Midwifery 30 (2014) 969–971
Contents lists available at ScienceDirect
Midwifery journal homepage: www.elsevier.com/midw
Conference Report
The International Confederation of Midwives 30th Triennial Congress-‘Midwives: Improving women's health globally’ Elizabeth Duff (International News Editor)
Opening of the Congress – June 1 To mark the 30th congress, set in Prague, capital of the Czech Republic, the opening ceremony began with a look at the history of the ICM's three-yearly global conferences, held since 1919. Although the detailed records of the Confederation's early meetings were lost during World War II, a collage of photographs and programmes of past congresses had been collected and were shown in a short video, along with film clips of the more recent events. The names of every past President were also commemorated. The current President, Frances Day-Stirk, from the UK, greeted the delegates with the news that 126 countries were represented by over 3800 midwives at the congress. She extended a special welcome to the student midwives and those attending for the first time. Every congress, she said, is ‘inspirational’, and this one is no different. Turning to midwives' work, Frances said that global progress in maternal and newborn health remains too slow, but it is moving in the right direction. Midwives ‘know what works’ and because of this, they save lives. It is important to guard the autonomy of midwives in every country. She reminded the audience that the recently published ‘Every Newborn Action Plan’ – from WHO and UNICEF – supports midwifery as the best start to a child's life.
The Marie Goubran award This award, created in memory of Marie Goubran, a former Executive Secretary of the ICM, is designed ‘to assist in the furthering of midwifery education and practice in countries with special needs and limited funding opportunities’. To great applause, the 2014 award was presented to Kingsley Masuma of Zambia, the first ever male midwife to receive it. Kingsley has been instrumental in establishing and expanding community midwifery services in the eastern part of Zambia, with a special focus on safe motherhood, exclusive breast feeding and family planning. He hoped to use the funds from the award to reach more families in his region and to pursue his own further midwifery education.
ICM's Global Goodwill Ambassador The new ‘Global Goodwill Ambassador’ role has been taken by Her Excellency Toyin Saraki of Nigeria, who gave a passionate http://dx.doi.org/10.1016/j.midw.2014.07.005 0266-6138/& 2014 Elsevier Ltd. All rights reserved.
address to the delegates. ‘The lives of so many mothers and babies hang in the balance for lack of enough skilled and qualified midwives’, she said, and appealed to governments to ‘tackle the global deficit of midwives’. She urged everybody to ‘celebrate the essential role of midwives’ and, referring to the ICM's key function in supporting midwifery associations, she quoted the proverb ‘if you want to go fast, go alone; if you want to go far, go together!’.
Decisions from ICM Council The Vice-President of the ICM, Debrah Lewis, reported to the delegates the major decisions taken by the Confederation's governing body, the Council, at their meeting immediately previous to the Congress. The Council meeting consisted of 160 representatives from 83 member associations in 70 different countries. Three new categories of membership have been created: collective, associate and affiliate. The details of eligibility for these groups will be published on the ICM website. This new move will enable organisations who cannot yet fulfil the criteria to be full members to learn more about the ICM's activities and be in contact with other national associations. New Board members have been elected, including a third representative for the Asia-Pacific Region, which is another innovation. All names and details of the Board are also published on the website. A vote was taken to decide the venue for the 32nd triennial congress, and this will be Bali in Indonesia. Debrah was also able to assure delegates that the financial situation of the ICM is stable and the Confederation is fit to address its work programme for the next triennium.
