In some countries, midwifery is a recognised autonomous health profession. In other countries, midwifery struggles to attain recognition as an autonomous profession. Professional autonomy implies that midwives determine and control the standards for midwifery education, regulation, and practice. The concept of professional autonomy does not mean working alone or in isolation from women seeking care or other colleagues. It should also not be confused with terms such as ‘independent’ or “private” midwifery practice, that describe the way in which a midwife chooses her work type and income source.
Autonomous midwifery practice enables midwives to conduct their professional work by providing up-to-date, evidence-based, high-quality, and ethical care across pregnancy, childbirth and postpartum, as well as providing other reproductive health care, as set out in the ICM Definition of the Midwife. However, in some areas of the world, midwifery education and practice are being defined by those without midwifery knowledge and skills. In other areas, even though midwifery education and practice are defined by midwives, the regulation of midwifery practice rests in the hands of other health professionals or governmental authoritieswho may also seek to control and limit the scope of midwifery practice. Midwifery practice may also be restricted by the misuse of policies, protocols and contractual or employers’ obligations. An enabling environment for midwifery needs to be in place so that women and gender diverse people can benefit from of professional, autonomous midwifery care.
Midwifery is one of the oldest and most respected professions in the world. It has its roots in ancient wisdom and philosophies and maintains its contract with society in partnership with women and communities. Midwifery practice includes a commitment by each practitioner to update their knowledge and skills continuously in keeping with the ICM Essential Competencies of Midwifery Practice, the International Code of Ethics for Midwives, and the regulated standards of education and practice as required by the country in which they practice. Autonomy is more likely to be supported if countries base their regulation and education standards on ICM standards.
Midwifery should be recognised as an autonomous profession. As the midwifery body of knowledge reflects the ICM Philosophy and Model of Midwifery Care that recognises pregnancy and childbirth as a life stage where women and gender diverse people receiving care are the primary decision makers. An autonomous midwifery profession facilitates their informed decision making in a manner that improves perinatal outcomes.
ICM promotes and supports midwives to advocate for and maintain midwifery as an autonomous profession.
The elements of an autonomous profession must include:
- a unique body of knowledge
- a code of ethics
- processes for decision-making by its members
- recognition from society through regulation
Member associations are encouraged to use this position statement as a guide for political and legal action to secure and maintain the autonomy of the profession in order to provide quality care.
Global Standards for Midwifery Regulation
The goal of these standards is to promote regulatory mechanisms that protect the public by ensuring that safe and competent midwives provide high standards of midwifery care.
Other Relevant Documents
- Homer et al. 2014.The projected effect of scaling up midwifery.
- Nove A, Friberg IK, de Bernis L, McConville F, Moran AC, Najjemba M, Ten Hoope-Bender P, Tracy S, Homer CSE. (2021) Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study. Lancet Glob Health. Jan;9(1):e24-e32. https://pubmed.ncbi.nlm.nih.gov/33275948/ Renfew et al.
- UNFPA. 2021. State of the World’s Midwifery. http://www.unfpa.org/sowmy
- World Health Organisation (2016) Midwives voices, midwives realities. Findings from a global consultation on providing quality midwifery care
- Zolkefli. Z; Mumin. K; Idris, D (2020) Autonomy and its impact on midwifery practice British Journal of Midwifery. Vol 28, issue 2
Adopted at Brisbane International Council meeting, 2005
Revised at Toronto International Council meeting, 2017
Revised at Bali International Council meeting 2023
Due for next review 2026