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The ICM 'showcases'--a new feature at the international congress in Brisbane, Australia: representatives from ICM's global partner organisations came to Brisbane to tell midwives of their commitment to working together for safe motherhood.

The International Confederation of Midwives has always invited distinguished guests to its triennial congresses, but--as the ICM continues to gain influence and credibility among policy-makers at the global level--it was felt important on this occasion to give speakers from the most significant partners the opportunity to explain to the midwives in Brisbane how the collaboration with ICM works and how the future of joint work is envisaged.

World Health Organization

The first speaker, on the morning of Monday July 25, was Joy Phumaphi, Assistant Director General, Family and Community Health, WHO.

As the theme of Day 1 of the Congress was 'History', Joy had been asked to highlight the history of the collaboration between the ICM and the World Health Organization. However, she said that as she studied the details of the joint working over the years, she became convinced that the most important thing to focus on was the future.

To start with, Joy described what she felt was the 'unique point in history' of the present time. As had been clearly stated in the World Health Report 2005, 'With today's knowledge and technology, the vast majority of the problems that threaten the world's mothers and children can be prevented or treated'. Joy drove home this point, setting out in telling detail the fact that 'mankind has the capability to make birth a true celebration of life--and not a threat to life--for the 1 in 16 women in developing countries, or the 2.3 million stillborns and 3 million newborns that we lose every year?' She also asserted that 'we can ensure that every couple's need for reproductive health services is met' yet there are still 87 million unwanted pregnancies a year and 19 million women are pushed into a corner where they undergo life-threatening unsafe abortion. Mankind, she said, has the skills, resources and opportunity to ensure that women enjoy the right to life, have choices and be healthy; yet they still suffer debilitating conditions such as obstetric fistulae, because they are denied access to services and excluded from care.

At the World Health Assembly this year, all 192 member countries committed to the policy recommendations of the World Health Report 2005, Make every mother and child count:

* To end exclusion from life-saving health services and scale up effective programmes

* To protect and invest in human resources for health

* To engage communities in finding solutions and implementing them

* To stop out-of-pocket charges for maternal, newborn and child health services, and promote prepayment schemes.

Joy Phumaphi went on to outline plans for the new Partnership for Maternal, Newborn and Child Health: 'The necessary elements now exist for an exciting new global health architecture ... a structure that respects the unique roles, skills and comparative advantage of every player'. These would include communities, professionals, NGOs, the private sector, academia, research institutions, the public sector and multilateral and bilaterals funding agencies. The ICM, she said, is a critical partner in the merger to form the new partnership.

An important aspect of the challenges to midwifery services worldwide is the shortage of personnel. Joy Phumaphi stated that 'Putting people at the centre of development', and accepting that 'people are the basic unit of socio-economic interaction', will be the focus of future work. Development must start with education and the acquisition of skills. There must be full appreciation of the fact that 'midwives are uniquely at the centre of the birthing process because of what they have to offer the mother and child'. Investing in human capital such as midwives for childbirth is the wisest investment to be made, to ensure sustainability, ownership, fulfilment and consistently high results.

Continuing with her emphasis on the importance of recruiting, training and supporting appropriate health workers, Joy said, 'We must match the personal vision and goals not only of the clients that we serve, but also the self-actualisation of the health care provider. The midwife is just as important in this compact as the mother and the baby.'

The theme of people-centred services was picked up again when Joy said: 'It is not about choosing between a skilled attendant and a traditional birth attendant. It is not about choosing between routine and emergency obstetric care. It is about giving women access to the care they need when they need it. It is about skilled care before pregnancy, during pregnancy, during delivery and after delivery.'

Finally, she summed up the WHO/ICM continuing collaboration: 'We commit to working with the ICM at every opportunity. We shall collaborate more closely at country level, working through our new department of Making Pregnancy safer. We look forward to seeing ICM [representatives] seated around the table in countries, together with WHO, other members of the UN family, governments, bilaterals, foundations, NGOs, as we agree on a joint work plan, and partner to promote coverage and access for women and children.

