Strengthening Midwifery Globally International Confederation of Midwives Frances Ganges, MPH, CNM...

Strengthening Midwifery Globally

International Confederation of Midwives

Frances Ganges, MPH, CNMBOD- Americas Regional Rep

International Strategies for Strengthening Midwifery



The sole voice representing midwives globally

Africa

Americas

Asia

Europe

Umbrella organization of professional midwifery associations 108 member associations

250,000 midwives 98 countries

4 regions

ICM Americas Region North America

USA, CanadaCaribbeanLatin America

BOD Regional Representatives:Mirian Solis – Latin AmericaFrances Ganges – N. America/Caribbean



ICM History1919: International Midwives Union

1934: International Federation of Midwives

1954: 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



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 and promoting the profession Focus of global efforts



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)

ICM global partners



Millennium development goals



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



Acute shortage of midwives350,000 needed

Number of trained midwives do not meet needsDiversity in midwifery definition and trainingScope of practice inadequate

Constraints on the role of the midwife in midwifery regulation

Prescriptive authority lackingLack of regulatory framework

Challenges and Issues

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.

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3 Pillars of ICM

Provides professional support Contributes to policy developmentSupports relationships with other health care professions

Provides practice standards

Defines & protects scope of practice

Provides a highly qualified workforce

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.

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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

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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 public18

Purpose of Education Standards

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

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The Process

Task Force Members

Atf Gherissi – Tunisia

Ans Luyben – Switzerland (ICM ESC)

Karyn Kaufman – Canada

Sally Tracy – AustraliaMary Higgins – Ireland

(ICM BOD)Angela Sawyer –

LiberiaBente Silversten –

Denmark (WHO rep)

Ellen Chirwa – MalawiKyllike Christensson –

SwedenHilda Bonilla – ChileRafat Jan – Pakistan Nester Moyo –

Zimbabwe(ICM staff liaison)

Joyce Thompson – USA

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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

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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 ?

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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/2009Phase 2: validation of standards, revising as needed after each round with diverse panel of stakeholders

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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)

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Final DocumentPreface, 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)

ICM Global Standards For Midwifery Education (2010)

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

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These are minimum standards = adaptabilityAny 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

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Caveats

The steps ahead….

Raise awareness about these EducationStandards 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

ICM Global Standards for Midwifery Education (2010) with Guidelines



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)

The Midwife effect



Americas Regional Midwifery Conference Quito, Ecuador

May 2013



30th ICM Triennial CongressJune, 2014

http://www.midwives2014.org/

See you there…



International Confederation of MidwivesLaan van Meerdervoort 70

2517 AN, The HagueNetherlands

Telephone: +31 (0)70 306 0520 Fax: +31 (0)703 555 651

[email protected] www.internationalmidwives.org

Thank You!

mailto:[email protected]

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