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

The sole voice representing midwives globally 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

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

International Confederation of Midwives Strengthening Midwifery Globally

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

Midwives Associations 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

International Confederation of Midwives Strengthening Midwifery Globally

International Confederation of Midwives Strengthening Midwifery Globally

Strengthening and promoting the profession International Confederation of Midwives Strengthening and promoting the profession Focus of global efforts 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 Strengthening Midwifery Globally

International Confederation of Midwives ICM global partners 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) Strengthening Midwifery Globally

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

Midwifery: a critical workforce for achieving MDGs 4,5 & 6 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

Challenges and Issues Acute shortage of midwives International Confederation of Midwives Challenges and Issues 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 Strengthening Midwifery Globally

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.

3 Pillars of ICM Provides practice standards International Confederation of Midwives 3 Pillars of ICM 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 Strengthening Midwifery Globally

Why ICM Standards. ICM represents the world’s midwives 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.

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

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

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

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

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

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 ?

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

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)

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)

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

Caveats These are minimum standards = 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

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

International Confederation of Midwives The Midwife effect 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) Strengthening Midwifery Globally

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

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

Thank You! International Confederation of Midwives Laan van Meerdervoort 70 2517 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