The 13th International Conference of the Jordanian Society of Obstetricians and Gynaecologists – 31 August-2 September 2016 Midwives save lives, enhance health and help give the mother, baby and family the best start in life Professor Lesley Page, President, The Royal College of Midwives, United Kingdom

Giving the best start in life

State of the World’s Midwifery 2014 Midwives who are educated and regulated to international standards can provide most of the essential care needed for mothers and babies Investing in midwifery education, with deployment to the community, can yield a 16-fold return on investment and is one of the "best buys" in primary health care How to persuade the global community – donors, policy makers governments www.unfpa.org/sowm

The Lancet Series on Midwifery @midwiferyaction #lancetmidwifery www.midwiferyaction.org

The Lancet Series on Midwifery Multidisciplinary group of 35+ specialists from 20+ countries health systems analysts, demographers, statisticians, epidemiologists, health service researchers, social scientists, health economists, specialist midwife researchers, service user advocates, public health and policy experts, and clinical experts: midwives, obstetricians, paediatricians, other related disciplines Input from close readers/critical friends, WHO, Gates Foundation, ICM, FIGO, Lancet editors and reviewers Supported by the Bill & Melinda Gates Foundation + NORAD

The Lancet Series on Midwifery Context - global developments Sustainable Development Goals Universal Health Coverage Global Newborn Action Plan Health workforce development Beyond saving lives - improving the quality of care State of the World’s Midwifery 2011, 2014

The global context Unacceptable rates of mortality and morbidity Longer term and psycho-social outcomes overlooked birth is the start of the journey High rates of unnecessary interventions Inequalities in outcomes and care Care and compassion seen as less important yet integral to system failures Disrespect and abuse of women within the health system

Framework for quality maternal and newborn care For all childbearing women and newborns For women and newborns with complications Effective practices Education, information, health promotion Assessment, screening, care planning Promotion of normal processes, prevention of complications First-line management of complications Medical obstetric neonatal services Organisation of care Available, accessible, acceptable, good quality services – adequate resources, competent workforce Continuity, services integrated across community and facilities Respect, communication, community knowledge and understanding Care tailored to women’s circumstances and needs Values Mary Renfrew says -And because the evidence was not in a form that could be used off the peg, we had to develop a framework – a different way of seeing it. - What, how, who Integrated – not fragmented – including all needs and relevant across the health system and all the providers - One framework, one way of seeing Our analysis used core concepts – continuity, normal processes, prevention as well as treatment – as an innovative way of looking at and assessing the evidence Most evidence in the top right hand box Optimising biological, psychological, social and cultural processes, strengthening women’s capabilities. Expectant management, using interventions only when indicated Philosophy Practitioners who combine clinical knowledge and skills with interpersonal and cultural knowledge Division of roles based on need, competencies and resources Care providers Renfrew, McFadden, Bastos et al The Lancet 384, I9948, 1129 – 1145, 2014

Scale of the impact of midwifery care Universal coverage of midwifery would result in reductions in maternal deaths, stillbirths, and neonatal deaths in 78 countries maternal mortality, stillbirths, and neonatal deaths reduced by around 80% Homer, Friberg, Bastos Dias et al The Lancet 384, 1146-1157 Sept 2014

Midwifery – key to quality care Implications of The Lancet Series on Midwifery

Midwifery in the UK The Royal College of Midwives Regulation Direct entry midwifery at degree level Academic development Every woman has a midwife-some have a doctor too Woman centred policy-Better Births Development of midwifery

Thank you With thanks to Jess and Nick

For further information Website: www.rcm.org.uk Telephone: 0300 303 0444 Email: info@rcm.org.uk www.facebook.com/midwivesRCM @MidwivesRCM