1. 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

2. 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

3. 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

4. International Confederation of Midwives
Strengthening Midwifery Globally

5. 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

6. 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

7. International Confederation of Midwives
Strengthening Midwifery Globally

8. International Confederation of Midwives
Strengthening Midwifery Globally

9. 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

10. 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

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

12. 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

13. 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

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. 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

16. 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.

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 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 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

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. 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

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

31. 30th ICM Triennial Congress
International Confederation of Midwives
30th ICM Triennial Congress
June, 2014
See you there…
Strengthening Midwifery Globally

32. Thank You! International Confederation of Midwives
Laan van Meerdervoort AN, The Hague
Netherlands
Telephone: +31 (0)
Fax: +31 (0)
Strengthening Midwifery Globally