Strengthening Midwifery Globally

1. Frances Ganges, MPH, CNM BOD- Americas Regional Rep International Confederation of Midwives International Strategies for Strengthening Midwifery Strengthening Midwifery Globally

2. International Confederation of Midwives The sole voice representing midwives globally • Umbrella organization of professional midwifery associations • 108 member associations • 250,000 midwives • 98 countries • 4 regions Africa Americas Asia Europe Strengthening Midwifery Globally

3. ICM Americas Region • North America • USA, Canada • Caribbean • Latin America • BOD Regional Representatives: • Mirian Solis – Latin America • Frances Ganges – N. America/Caribbean

4. International Confederation of Midwives Strengthening Midwifery Globally

5. International Confederation of Midwives ICM History 1919: International Midwives Union 1934: International Federation of Midwives 1954: International Confederation of Midwives Strengthening Midwifery Globally

6. International Confederation of Midwives Midwives Associations • Swedish Association of Midwives: 1711(!) • Royal College of Midwives: 1881 • Ghana Registered Midwives Society: 1932 • American College of Nurse Midwives: 1955 • Trinidad and Tobago Association of Midwives: 1995 • Caribbean Midwifery Initiative: 2012 Strengthening Midwifery Globally

7. International Confederation of Midwives Strengthening Midwifery Globally

8. International Confederation of Midwives Strengthening Midwifery Globally

9. Global standards and tools (education, regulation, competencies) produced to define scope of practice and guide governments Strengthening midwives associations - to promote autonomy and ability to advocate and lobby governments. To aggregate midwives‘ efforts and influence policy Advocacy –raising the profile of midwives--Positioning and professionalizing midwifery and midwives for visibility and impact Twinning – to disseminate expertise and knowledge among midwives across national boundaries International Confederation of Midwives Strengthening and promoting the profession Focus of global efforts Strengthening Midwifery Globally

10. International Federation of Gynecologists and Obstetricians (FIGO) International Pediatric Association (IPA) International Council of Nurses (ICN) World Health Organization (WHO) United Nations Population Fund (UNFPA) White Ribbon Alliance for Safe Motherhood (WRA) International Confederation of Midwives ICM global partners Strengthening Midwifery Globally

11. International Confederation of Midwives Millennium development goals Strengthening Midwifery Globally

12. International Confederation of Midwives Midwifery: a critical workforce for achieving MDGs 4,5 & 6 Making sure women throughout the world can give birth… in the presence of a midwife, is the best strategy for substantially reducing maternal mortality worldwide.... Lancet Maternal Survival Series 2005 The world needs midwives now more than ever Strengthening Midwifery Globally

13. Acute shortage of midwives 350,000 needed Number of trained midwives do not meet needs Diversity in midwifery definition and training Scope of practice inadequate Constraints on the role of the midwife in midwifery regulation Prescriptive authority lacking Lack of regulatory framework International Confederation of Midwives Challenges and Issues Strengthening Midwifery Globally

14. ICM Council Decisions 2008 • Update existing & develop new core documents • Work to be accomplished became known as the “Three Pillars” of ICM’s global efforts to strengthen midwifery worldwide • Pillars include education based on updated core competencies, regulation, and strong Member Associations.

15. Provides practice standards Defines & protects scope of practice Provides a highly qualified workforce Provides professional support Contributes to policy development Supports relationships with other health care professions International Confederation of Midwives 3 Pillars of ICM Strengthening Midwifery Globally

16. Why ICM Standards?ICM represents the world’s midwives.ICM has goal to strengthen midwifery worldwide. Need global consensus on how one educates a fully qualified midwife*. *Persons educated and trained to competency in all the ICM basic or core competencies, legally recognized to practice full scope midwifery, and who maintain competency over time.

17. Need for Education Standards • Many individuals use ‘title’ midwife • Education varies as does quality • Scope of practice & practice competencies vary • Many countries needing midwives do not have a midwifery education program

18. Purpose of Education Standards • Set quality indicators based on global norms/expectations • Standardize core elements of basic preparation • Encourage flexibility in curricular design & content • Provide framework for: • Design • Implementation, and • Evaluation of ongoing quality of program • Align scope of midwifery practice with regulatory body • Establish ‘trust’ between employers & programs • Provide credibility of graduates • Hold midwifery program accountable to public