Keynote speeches Lisa Kane Low Lisa Kane Low, of the University of Michigan, spoke on Monday, June 2, with her topic ‘bridging the gap to improved care’ and she began by asserting it had been her ‘privilege and experience to listen to women’. She described the background to the high levels, in some countries, of maternal mortality. Providing a woman with
970
E. Duff / Midwifery 30 (2014) 969–971
access to health care is important but so are her social circumstances – where and how she lives, learns, works and plays – these may have more impact on her long-term health. Health inequalities are human rights issues, and poorer women and children still bear the brunt. Lisa described her work in parts of Detroit, USA, where she found that health care needed to be taken to where women were: sometimes in community centres, sometimes prisons, sometimes around soup kitchens. New facilities with bright lights deterred some women from entering unless they had a known and trusted provider there. She had also worked in Honduras. This country has no association of professional midwives but when she first went there, there was a strategic approach of maternity provision in freestanding birth centres. But later, with new resources and funding, a ‘template of technology’ was brought in. First-time mothers were no longer allowed to give birth in the centres, but were referred to hospital. Soon, use of either facility diminished. This was a misapplied use of technology: as often happens, the women had not been listened to and the solution offered was not one they found acceptable. As well as the need to ‘listen to women’, Lisa stressed the importance of collaborative and interprofessional work, with all health disciplines ‘playing in the same sandbox’! Her speech closed with a quotation from obstetrician Professor Mahmoud Fathalla, ‘Women are not dying of diseases we cannot treat, but because society has not yet made the decision that their lives are worth saving’. Cecily Begley The keynote speech on Wednesday, June 4, was given by Professor Cecily Begley, Trinity College Dublin, Republic of Ireland. She also had a theme of ‘bridging’ but she wanted to talk about education and research as the two pillars that support the bridge between knowledge and practice. Asking members of the audience to raise their hands if they had trained as midwives in the 1970s, she told that group: ‘You are the wise and wonderful women of the world!’. Cecily reflected on the differences in care over these years, for example some midwives in Ireland were performing episiotomies on 84% of women. But, she said, what will the midwives of 2034 say, looking back at 2014? Why did so many women die? For example in South Sudan, where 2054 women die for every 100,000 live births? Cecily went on to speak about pain management in labour and emphasised the benefits of non-drug strategies. There is good evidence of effectiveness for use of water, massage, acupuncture and relaxation techniques. She also praised the contribution of lay health workers who can be successful in supporting breast feeding and reducing infant mortality. Ngai Fen Cheung The image of ‘bridging’ was picked up again by the last keynote speaker, Professor Ngai Fen Cheung, adviser to the Midwifery Expert Committee in China. She described midwifery as bridging culture and practice, noting that ‘cultural sensitivity’ is one of ICM's key concepts for midwifery. Culture, Fen said, is close to ‘society’. It means the understood rules that govern our behaviour and values. It is connected to law, education, artistic expression and many other aspects of life. But culture changes and evolves, and it may be interpreted differently by individuals. Cultural sensitivity for midwives means to meet women's cultural needs, to promote a health culture in midwifery and to overcome harmful cultural practices. Midwives must appreciate the cross-cultural aspects of religion, ritual, gender, food and language, which can make a profound difference to women's experience of childbirth.
Launch of the ‘State of the World's Midwifery’ The second edition of the State of the World's Midwifery (SoWMy 2014), following on the original document launched in Durban in 2011, is subtitled ‘A Universal Pathway: a Woman's Right to Health’. SoWMy 2014's main objective, agreed at the 2nd Global Midwifery Symposium held in Kuala Lumpur in May 2013, is to provide an evidence base on midwifery in 2014 that will:
support policy dialogue between governments and their partners;
accelerate progress on the health MDGs; identify developments in the three years since the SoWMy 2011 report was published;
