Midwifery Education: Building Global Consensus The ICM Global Standards for Midwifery Education

1. Midwifery Education: Building Global ConsensusThe ICM Global Standards for Midwifery Education Joyce Beebe Thompson, DrPH, CNM, FAAN, FACNM Professor Emerita Co-Chair ICM Task Force on Standards

2. Overview of Presentation • Role of education in preparing fully qualified midwives to meet MDGs • Need for global midwifery standards: background review & challenges • ICM Collaborative Process for reaching global consensus: modified Delphi survey process • Draft ICM/WHO midwifery standards • Reflections for the future

3. Healthy Women & Children

4. Healthy Women & Midwives • A natural, mutually beneficial partnership • Midwifery model of care – teach women how to be healthy • Midwives are the skilled attendant needed to keep women safe and healthy • A fully qualified midwife = formal education based on ICM Essential Competencies

5. Value of Education Standards • Program graduates held to established standards of proficiency • Knowledge • Professional behaviors • Specific skills • Program meets defined country needs for health • Program faculty & students demonstrate critical thinking & informed judgment • Promotes best practice by adapting to changing evidence • Enhances legal recognition for midwifery practice

6. UN Millennium Development Goals (MDGs) 2000 3. Promote gender equality & empower women – essence of midwifery care 4. Reduce child mortality – healthy & informed mothers needed 5. Improve maternal health – entire midwifery model of care

7. World Health Report 2005 “Women risk death to give life….for optimum safety, every woman needs professional skilled care .. in an appropriate environment that is close to where she lives and respects her birthing culture.” “Such care can best be provided by a registered midwife or health worker with midwifery skills in decentralized, first-level facilities…” Dr. Lee, WHO Director-General, p. xv

8. Lancet – Maternal Survival 2006 “where an option still exists [for a professional attendant – midwife or doctor], the evidence is strongly in favor of midwives as the main providers.” Campbell & Graham, p.32

9. Linking Midwives to Healthy Women • Countries understand need for skilled midwives • Some countries willing to invest in fully qualified midwives • Some countries want cheaper solutions through various other cadres of health workers – most without midwifery competencies; e.g.TBAs, CHWs • Many countries asking for help in scaling up health workforce • Need consensus on how one educates a fully qualified midwife adapted to country needs

10. ICM Council Deliberations 2008 • Many individuals using ‘title’ midwife • Education processes vary • Scope of practice varies • Practice competencies vary • Many countries needing skilled attendants do not have a midwifery education program • Great confusion & disagreement about how to prepare ‘fully qualified’ midwives

11. ICM Council Considerations 2008 • ICM – the “voice” of fully qualified midwives globally (Definition of the Midwife) • ICM Essential Competencies…2002 - the building blocks for education & regulation • ICM position statements - qualifications of midwifery teachers, ongoing education, ethics • ICM’s role & responsibility – to establish standards of midwifery education: • in keeping with core ICM documents • in collaboration with WHO • in synergy with other global partners

12. ICM Council Decisions - 2008 • Update and expand Essential Competencies.. • Establish Global Standards for Midwifery Education • Establish global regulatory standards • Strengthen midwifery associations to meet needs for healthy women and newborns

13. ICM Study Process 2009-2010 • Established global task force representing all ICM regions, language groups, Board, WHO • Appointed J. Thompson & A. Sawyer as co-Chairs • Study leader for standards - J. Thompson • Coordinator Guidelines – A. Sawyer • Consultant – J. Fullerton

14. The First Step for Task Force Task Force critiqued existing midwifery standards • WHO Midwifery toolkit, Chapters 5 & 6 • Accreditation Commission for Midwifery Education (US) - 2008 • East, Central, Southern African College of Nursing midwifery standards • WHO Initial Nursing & Midwifery Standards - 2009

15. Definition Used by TF Definition of standard: “a norm/uniform reference point that describes a required level of achievement for quality midwifery education.”

16. Research Question What are the elements of quality that should be reflected in any type of midwifery educational program that prepares a person to meet the ICM International Definition of the Midwife?

17. ICM Methodology • Modified Delphi survey process • Internal & external global rounds • Consensus at .80 level or above = retain • Two-phase process over two years Phase 1: development of survey instruments, human subjects research approval Phase 2: validation of standards, revising as needed after each round

18. Preliminary Responses* Total number of completed surveys N = 162 Total number respondents N = 190 Total number ICM MA countries N = 46/88 Language groups English N = 138 French N = 28 Spanish N = 23 *As of May 28, 2010; includes two external rounds

19. Responses by ICM Region Africa 10/19 countries = 53% Americas 10/14 countries = 71% (plus 3 non-ICM member countries) Asia Pacific 8/19 countries = 42% target Southeast Asia Europe 18/36 countries = 50% target southern Europe Overall response rate to electronic survey = 52% (46/88)

20. Glossary of Terms & Preface • 32 glossary terms agreed • 11 components of Preface, with 9 agreed including post-secondary level of education to begin program • Areas that currently lack of .80 level of consensus Minimum length of direct entry program Minimum length of post-nursing program Minimum years clinical practice of midwife teachers

21. ICM Organization of Standards • Organization and administration (6) • Midwifery faculty (8 plus 8 subparts) • Student body (6 plus 8 subparts) • Curriculum (6 plus 4 subparts) • Resources, facilities & services (5 plus 5 subparts) • Assessment strategies (5 plus 5 subparts)

22. Key Details Addressed • Midwifery leadership of program • Entry level of students & other qualifications • Qualifications of midwifery classroom & clinical teachers • Content of curriculum beginning with ICM Essential Competencies • Resources and practice facilities • Length of program • Ongoing evaluation processes: students, teachers, curriculum, program

23. ICM Lessons Thus Far • Resource poor nations need support for educating fully qualified midwives • All agencies need to work together to avoid “quick fixes” as alternative to midwife • Multiple languages and country needs require clarity in Standards and Guidelines • Preparation of fully qualified midwife requires support of regulatory body & midwifery association • Standards can provide benchmarks for measuring quality

24. Joint Statement “We will work together with governments and civil society to strengthen national capacity to: • Address the urgent need for skilled health workers, particularly midwives;..” WHO, UNFPA, UNICEF, World Bank (2008) Joint Statement on Maternal and Newborn Health Accelerating efforts to save the lives of women and newborns.

25. Reflections on Future Need further evidence of: • Effective curriculum models tailored to country needs • Effective teaching methods for competency-based education • Effective clinical learning (practice) settings Need: • Appropriate skill mix of health professionals and community workers • Effective midwifery regulation to allow fully qualified midwife to practice to full scope of abilities • Strong midwifery associations to support global standards for education, regulation, and practice