ICM promotes international leadership development for young midwives: ICM Programme Manager Nester Moyo gives the background and progress on a groundbreaking ICM initiative launched in Port of Spain, Trinidad, April 2004.

The Young Midwifery Leaders Programme is one of ICM's major undertakings in leadership development among midwives across the globe. A full report on the progress of the new programme, 'Young Midwifery Leaders', has followed the successful launch of the project in Trinidad, April 2004, and this summary highlights the significance of the work in a global context.

The February 2001 international consultative meeting--the 'Meeting of the Minds'--convened by ICM (Midwifery, International news, 17(2): 158-159), focused on determining the issues that must be addressed to strengthen the profession of midwifery across the world. Such action was planned with the ultimate goal of improving the health of women and their families. Leadership development was identified as a key issue.

ICM has also repeatedly received requests from midwives' associations for leadership training; and is vigorously participating in the international thrust led by WHO towards strengthening nursing and midwifery services. Overall, the awareness that it is midwives' responsibility to take the lead in health care for healthy mothers and babies, led to the creation of the Young Midwifery Leaders programme.

Through this project the ICM sees a future with midwifery leaders actively working in the global health arena as primary advocates for women and children; charting the way for midwifery and safe motherhood activities; contributing to global policy and approaches to midwifery and reproductive health; and holding key positions in the international institutions and agencies that are concerned with reproductive health, safe motherhood and midwifery. The new midwifery leaders will drive change in social, political and cultural areas where women and children are currently disadvantaged; they will promote the profession; and act as inspiring role models both for midwives and for other health care workers.

Among the aims of the project is the development of leadership skills among midwives at local, national, regional and global levels. The anticipated result will be a network of visionary midwifery leaders who think strategically and systematically, see beyond their own national and professional boundaries, take risks and are able to embrace challenges as opportunities to improve their own performance.

ICM is well aware that such leaders of the profession do exist now and always have done, but seeks by this initiative to ensure there is coherent support and network communications to reduce duplication of effort and lighten the heavy burden on individuals.

Development through a mentor:mentee approach

A distance learning approach, with mentorship, and three four-day face to-face workshops over a period of three years are being used as the principal tools for learning. Mentors and mentees have been identified from all regions.

A crucial part of the sessions held in Trinidad was a detailed examination of the nature of the mentor:mentee relationship, what both may understand to be their roles and what are the expectations of results from the partnership. There is a two-tier structure to the scheme, so that each mentee has identified her or his own mentor within the same country--and these pairs are expected to work closely together--while there are a number of other ICM identified mentors, established midwife leaders in the in the global community, who may be called upon for particular areas of expertise. In this way the mentees have a source of immediate support for their activities from their own personal mentor while both mentors and mentees have access to the support, knowledge and wide perspective of existing leaders in the global midwifery community.

Maureen Kelly tackled leadership training on an international level and gave an overview of mentorship. Mentorship opens doors to what one does not know. It has both personal and professional benefits; a mentor who is remembered is usually:

* A good teacher

* Somebody one respects

* Someone who is willing to listen and to share.

* Someone who attempts to communicate effectively.

The discussion progressed to show that mentees can learn from negative experiences as well--one can learn how not to do something from a negative experience with one's mentor. When a mentor is chosen for a mentee the relationship is different from when the mentee identifies her/his own mentor. It is important in a mentor:mentee relationship to remember always the value of effective communication and the need to consider the personal values, safety, inspiration and trust of the mentee.

Global issues in midwifery

During the Trinidad meetings, both mentors and mentees spent time with members of the ICM Executive Committee and had sessions with the Director and Deputy Director of the Board of Management. Judi Brown, Deputy Director, took the participants on a whistle-stop tour of global 'hot topics' for midwives, suggesting that they may have to tackle issues such as:

* privatisation of health care services and restructuring of health systems,

* the role of indigenous midwives

* midwives working with other health professionals

* liability, litigation and professional insurance

* strategic planning 

* HIV/AIDS in the workplace

* international and civil war, and terrorism--impact on women, families and midwives

* media relations

* globalisation of midwifery

* lack of support and status for midwifery and midwives

* medicalisation of childbirth, e.g. Caesarean section rates rising without clinical indication.

Joyce Thompson, ICM Director, added to this list the stares of women and their lack of human rights; the erosion of standards in midwifery education and practice; recruitment and retention of midwives; and the involvement of midwives in the drive to reach the UN Millennium Development Goals.