inform negotiations for and preparation of the post-2015 development agenda. SoWMy 2014 focuses on 73 of the 75 low- and middle-income countries that are included in the ‘Countdown to 2015’ reports. More than 92% of all the world's maternal and newborn deaths and stillbirths occur within these 73 countries. However, only 42% of the world’s medical, midwifery and nursing personnel are available to women and newborn infants (hereafter ‘newborns’) in these countries. The launch event brought thousands of midwives together in a plenary session to hear from the authors and contributors. Many well-known midwives and other stakeholders were involved in the compiling of the document, with the steering committee comprising Frances Day-Stirk of ICM, Laura Laski, Elizabeth Mason, Jean Barry, Benedict David, Luc de Bernis, Peter Johnson, Louise Holly, Tina Lavender, Gillian Mann, Betsy McCallon, Anders Molin, Arulkumaran Sabaratnam, Carole Presern and Simon Wright; while the core group of contributors were: Luc de Bernis, Jim Campbell, Catherine Carr, Sheena Currie, Caroline Homer, Petra ten Hoope-Bender, Peter Johnson, Zoë Matthews, Fran McConville, Nester Moyo, Mwansa Nkowane, Grace Omoni, Francisco PozoMartin, CN Puradane, Amani Siyam and Laura Sochas. The principal organisations behind the initiative are the ICM, UNFPA and WHO. A foreword to the SoWMy was written by UN Secretary-General Ban Ki-moon, who said: ‘The midwifery workforce, within a supportive health system, can support women and girls to prevent unwanted pregnancies, provide assistance throughout pregnancy and childbirth, and save the lives of babies born too early…. Every year, more governments, professional associations and other partners are acting on the evidence that midwifery can dramatically accelerate progress on sexual, reproductive, maternal and newborn health and universal health coverage. I fully support the Midwifery 2030 vision articulated in this report’. At the launch, Laura Laski of UNFPA, one of the co-chairs, began by thanking ‘all the midwives involved in the making of this report – in remote and rural areas, in urban slums, in hospitals and in women's homes’. We are working, she said, towards a world, where every pregnancy is wanted and every birth is safe, and she addressed midwives directly with the words ‘you are at the forefront of women's health rights’. Laura was joined on the platform by ICM's President Frances Day-Stirk and Vice-President Address Malata, and UNFPA's Executive Director Dr. Babatunde Osotimehin, who spoke of the importance of investing in midwives: midwifery, he said, is the ‘best buy’ in primary health care. Frances Day-Stirk welcomed this long-awaited celebration of the launched document. It has arrived she said, after a long gestation and a hard labour! Representatives from three of the featured countries – Bangladesh, Pakistan and Morocco – then spoke. Rafat Jan, from Aga Khan University in Pakistan, said she plans to translate key messages to share with the midwives in her country working at grassroots level, adding ‘It's time now. We know what needs to be
E. Duff / Midwifery 30 (2014) 969–971
done. The report is here, so let's go for action’. Hanane Masba, midwife from Morocco, shared her experience and stressed the importance of keeping women at the centre of maternal health policy. She felt there were two major gaps in terms of women's access to care, and the coverage of the continuum of care. She reported that in Morocco midwives are gaining status, recognition and visibility, but the regulation governing the profession dates from the 1950s and clearly needs refreshing. Hanane called for action and interprofessional collaboration, as midwives can only drive change together – ‘Hommage à toutes les sages-femmes!’ she concluded. Arul Sabaratnam of the International Federation of Gynaecologists and Obstetricians (FIGO) assured midwives that the content and recommendations of the publication would be disseminated to all member societies of FIGO, with the added encouragement to work collaboratively with their relevant midwifery associations. A speaker from Sweden reflected that the obstacles to achieving effective midwifery coverage include ‘not knowing what to do’, ‘knowing what to do but not being able to afford it’ and ‘knowing and affording but not wanting to’. Sweden, he said, is a rich country, and there healthy women go through pregnancy and birth without ever ‘shaking the hand of a doctor’; the reason is that we choose midwives: not because they are the cheapest, but because they are the best. Dr Flavia Bustreo, Assistant Director General for Family, Women's and Children's Health at WHO, said that ‘by working together we can spark needed action for women and children around the world’. She pledged full support of the action plans, but warned, ‘these are only the first stop’. The Lancet series on midwifery This long-awaited publication could not be launched at the Congress (an event that happened later in June, in London) but a discussion session previewed the structure and format of the series and heard from some of the authors. The series consists of four papers entitled: Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care; The projected effect of scaling up midwifery; Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality; and Improvement of maternal and newborn health through midwifery. Petra ten Hoope, one of the authors, answered the question ‘why a midwifery series?’, by explaining that such a subject merits more than one article. Most articles are written about a ‘vertical’ topic – e.g. a disease that must be diagnosed, treated