Stronger Standards = Better Care for Women: Why the EU Must Strengthen its Midwifery Directive
In 2024, the European Commission announced that the European Directive on Professional Qualifications: Midwife (Directive 2005/36/EC) was due for revision. The Directive establishes minimum standards for midwifery education and training across EU/EEA countries. While the document was last updated in 2013, the provisions on midwifery have seen almost no change since 1980.
Forty-five years later, the text no longer reflects the realities of modern midwifery, nor the latest research and innovations that have shaped sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) in Europe in the last years.
For ICM, the announcement of this revision represented a unique opportunity to modernise outdated provisions and ensure that the Directive could truly support safe, high-quality, and equitable midwifery care across EU/EEA countries.
A Flawed Review Process
The initial review, conducted by Spark Legal and Policy Consulting, engaged professional associations, educators, and regulators across Europe. Throughout the process, ICM provided detailed input to align the Directive with scientific developments and ICM’s global standards, including the Essential Competencies for Midwifery Practice and the Global Standards for Education and Regulation.
However, the proposed revisions fell short. They lacked actionable updates, offered little practical value, and failed to integrate the advances that define today’s midwifery profession. In response, ICM, the European Midwives’ Association (EMA), and the European Forum of National Nursing and Midwifery Associations (EFNNMA) have collaborated to provide coordinated feedback with 96 midwifery associations and stakeholders across 24 EU/EEA countries—ensuring that the profession’s voice was fully represented.
Making the Directive Work
Because the Directive often serves as both a minimum benchmark and a basis for national curricula, meaningful updates are essential. The findings of this process and the proposed changes are comprehensive and extensive. The main areas of focus are:
- Core Competencies: reflect core competencies drawn from the ICM Essential Competencies to support labour mobility and consistent implementation across Member States.
- Prescribing and pharmacology: ensure that pharmacology content prepares midwives for national prescribing roles.
- Digital and health literacy: include digital health literacy and information navigation to equip midwives for modern communication and public health challenges.
- Fertility and subfertility care: highlight the midwife’s role in promoting reproductive health (including fertility), early identification of subfertility, in line with WHO and EU SRH priorities
- Gender and equity: embed a rights-based, equity-sensitive approach in education content, consistent with broader EU gender equality strategies.
These changes adhere to the new Essential Competencies, the Midwifery Models of Care Global Position Paper and Implementation Guide, and the Midwifery Accelerator. As such, the directive is clearer and aligned across the requirements and therefore, it is also easier to implement across countries.
ICM recognises that this revision process signals EU acknowledgement of midwifery’s essential role in health systems. But for the Directive to reach its potential, the process must overcome several barriers:
- Consensus thresholds that limit innovation.
- Limited transparency and accessibility in consultation processes.
- Insufficient integration of evidence-based global standards.
With a more rigorous, transparent, and inclusive approach, this Directive could go beyond compliance. It could advance EU commitments to gender equality, public health, and sustainable development, while enabling midwives to practise at the full scope of their profession.
The Way Forward
Updating the EU Midwifery Directive should not be just a technical exercise. It is a chance to align education and regulation with the health needs of Europe’s populations and ensure the mobility of a well-prepared workforce. Above all, it can strengthen the quality and safety of care for women, gender diverse people, newborns, and families.
ICM will continue to advocate for a Directive that reflects the realities of today’s profession and the underlying evidence base. With the right changes, this revision could set a new standard for midwifery that strengthens the profession, advances health equity, and safeguards the sexual and reproductive health and rights of all.
Read ICM’s Policy Position Paper here.