'Whilst WHO regrets lost opportunities for enhanced collaboration with ICM in the past, we celebrate this opportunity to work with the midwives of the world not only in the delivery room and health facility corridors ... but in the planning, execution, reporting and monitoring and evaluation of country specific plans, crafted together with other partners.

'It is time for humanity to celebrate life.'

International Federation of Gynaecologists and Obstetricians (FIGO)

Dr Sabnaratnam Arulkumaran addressed the Congress participants on Day 2, with the theme of 'professionalisation'. He discussed the meaning of the term 'professional', agreeing with Lennie Kamwendo, the keynote speaker, that it implies a main interest in life, that membership of a profession is attained through higher education and that it involves elements of creativity, vocation and dedication. He also stressed that professionals should respect each other's vocation and work as a team.

The presentation continued with a number of slides showing the statistics of maternal mortality, both from the historical point of view and from its relationship to skilled attendance at birth. Three case studies of countries--Tunisia, Botswana and Sri Lanka--showed where progress has been made in recent years to raise levels of skilled attendance and bring down maternal mortality. In Sri Lanka, for example, the number of midwives in post has expanded by a factor of more than 10 over the past 50 years and this has had a major positive impact on outcomes for women. Arul also reminded his audience of the ICM/FIGO joint campaign launched in 2003 to ensure midwives and obstetricians worldwide were able to offer all women active management of the third stage of labour (AMTSL).

He then went on to outline some of the planed future work where FIGO and ICM can usefully collaborate. These include a major four-year project on women's sexual and reproductive rights, based in selected countries Ethiopia, India, Mexico, Nigeria, Pakistan and Sudan.

A second opportunity is in prevention and treatment of vaginal fistula, a joint project involving FIGO, UNFPA, WHO, Columbia University 'Averting Maternal Death & Disability' Programme and others.

Finally, Arul spoke of the 'language of collaboration' and the great need for respect for each individual's profession. He called for team working at international, national and district level, in the hospital or health care unit and in caring for the individual woman. Continuity of care is not possible without team work, and conflict within the team will affect the health and wellbeing of the mother, newborn and the child.

Partnership for Safe Motherhood and Newborn Health

Midwives in Brisbane had already heard from Joy Phumaphi of WHO about the plans for a merger of this partnership with others to create a new and more powerful agency. Effective collaboration and mutual respect will be more important than ever in the new way of working, so Khama Rogo of the World Bank, co-chair of the current partnership, based his message on this theme. Khama was unable to attend himself but had asked Joyce Thompson to present it on his behalf. Joyce kindly asked delegates to imagine her as a male Kenyan obstetrician, nearly two metres tall!

Khama Rogo's words were greeted with spontaneous applause by midwives:

'Reduction of maternal mortality by 2015 is one of the key Millennium Development Goals and it is now self-evident that skilled care is at the core of this quest. Midwifery is the currency of measurement of the level of skilled care.

'As a trained obstetrician, I can confess one thing that you already know. I learnt my obstetrics at the feet of midwives. Most of us do. All good obstetricians must. This acceptance has always provided me with a strong sense of identity with midwives and serene humility in their presence.

'The world needs midwives, now more than ever. The world recognises that without you, there can be no safe motherhood. My passionate appeal is therefore to you, the midwives of the world. For the sake of safe motherhood, I appeal to your leadership, global, regional and national, to propose and approve a roadmap that will open up dialogue at all levels, leading to a new relationship of love and respect for each other, to the great benefit of millions of women and mothers that depend so much on the combination of our skills. As the older of these two professions, you have the maturity and patience to lead the way to success!

'In the last four years, I have had the great pleasure of co-chairing the global Safe Motherhood movement with Professor Joyce Thompson of the USA. I have learnt a lot from her. This is what the world needs if we are to attain the MDGs: coherence, tolerance and harmony between the professions, putting the interest of the women and families first. I wish you the very best in your deliberations and pray that with our combined efforts, there will be genuine and successful efforts to build the bridges. After all, we need each other and the women whose health we are trained to preserve, need us together.'
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Publication:International Midwifery
Date:Sep 1, 2005
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