and cured. Midwifery, in contrast, is a comprehensive ‘horizontal’ subject – not a tool but a crucial ongoing component of health care for families. Referring to the last paper, she asked the question (mixing her metaphors) ‘does this wrap up the building blocks?’; and answering it, said ‘it does more than that’. It sets out next steps for midwifery associations, for policy makers and for key players in education and regulation. Mary Renfrew, another of the lead authors, described it as ‘an awesome responsibility, to lead on this project’. She also explained that, in addition to the four papers listed that will appear as a series, there will be further publications on the human rights aspect of midwifery and the future research agenda. She said the first paper described the ‘landscape of midwifery’. It is clear that, across the globe, midwives have a hugely variable experience in terms of their status and role. The authors examined more than 460 Cochrane reviews and other systematic analyses of data to reach their conclusions. Caroline Homer answered another key question: ‘How will this publication make things better for women and their families?’. She stressed the value of ‘putting this altogether in one place’. Caroline also highlighted the perspective of care that is ‘woman-centred’,
971
not centred on a profession, a country or an institution. Every woman needs an individualised ‘package of care’, not just one intervention. She and co-authors had used the ‘lives saved’ model to calculate the impact of scaling up midwifery. Zoe Matthews, a non-midwife sociologist, economist and statistician, who has worked closely with midwives and the White Ribbon Alliance, emphasised the power of the interdisciplinary group of contributors, which nevertheless held midwifery at the centre. She described case studies, used in the article, of counties which have made significant progress over the past: lessons can be learned here. Eighteen authors had worked on this paper to ensure the ‘stories’ from their countries reflected authentically what has been done. Holly Powell-Kennedy joined the other speakers to talk about the future research agenda, a paper that will be published in the autumn. She is working closely with WHO to identify gaps. Soo Downe also spoke about the forthcoming human rights publication: it will look at three levels of rights: micro-level, for individual women and care providers; meso-level to address accessibility and affordability; and macro-level to explore over-arching themes like women's education and status. This session continued with vigorous debate and questions from a full congress hall, and many contributors expressed their excitement about the ground-breaking publication and keenness to read the articles in full. Conference programme and exhibition In addition to the keynote speeches and other plenary sessions as described above, the full programme offered a wide view of midwifery topics as panoramic as the physical view from the attractive setting of the Congress centre. The 3500þ midwives attending packed the smaller rooms of the building to attend their choice of presentations, seminars, workshops, debates, films and the huge array of posters available to view at all the breaks. A skim through the highlights included an excellent session on ‘place of birth’ with Patti Janssen from Canada and Ingegerd Hildingsson from Sweden showing spectacular photographs of the winter landscapes of their northern countries to illustrate the terrain that women or midwives must travel to meet at the place of birth; a thoughtful focus on ‘decision making’ with contributions from the UK, USA and the Republic of Ireland; a fascinating preview of selected material from the UK-based self-hypnosis trial, exploring women's experiences of taking part; Dutch, Australian and British aspects of ‘women's choice’ over their intra-partum care; a session entitled ‘risk’ which picked up aspects of this enormous subject from Australia, New Zealand and Canada. An event in the main hall that drew a large audience was a debate on ‘Midwifery practice is driven by women's wishes (or choices)’. The speakers on either side came from Ghana, Netherlands, Malawi and New Zealand. After impassioned addresses from these four midwives and numerous contributions from the floor, the vote went against the motion. However, the chair called for a further vote as to whether practice should be driven by women's choices, which turned the balance the other way. A wide-ranging exhibition kept delegates busy at every break visiting stands leaning about new products, books, journals, resources and initiatives from non-profit or commercial organisations. Save the Children drew midwives in with the offer of wool and needles to knit a square for a blanket to keep an infant warm; while the global midwifery twinning movement had crafts and trinkets to sell for their fund-raising. Finally, the closing ceremony featured an inspiring and moving presentation from singing and dancing Canadian midwives who invited all the world's midwives to join them in Toronto for the next ICM Congress in 2017.