All of the five mentees--from Germany, Malawi, South Africa, Slovedia and Trinidad--also underwent psychological assessment and learned about their own strengths and weaknesses, identified their own ambitions and explored their set of shared values.

Participants learned about the various types of health systems that are prevalent, depending on the political orientation, socioeconomic status and level of development of the country. Those described included: 'entrepreneurial', 'welfare-oriented', 'universal comprehensive' and 'socialist'. From discussion it was clear that none of the mentors/mentees' own countries fitted neatly into one category, but instead were combinations of systems or transtional:

* Malawi is welfare-oriented. It is a poor country, where midwives offer direct patient care in an autonomous fashion. There is a good relationship between midwives and obstetricians. Midwives hold positions in policy-making organisations. The midwifery association is powerful and is involved in the process of developing legislation to separate nursing and midwifery.

* South Africa is a combination of several approaches. The system is fragmented. Ten years ago midwives were mainly obstetric nurses, and many retain that role today. However, there is an emerging group of independent midwives.

* Slovenia is transitional-universal. The midwifery school was closed for 22 years and has now reopened. No home births are allowed at the moment. The number of midwives has dropped from 1,300 to 300.

* Germany seems to be welfare-oriented moving to entrepreneurial. Many midwives have the obstetric nurse role. There are strong lobbies from midwives offering comprehensive care. It is legislated that a midwife must be present at all births.

* Trinidad and Tobago is universal-comprehensive. It is a developing and transitional country, and there are midwives at ministerial level in regional offices and in the accreditation body, as well as a professional body of midwives. Some midwives work in private practice.

Power and power bases

Nester Moyo's presentation on this theme helped the participants to realise that midwives have professional, position and personal power bases and they also have the power of numbers. They need to acknowledge these and use them selectively. Midwives are far from powerless--but they need to know how, where and when to use that power.

Definitions of power were discussed, including power as the capacity to: produce effects on others; influence the behaviour of others who are in a state of dependency; influence others so that they do what they may not have done if the influence had not been exerted; compel obedience; wage war.

The characteristics of power were also examined: it may flow in any direction within an organisation; some types are expendable and need to be replenished; power may be overt, covert or even insidious and is a possession of both individuals and groups.

Power bases are the sources of power. Within an organisation, there may be 'position power' also referred to as legitimate power or authority, 'reward power' which tends to be backed up by position power and 'coercive power' which is related to some kind of force (overt or covet). In contrast, personal power resides in the individual due to some characteristic inherent, acquired or potential. "Charisma' and 'goodwill' fall into this group, as do 'expert' and 'information' power.

It is important to know people, build relationships over shared interests, respect different interests and avoid the risks of being reliant on one base only. Effective leaders take advantage of all their sources of power, are open to being influenced by others and their followers, vary to the extent they share their power and work to increase their power bases. Midwives have tended to keep most of their power latent. But be convinced: midwives have power-they just need to unleash it.

The impact of gender and poverty on women's health 

Dr Christina Mudokwenyu from Zimbabwe gave an outline of gender as an issue of relationships; gender and poverty as issues of maternal and child health; and implications for midwifery leaders.

Worldwide, women are involved on a large scale in unpaid work, reproductive risk, and risks associated with caring for others; they may be involved, but often on a smaller scale, in formal employment, policy and decision making and positions of influence.

Work on a case study clearly illustrated that pregnancy and poverty are a poor mix. There is an increased risk of complications and when complications occur they make a bad situations worse. Those children born in poverty either die or survive to be poor themselves, and also suffer the disadvantages of illiteracy and poor general health leading to poor reproductive health.

The challenges presented were: how can young midwifery leaders reach out to women and girls in this situation? What leadership skills are needed? Axe gender and poverty policy issues? The discussion that followed pulled out the following issues

* The Millennium Development Goals cut across all issues and midwives should be concerned with all of them

* The issue of child-headed families, now prevalent in those countries hard hit by HIV/AIDS, prejudice the chances of children, particularly girls, escaping from poverty. Often girls take up the task of looking after the other siblings and stop going to school. The damaging effect of female gender and poverty is perpetuated.

* Having looked at education in different parts of the world, the impact of environmental health, gender and poverty on maternal and child health, it became clear that it is important to look at the world as a whole and attempt to strike a balance when thinking of developing interventions.

Evaluation of all the sessions was extremely positive, and all concerned left the workshop highly motivated to continue the work.

ICM is actively seeking further funding and exploring partnership possibilities to organise a workshop on advocacy for all the mentors and mentees in 2005, as well as finding opportunities for the young midwifery leaders to become involved in other ICM projects.