3.

Global voices for change:

consultations on the future of
quality midwifery education
As well as the evidence provided in section 2,
this report builds on a series of joint global
consultations held between 2016 and 2018 and
convened by ICM, UNFPA and WHO (Box 11).
The aim was to have a better understanding of
what action needs to be taken to strengthen
midwifery education and improve quality of care
(Box 12). This section sets out the consensus reached, including innovative examples
from the
participants of progressive change already
taking place (Boxes 13−23).
3.1 Three strategic priorities for
strengthening quality midwifery
education
Strategic priority (a): Every woman and
newborn to be cared for by a midwife,
educated and trained to international
standards and enabled legally to practise
the full scope of midwifery. The professional
title “midwife” should only be used for
providers who are educated and regulated
to international standards.

The consultations demonstrated a striking

global consensus on this strategic priority.
While acknowledging this as aspirational in
some contexts, because of limited or no
midwifery capacity at present, the case studies
in Box 14 below demonstrate it is possible,
even in difficult conditions.
Participants based this priority on the evidence,
and on examples showing how the introduction
of educated, professional midwives has made a
radical improvement in outcomes for women and
their newborns.
Box 13. Bangladesh introduces a
cadre of professional midwives
educated to international standards
A new cadre of professional midwives is
successfully meeting the needs of mothers,
newborns and families in health facilities
across Bangladesh.
Since 2010, UNFPA’s Maternal Health
Thematic Fund (MHTF) has supported the
government in its pledge to train an
additional 3000 midwives and double the
share of births attended by a skilled health
professional. In January 2013 Bangladesh
Box 14. Sierra Leone keeps midwifery
education on track
Despite experiencing the devastation of civil
war and the Ebola outbreak, Sierra Leone
continues to focus on educating midwives to
international standards:
• the number of midwifery educational
institutions has increased from two to three,
and the number of midwives has doubled to
over 600 in 2018;
• the National Nursing and Midwifery Strategic
Plan 2019−2023 includes establishment of
the first direct-entry midwifery programme;
this means midwives no longer need to train
first as nurses before becoming a midwife;
• the midwifery schools have established a
National Midwifery Education Institutions
Committee aiming to pursue continuous
improvement in midwifery education;
• the Nurses and Midwives Board has assessed
all midwifery schools against international and
national standards: temporary accreditation
has been granted. launched a three-year, direct-entry diploma
midwifery education programme. In October
2018, 1150 new professional midwives were
deployed at local level.
UNFPA has resourced over 38 midwifery
educational institutions across Bangladesh with
teaching and learning aids; helped to develop a
national curriculum and supported faculty
training; this included further study via an onsite
and Internet-based Masters programme with
technical support from Dalarna University,
Sweden. To strengthen clinical skills, UNFPA has
sponsored over 1777 midwifery graduates on
internships at 110 subdistrict hospitals. The MHTF has assisted with the development
of
midwifery policies and regulations, including
licensing exam and registration guidelines, a
code of ethics and standard operating
procedures for midwifery services. The
Bangladesh Nursing and Midwifery Act was
approved by Parliament and launched in 2016.
Bangladesh regularly experiences humanitarian
crises including devastating cyclones, flooding
and a major refugee influx in 2017. Midwives
play a key role in the response working with
NGOs in and around refugee camps and remote
coastal areas helping the most vulnerable
women and children.
Strategic priority (b): Midwifery leadership
to be positioned in high-level national
policy, planning and budgeting processes
to improve decision-making about
investments for midwifery education to
help achieve UHC.
This strategic priority reflects the consensus of
participants, and the evidence, that a major
barrier to improving quality of care is the absence
of midwifery leadership in global, national,
regional and local level decision-making, on
investing in sexual, reproductive, maternal and
newborn health, as well as in research.
Box 15. Reforms in the State of
Odisha, India
In the Indian State of Odisha the government
took a holistic approach to reform,
addressing policy, management structure,
staff shortages and low pay. A state-level
nursing directorate has been created (India
has nurse-midwives) and a director of
nursing appointed. As a result, nursemidwives
are represented for the first time at
senior management level and their
perspectives are contributing to further
development of pre-service and in-service
education and training.
Box 16. England and Kyrgyzstan
announce first government chief
midwifery officers (GCMOs)
In 2017, by order of the ministry of health, the
first chief midwife of Kyrgyzstan was appointed.
Source: ICM
In 2019 the National Health Service for England
(NHS England) appointed its first chief midwifery
officer; up to this point one single post covered
both nursing and midwifery.
This is 117 years after the Central Midwives
Board (CMB) for England and Wales was
established and legal regulation for midwives
introduced. This meant that a woman could not
call herself a midwife, or practise as a midwife,
unless she was certified by the CMB.