Contents lists available at ScienceDirect
Midwifery journal homepage: www.elsevier.com/midw
Conference Report
The International Confederation of Midwives 30th Triennial Congress-‘Midwives: Improving women's health globally’ Elizabeth Duff (International News Editor)
Opening of the Congress – June 1 To mark the 30th congress, set in Prague, capital of the Czech Republic, the opening ceremony began with a look at the history of the ICM's three-yearly global conferences, held since 1919. Although the detailed records of the Confederation's early meetings were lost during World War II, a collage of photographs and programmes of past congresses had been collected and were shown in a short video, along with film clips of the more recent events. The names of every past President were also commemorated. The current President, Frances Day-Stirk, from the UK, greeted the delegates with the news that 126 countries were represented by over 3800 midwives at the congress. She extended a special welcome to the student midwives and those attending for the first time. Every congress, she said, is ‘inspirational’, and this one is no different. Turning to midwives' work, Frances said that global progress in maternal and newborn health remains too slow, but it is moving in the right direction. Midwives ‘know what works’ and because of this, they save lives. It is important to guard the autonomy of midwives in every country. She reminded the audience that the recently published ‘Every Newborn Action Plan’ – from WHO and UNICEF – supports midwifery as the best start to a child's life.
The Marie Goubran award This award, created in memory of Marie Goubran, a former Executive Secretary of the ICM, is designed ‘to assist in the furthering of midwifery education and practice in countries with special needs and limited funding opportunities’. To great applause, the 2014 award was presented to Kingsley Masuma of Zambia, the first ever male midwife to receive it. Kingsley has been instrumental in establishing and expanding community midwifery services in the eastern part of Zambia, with a special focus on safe motherhood, exclusive breast feeding and family planning. He hoped to use the funds from the award to reach more families in his region and to pursue his own further midwifery education.
ICM's Global Goodwill Ambassador The new ‘Global Goodwill Ambassador’ role has been taken by Her Excellency Toyin Saraki of Nigeria, who gave a passionate http://dx.doi.org/10.1016/j.midw.2014.07.005 0266-6138/& 2014 Elsevier Ltd. All rights reserved.
address to the delegates. ‘The lives of so many mothers and babies hang in the balance for lack of enough skilled and qualified midwives’, she said, and appealed to governments to ‘tackle the global deficit of midwives’. She urged everybody to ‘celebrate the essential role of midwives’ and, referring to the ICM's key function in supporting midwifery associations, she quoted the proverb ‘if you want to go fast, go alone; if you want to go far, go together!’.
Decisions from ICM Council The Vice-President of the ICM, Debrah Lewis, reported to the delegates the major decisions taken by the Confederation's governing body, the Council, at their meeting immediately previous to the Congress. The Council meeting consisted of 160 representatives from 83 member associations in 70 different countries. Three new categories of membership have been created: collective, associate and affiliate. The details of eligibility for these groups will be published on the ICM website. This new move will enable organisations who cannot yet fulfil the criteria to be full members to learn more about the ICM's activities and be in contact with other national associations. New Board members have been elected, including a third representative for the Asia-Pacific Region, which is another innovation. All names and details of the Board are also published on the website. A vote was taken to decide the venue for the 32nd triennial congress, and this will be Bali in Indonesia. Debrah was also able to assure delegates that the financial situation of the ICM is stable and the Confederation is fit to address its work programme for the next triennium.
