendance. There was as much as a 44% increase in women having home births, this could’ve been due to not being able to access care in hospitals, but not enough midwives to provide adequate care. Most startlingly, 10% of women reported being unable to access a midwife at all.

Stories behind the numbers

This data helped to quantify what many of us already knew and were experiencing. Midwives were battling through dangerous situations to continue providing care for women and newborns.

The research and case studies show what we already know to be true: resilience and perseverance are innate to midwifery. Midwives continued to uphold care despite limited resources, stoppages in pay and the stark reality of the illness, yet many of them continue to work in these situations, over a year and a half on since the beginning of the pandemic.

As we look to build back better from the effects of COVID-19, governments should look to midwife-led continuity of care models and more community-based primary health maternity services as they redesign responsive health systems that are capable of upholding quality care during health threats.

 

Every profession needs a professional framework — an informative tool aimed at strengthening the profession and guiding its development. In 2009, ICM established the original professional framework for midwifery. It was made up of three pillars: education, regulation and association. Two further elements underpinned the three pillars: the essential competencies of midwifery and midwifery research.

Over time, as the global health landscape has shifted and evolved, it has also become increasingly obvious that elements are missing from the framework. We began to see that in many countries around the world, education, regulation and association was not enough to advance the profession, even when underpinned by the essential competencies and research if they did not exist in a context conducive to supporting midwives and midwifery.

We have developed a new and improved professional framework for midwifery to reflect the evolution of our profession and better represent midwifery as it exists today. It is an illustration of why and how we exist as a profession and a representation of our core beliefs. The new and improved professional framework for midwifery will support our profession to remain relevant, innovative, and ahead of the curve.

We’ve developed the below animation to articulate the key elements of the new professional framework. This animation is only the beginning of ICM’s efforts to ensure the framework is understood by our midwives’ associations and each and every stakeholder engaged with midwives and midwifery. In early 2022, ICM will share an in-depth explanation of the new professional framework designed to support midwives to integrate the framework at a country level.

In an effort to ensure high-quality midwifery services for women everywhere, ICM sets Essential Competencies for Midwifery Practice outlining the minimum set of knowledge, skills and professional behaviours required to use the designation of ‘midwife’. In 2019, ICM revised these competencies to better accommodate the diverse cultural considerations that influence and guide the practice of midwifery around the world.

This year, ICM released the revised Global Education Standards in order to:

• Promote a common understanding and approach to midwifery education across countries of the world
• Guide the development of new programmes or the restructuring of existing programmes where qualified midwives are needed
• Assist other midwifery accrediting agencies, government health/education departments and education institutions within countries/states to develop or revise their own standards.

ICM recognizes that in setting international standards, we strive to find the competencies required by all practising midwives while keeping progress markers flexible and adjustable based on each country's context. The revised competencies produce a model that is simple and more general in scope, empowering regulators, educators and midwives’ associations to provide improved midwifery education across all settings.

You can find more about the 2019 revised competencies here.

In late 2021 and in 2022, UNFPA is set to launch new midwifery education and training resurces, some of which ICM is working closely with them on. These resources include

• A series of films on safe abortion care developed together with Global Health Media Products;
• Arabic and Spanish versions of the Safe Delivery App, along with a new module on safe abortion care developed together with the Maternity Foundation;
• E-learning modules developed together with the Liverpool School of Tropical Medicine.
• New pre-service education resources and new training modules on perinatal mental health, maternal and perinatal death surveillance and response and simulation-based training for Emergency Obstetric and Newborn Care (EmONC), as well as a facility-based mentorship toolkit and training package, developed together with Liverpool School of Tropical Medicine and Laerdal Global Health.

Education in practice: Upskilling midwives in rural Pakistan

“I was seventeen when my first daughter was born at home. My mother-in-law tells me to take care of myself and prays for my life because a mother’s life is important for little children. That is why I visit the hospital.” - Seema, a Pakistani woman who received midwife-led care at Koohi Goth Hospital, located on the outskirts of Karachi.