19. The Process • ICM Board appointed Education Task Force Co-Chairs 1/2009 • J. Thompson & A. Sawyer • 11 additional members confirmed 4/2009 • All ICM regions, 3 official language groups, WHO rep. • Member of ICM Board & Education Standing Committee • Reviewed existing literature & standards available • Drafted Preface, Standards, & Glossary 5/2009 • IRB approval for international modified Delphi study 8/2009 • Agreed need for Companion Guidelines • How to implement the standard • How to determine if standard is met

20. Task Force Members • Atf Gherissi – Tunisia • Ans Luyben – Switzerland (ICM ESC) • Karyn Kaufman – Canada • Sally Tracy – Australia • Mary Higgins – Ireland (ICM BOD) • Angela Sawyer – Liberia • Bente Silversten – Denmark (WHO rep) • Ellen Chirwa – Malawi • Kyllike Christensson – Sweden • Hilda Bonilla – Chile • Rafat Jan – Pakistan • Nester Moyo – Zimbabwe (ICM staff liaison) • Joyce Thompson – USA

21. Key Documents Reviewed • Core ICM documents & position statements • WHO Midwifery Modules & Midwifery Toolkit (draft) • WHO Global standards for the initial education of professional nurses and midwives (2009) • Accreditation Commission for Midwifery Education (2008) – USA • East, Central, & Southern Africa Council on Nursing (ECSACON): Professional nursing and midwifery standards • European Union and United Kingdom midwifery standards • TF members country/regional standards for midwifery education

22. Research Question What are the elements of quality that should be reflected in any type of midwifery education programme that prepares a person to meet the ICM International definition of the midwife & ICM Essential competencies for basic midwifery practice ?

23. Study Methodology • Modified Delphi survey process • Internal (1) round • External (2) global rounds • Consensus at .80 (80%) level or above • Two-phase process over two years (May 2009 through December 2010) Phase 1: development of survey instruments, human subjects research approval – May to September/2009 Phase 2: validation of standards, revising as needed after each round with diverse panel of stakeholders

24. Country Responses by ICM Region Africa 10/20 countries = 50% Americas 9/14 countries = 64% (plus 3 non-ICM member countries) Asia Pacific 8/18 countries = 44% Europe 19/36 countries = 53% Overall response rate to electronic survey = 52% (46/88)

25. ICM Global Standards For Midwifery Education (2010) Final Document • Preface, Glossary, Standards and Guidelines • post-secondary level of education to begin program • 3 years minimum direct entry • 18 months minimum post-health professional • Framework for Standards:I. Organisation and administration (6)II. Midwifery faculty (8 plus 8 subparts)III. Student body (6 plus 8 subparts)IV. Curriculum (6 plus 4 subparts)V. Resources, facilities and services (5 plus 5 subparts)VI. Assessment strategies (5 plus 5 subparts)

26. Approval Process Standards • Final drafts sent to ICM Board in November 2010 • ICM Board approved the Standards December 16, 2010, including glossary of terms used • ICM Board approved the revised Preface in January 2011 • ICM Board endorsed the developing Companion Guidelines 2010 • Spanish & French translations completed March 2011 • Documents placed on ICM website April 2011 • ICM Council overwhelmingly endorsed standards in June 2011

27. Caveats • These are minimumstandards = adaptability • Any country/program can exceed standards based on country philosophy & needs • Any country/program can exceed basic ICM essential competencies based on priorities, needs • Any country/program must exceed minimum length if have other non-midwifery content included • Any country/program can add more midwifery content – extend length

28. ICM Global Standards for Midwifery Education (2010) with Guidelines The steps ahead…. • Raise awareness about these Education Standards and Companion Guidelines • Discuss and develop processes for the Implementation of the Education Standards in selected countries • Support Implementation of the Standards by working with partners and provision of adequate quality education material and expert support

29. I found – and it was not a finding I had expected – that wherever (there was) a system of maternal care . . . based on trained . . . and respected midwives . . . maternal mortality was at its lowest. I cannot think of an exception to that rule (Loudon 1992) International Confederation of Midwives The Midwife effect Strengthening Midwifery Globally

30. International Confederation of Midwives Americas Regional Midwifery Conference Quito, Ecuador May 2013 Strengthening Midwifery Globally

31. 30th ICM Triennial Congress June, 2014 http://www.midwives2014.org/ See you there… International Confederation of Midwives Strengthening Midwifery Globally

32. International Confederation of Midwives Thank You! International Confederation of Midwives Laan van Meerdervoort 702517 AN, The Hague Netherlands Telephone: +31 (0)70 306 0520 Fax: +31 (0)703 555 651 info@internationalmidwives.org www.internationalmidwives.org Strengthening Midwifery Globally