Keynote speeches Lisa Kane Low Lisa Kane Low, of the University of Michigan, spoke on Monday, June 2, with her topic ‘bridging the gap to improved care’ and she began by asserting it had been her ‘privilege and experience to listen to women’. She described the background to the high levels, in some countries, of maternal mortality. Providing a woman with
970
E. Duff / Midwifery 30 (2014) 969–971
access to health care is important but so are her social circumstances – where and how she lives, learns, works and plays – these may have more impact on her long-term health. Health inequalities are human rights issues, and poorer women and children still bear the brunt. Lisa described her work in parts of Detroit, USA, where she found that health care needed to be taken to where women were: sometimes in community centres, sometimes prisons, sometimes around soup kitchens. New facilities with bright lights deterred some women from entering unless they had a known and trusted provider there. She had also worked in Honduras. This country has no association of professional midwives but when she first went there, there was a strategic approach of maternity provision in freestanding birth centres. But later, with new resources and funding, a ‘template of technology’ was brought in. First-time mothers were no longer allowed to give birth in the centres, but were referred to hospital. Soon, use of either facility diminished. This was a misapplied use of technology: as often happens, the women had not been listened to and the solution offered was not one they found acceptable. As well as the need to ‘listen to women’, Lisa stressed the importance of collaborative and interprofessional work, with all health disciplines ‘playing in the same sandbox’! Her speech closed with a quotation from obstetrician Professor Mahmoud Fathalla, ‘Women are not dying of diseases we cannot treat, but because society has not yet made the decision that their lives are worth saving’. Cecily Begley The keynote speech on Wednesday, June 4, was given by Professor Cecily Begley, Trinity College Dublin, Republic of Ireland. She also had a theme of ‘bridging’ but she wanted to talk about education and research as the two pillars that support the bridge between knowledge and practice. Asking members of the audience to raise their hands if they had trained as midwives in the 1970s, she told that group: ‘You are the wise and wonderful women of the world!’. Cecily reflected on the differences in care over these years, for example some midwives in Ireland were performing episiotomies on 84% of women. But, she said, what will the midwives of 2034 say, looking back at 2014? Why did so many women die? For example in South Sudan, where 2054 women die for every 100,000 live births? Cecily went on to speak about pain management in labour and emphasised the benefits of non-drug strategies. There is good evidence of effectiveness for use of water, massage, acupuncture and relaxation techniques. She also praised the contribution of lay health workers who can be successful in supporting breast feeding and reducing infant mortality. Ngai Fen Cheung The image of ‘bridging’ was picked up again by the last keynote speaker, Professor Ngai Fen Cheung, adviser to the Midwifery Expert Committee in China. She described midwifery as bridging culture and practice, noting that ‘cultural sensitivity’ is one of ICM's key concepts for midwifery. Culture, Fen said, is close to ‘society’. It means the understood rules that govern our behaviour and values. It is connected to law, education, artistic expression and many other aspects of life. But culture changes and evolves, and it may be interpreted differently by individuals. Cultural sensitivity for midwives means to meet women's cultural needs, to promote a health culture in midwifery and to overcome harmful cultural practices. Midwives must appreciate the cross-cultural aspects of religion, ritual, gender, food and language, which can make a profound difference to women's experience of childbirth.
Launch of the ‘State of the World's Midwifery’ The second edition of the State of the World's Midwifery (SoWMy 2014), following on the original document launched in Durban in 2011, is subtitled ‘A Universal Pathway: a Woman's Right to Health’. SoWMy 2014's main objective, agreed at the 2nd Global Midwifery Symposium held in Kuala Lumpur in May 2013, is to provide an evidence base on midwifery in 2014 that will:
support policy dialogue between governments and their partners;
accelerate progress on the health MDGs; identify developments in the three years since the SoWMy 2011 report was published;