Every day at Koohi Goth Hospital in rural Pakistan, approximately 400 women visit the facility’s outpatient department. Noor, a senior midwife at the facility is dedicated to providing women in her rural community with high-quality midwifery services. “I sometimes feel tired but these women need us. They need care as other hospitals were closed during restrictions due to COVID-19. When we facilitate them, we forget our pain,” says Noor.

UNFPA, together with Johnson and Johnson, local governments and other civic-society partners, are conducting work in Pakistan to provide Noor and midwives across the country with refresher trainings and e-module courses on the latest professional developments, enhancing their knowledge and improving health outcomes in the process.

Reproductive, maternal, neonatal, and child health (RMNCH) indicators remain poor in Pakistan (140maternal deaths per 100,000 live births). Early childbearing and lack of awareness put women at life-threatening risks and in remote areas, health facilities are scarce and childbirths are often attended by unskilled, community midwives. Moving forward, UNFPA and its local partners plan to take the midwifery education and services in Pakistan to new levels, supporting midwives like Noor to continually deliver quality midwife-led care to women and newborns.

“At times, when I reflect over challenging cases and obstetric complications, which I managed to handle, I feel proud of being a midwife who saves lives.”

The prevention, early recognition and treatment of maternal mental health (MMH) conditions is a challenge for many health care systems across the world. We know that maternal mental health care is still not well incorporated into pre-service/pre-registration training, particularly for nurses and midwives and many other maternity care providers in LMICs (Low and Middle Income Countries) and therefore, these health care providers who have contact with women and their families across the life course do not always have the requisite knowledge and skills to adequately support the perinatal health needs of women.

Fortunately, there has been some great work that has taken place this year to help address these issues. To help strengthen the knowledge and skills of nurses and midwives in these settings, the UNFPA Asia and Pacific Regional Office together with UNFPA Headquarters and the Burnet Institute in Australia, has developed and implemented perinatal mental health capacity building training. This has been well received by midwives and other health care providers in Papua New Guinea, Bangladesh, Myanmar, Afghanistan and Laos. UNFPA together with other partners is also currently developing new resources and research to support midwifery educators to train midwives in perinatal mental health both face to face and online. These resources and research publications will be available in 2022.

UNFPA also supported the ‘Giving Voice to the Silent Burden: Maternal Mental Health Technical Consultation’ in September. The Technical Consultation was hosted by USAID MOMENTUM together with UNFPA and WHO across three days in September. The Technical Consultation was facilitated by global and local MMH experts allowing members of the maternal, newborn, child health, nutrition, and mental health communities to collaborate and inform the path forward to ensure that pregnant and postpartum women receive respectful and nurturing mental health care they need and deserve. This consultation will inform efforts to strengthen the MMH research agenda, implementation approaches, and integration within health programs and services. A commentary on the Technical Consultation and Call to Action will be published soon. Find out more here.

UNFPA Maternal Health Thematic Fund (MHTF) Report and key results

Since 2008, the MHTF has served as UNFPA’s flagship programme on maternal and newborn health. The MHTF in 2020 supported 32 countries with among the highest rates of maternal and newborn mortality and morbidity across five regions (the Arab States, West and Central Africa, East and Southern Africa, Asia and the Pacific, and Latin America and the Caribbean). The fund continued to focus on building capacities to provide maternal and newborn health care; improve the quality of care through quality midwifery services, emergency obstetric and newborn care (EmONC) and maternal and perinatal death surveillance and response (MPDSR); and prevent and treat obstetric fistula to ensure the most marginalized women and girls realize their human right to a healthy life.

The latest MHTF report has highlighted that in 2020, the MHTF supported pre-service and in-service education and training of over 31,500 midwives and the further higher education of over 2,900 midwives who graduated from bachelor’s, master’s or doctoral degree programmes. More than 500 midwifery schools have been accredited across MHTF-supported countries, aligning with WHO and ICM standards. Nineteen countries have mainstreamed midwifery in their national human resources for health policies or have existing stand-alone midwifery policies. Find out more here.