inform negotiations for and preparation of the post-2015 development agenda. SoWMy 2014 focuses on 73 of the 75 low- and middle-income countries that are included in the ‘Countdown to 2015’ reports. More than 92% of all the world's maternal and newborn deaths and stillbirths occur within these 73 countries. However, only 42% of the world’s medical, midwifery and nursing personnel are available to women and newborn infants (hereafter ‘newborns’) in these countries. The launch event brought thousands of midwives together in a plenary session to hear from the authors and contributors. Many well-known midwives and other stakeholders were involved in the compiling of the document, with the steering committee comprising Frances Day-Stirk of ICM, Laura Laski, Elizabeth Mason, Jean Barry, Benedict David, Luc de Bernis, Peter Johnson, Louise Holly, Tina Lavender, Gillian Mann, Betsy McCallon, Anders Molin, Arulkumaran Sabaratnam, Carole Presern and Simon Wright; while the core group of contributors were: Luc de Bernis, Jim Campbell, Catherine Carr, Sheena Currie, Caroline Homer, Petra ten Hoope-Bender, Peter Johnson, Zoë Matthews, Fran McConville, Nester Moyo, Mwansa Nkowane, Grace Omoni, Francisco PozoMartin, CN Puradane, Amani Siyam and Laura Sochas. The principal organisations behind the initiative are the ICM, UNFPA and WHO. A foreword to the SoWMy was written by UN Secretary-General Ban Ki-moon, who said: ‘The midwifery workforce, within a supportive health system, can support women and girls to prevent unwanted pregnancies, provide assistance throughout pregnancy and childbirth, and save the lives of babies born too early…. Every year, more governments, professional associations and other partners are acting on the evidence that midwifery can dramatically accelerate progress on sexual, reproductive, maternal and newborn health and universal health coverage. I fully support the Midwifery 2030 vision articulated in this report’. At the launch, Laura Laski of UNFPA, one of the co-chairs, began by thanking ‘all the midwives involved in the making of this report – in remote and rural areas, in urban slums, in hospitals and in women's homes’. We are working, she said, towards a world, where every pregnancy is wanted and every birth is safe, and she addressed midwives directly with the words ‘you are at the forefront of women's health rights’. Laura was joined on the platform by ICM's President Frances Day-Stirk and Vice-President Address Malata, and UNFPA's Executive Director Dr. Babatunde Osotimehin, who spoke of the importance of investing in midwives: midwifery, he said, is the ‘best buy’ in primary health care. Frances Day-Stirk welcomed this long-awaited celebration of the launched document. It has arrived she said, after a long gestation and a hard labour! Representatives from three of the featured countries – Bangladesh, Pakistan and Morocco – then spoke. Rafat Jan, from Aga Khan University in Pakistan, said she plans to translate key messages to share with the midwives in her country working at grassroots level, adding ‘It's time now. We know what needs to be
E. Duff / Midwifery 30 (2014) 969–971
done. The report is here, so let's go for action’. Hanane Masba, midwife from Morocco, shared her experience and stressed the importance of keeping women at the centre of maternal health policy. She felt there were two major gaps in terms of women's access to care, and the coverage of the continuum of care. She reported that in Morocco midwives are gaining status, recognition and visibility, but the regulation governing the profession dates from the 1950s and clearly needs refreshing. Hanane called for action and interprofessional collaboration, as midwives can only drive change together – ‘Hommage à toutes les sages-femmes!’ she concluded. Arul Sabaratnam of the International Federation of Gynaecologists and Obstetricians (FIGO) assured midwives that the content and recommendations of the publication would be disseminated to all member societies of FIGO, with the added encouragement to work collaboratively with their relevant midwifery associations. A speaker from Sweden reflected that the obstacles to achieving effective midwifery coverage include ‘not knowing what to do’, ‘knowing what to do but not being able to afford it’ and ‘knowing and affording but not wanting to’. Sweden, he said, is a rich country, and there healthy women go through pregnancy and birth without ever ‘shaking the hand of a doctor’; the reason is that we choose midwives: not because they are the cheapest, but because they are the best. Dr Flavia Bustreo, Assistant Director General for Family, Women's and Children's Health at WHO, said that ‘by working together we can spark needed action for women and children around the world’. She pledged full support of the action plans, but warned, ‘these are only the first stop’. The Lancet series on midwifery This long-awaited publication could not be launched at the Congress (an event that happened later in June, in London) but a discussion session previewed the structure and format of the series and heard from some of the authors. The series consists of four papers entitled: Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care; The projected effect of scaling up midwifery; Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality; and Improvement of maternal and newborn health through midwifery. Petra ten Hoope, one of the authors, answered the question ‘why a midwifery series?’, by explaining that such a subject merits more than one article. Most articles are written about a ‘vertical’ topic – e.g. a disease that must be diagnosed, treated and cured. Midwifery, in contrast, is a comprehensive ‘horizontal’ subject – not a tool but a crucial ongoing component of health care for families. Referring to the last paper, she asked the question (mixing her metaphors) ‘does this wrap up the building blocks?’; and answering it, said ‘it does more than that’. It sets out next steps for midwifery associations, for policy makers and for key players in education and regulation. Mary Renfrew, another of the lead authors, described it as ‘an awesome responsibility, to lead on this project’. She also explained that, in addition to the four papers listed that will appear as a series, there will be further publications on the human rights aspect of midwifery and the future research agenda. She said the first paper described the ‘landscape of midwifery’. It is clear that, across the globe, midwives have a hugely variable experience in terms of their status and role. The authors examined more than 460 Cochrane reviews and other systematic analyses of data to reach their conclusions. Caroline Homer answered another key question: ‘How will this publication make things better for women and their families?’. She stressed the value of ‘putting this altogether in one place’. Caroline also highlighted the perspective of care that is ‘woman-centred’,
971
not centred on a profession, a country or an institution. Every woman needs an individualised ‘package of care’, not just one intervention. She and co-authors had used the ‘lives saved’ model to calculate the impact of scaling up midwifery. Zoe Matthews, a non-midwife sociologist, economist and statistician, who has worked closely with midwives and the White Ribbon Alliance, emphasised the power of the interdisciplinary group of contributors, which nevertheless held midwifery at the centre. She described case studies, used in the article, of counties which have made significant progress over the past: lessons can be learned here. Eighteen authors had worked on this paper to ensure the ‘stories’ from their countries reflected authentically what has been done. Holly Powell-Kennedy joined the other speakers to talk about the future research agenda, a paper that will be published in the autumn. She is working closely with WHO to identify gaps. Soo Downe also spoke about the forthcoming human rights publication: it will look at three levels of rights: micro-level, for individual women and care providers; meso-level to address accessibility and affordability; and macro-level to explore over-arching themes like women's education and status. This session continued with vigorous debate and questions from a full congress hall, and many contributors expressed their excitement about the ground-breaking publication and keenness to read the articles in full. Conference programme and exhibition In addition to the keynote speeches and other plenary sessions as described above, the full programme offered a wide view of midwifery topics as panoramic as the physical view from the attractive setting of the Congress centre. The 3500þ midwives attending packed the smaller rooms of the building to attend their choice of presentations, seminars, workshops, debates, films and the huge array of posters available to view at all the breaks. A skim through the highlights included an excellent session on ‘place of birth’ with Patti Janssen from Canada and Ingegerd Hildingsson from Sweden showing spectacular photographs of the winter landscapes of their northern countries to illustrate the terrain that women or midwives must travel to meet at the place of birth; a thoughtful focus on ‘decision making’ with contributions from the UK, USA and the Republic of Ireland; a fascinating preview of selected material from the UK-based self-hypnosis trial, exploring women's experiences of taking part; Dutch, Australian and British aspects of ‘women's choice’ over their intra-partum care; a session entitled ‘risk’ which picked up aspects of this enormous subject from Australia, New Zealand and Canada. An event in the main hall that drew a large audience was a debate on ‘Midwifery practice is driven by women's wishes (or choices)’. The speakers on either side came from Ghana, Netherlands, Malawi and New Zealand. After impassioned addresses from these four midwives and numerous contributions from the floor, the vote went against the motion. However, the chair called for a further vote as to whether practice should be driven by women's choices, which turned the balance the other way. A wide-ranging exhibition kept delegates busy at every break visiting stands leaning about new products, books, journals, resources and initiatives from non-profit or commercial organisations. Save the Children drew midwives in with the offer of wool and needles to knit a square for a blanket to keep an infant warm; while the global midwifery twinning movement had crafts and trinkets to sell for their fund-raising. Finally, the closing ceremony featured an inspiring and moving presentation from singing and dancing Canadian midwives who invited all the world's midwives to join them in Toronto for the next ICM Congress in 2017.
