Chief Midwife for the ICM: Reflections and insights

We are privileged to have Professor Jacqueline Dunkley-Bent OBE, the first Chief Midwife for the International Confederation of Midwives (ICM), write this week’s article and speak on the Midwifery Hour. She reflects on her role and highlights the importance of strengthening midwifery across the world.

_________________________________________________

As the first Chief Midwife for the International Confederation of Midwives (ICM), having served for four years as the first Chief Midwifery Officer for the NHS in England, I share my reflections and insights about my role thus far. Firstly, a little about the ICM. Celebrating its 102^nd birthday this year, ICM supports, represents and works to strengthen professional associations of midwives throughout the world. Professional Associations are often referred to as colleges or societies. There are currently 140 Members Associations, representing 119 countries across every continent. Together these associations represent over 1 million midwives globally.

My role as the Chief Midwife is described as the global figurehead for ICM’s midwifery expertise. I represent the interests of midwives around the world, and lead initiatives essential to the growth of midwifery globally.

A relatively new role for the midwifery profession, a Chief Midwife is typically a prominent senior midwife within a health system, government office, midwives’ association (MA) or non-governmental organisation (NGO). A Chief Midwife usually has executive responsibility for leading and advising on: the midwives contribution to maternity health outcomes and experiences of women and babies, midwifery policies, practice, and standards within a healthcare organization or at a broader healthcare system level, to lead midwives and midwifery, advocate for and advance midwifery care, collaborating with other healthcare leaders to end preventable maternal and perinatal morbidity and mortality.

I am responsible for developing the ICM regional approach to strengthen midwifery and create a leadership plan for midwives. The foundational principles of this work are rooted in the Professional Framework for Midwifery. This framework (figure 1) is made up of 10 key elements: 1) a philosophy 2) essential competencies for midwifery 3) education 4) regulation 5) association 6) research 7) a model of practice 8) leadership 9) an enabling environment 10) a commitment to gender equality and justice, equity, diversity and inclusion (JEDI). Each element is interdependent on the next, so strengthening one element will strengthen another and destabilising one, destabilises all. The ICM is confident that if every country sustainably implemented this professional framework, we would see higher quality midwifery services, more fulfilling careers for midwives, and enhanced reproductive health for women, their newborns, and their families.

Figure 1 Professional Framework for Midwifery

ICM envisions a world where every childbearing woman has access to a midwife’s care for herself and her newborn.

Realising the ICM’s vision for all women and babies to have access to a midwife, during my first 250 days as ICM’s Chief Midwife, I have amplified this vision in person in Australia, New York, Norway, Zambia, Turkey, Geneva and Washington. Advocating for midwives and the midwifery profession has been fundamental to these visits, discussing for example that midwives, educated & regulated to ICM’s standards and integrated into well-functioning health systems & providing family planning can:

• Provide 87% of essential care for women and newborns
• Avert more than 50% of maternal deaths, stillbirths and neonatal deaths
• Improve over 50 other health-related outcome, including in sexual and reproductive health, immunization, breastfeeding, tobacco cessation in pregnancy, malaria, TB, HIV and obesity in pregnancy, early childhood development and postpartum depression
• Provide care across the childbirth continuum – in home, communities and hospitals. Including humanitarian, fragile & conflict-affected settings

As I become more established in my role, it becomes more evident that there is so much to do globally to improve maternity outcomes and experiences, against a backdrop of many challenges including for example, humanitarian crises that are happening in many parts of the world. The ICM of course, is in contact with MAs in all affected countries and is working to connect them with resources and donors who can help midwives do their vital work, even in the most challenging circumstances. The maternal mortality ratio continues to shine a light on inequality in health outcomes with extremely high maternal mortality rates in: South Sudan with 1223 deaths, followed by Chad with 1063 deaths and Nigeria with 1047 deaths per 100 000 live births.

Despite these challenging unacceptable data, I remain steadfast in my vision for all women, gender diverse people and babies to have the same maternity outcomes and experiences as those who have the best. I will continue to advocate for midwives and continue to fulfil my role at the ICM to strengthen midwives’ associations, working with partners and donors, ministries and health systems, women and midwives, with much hope for this vision to become a reality.

January 2024

Professor Jacqueline Dunkley-Bent OBE

Chief Midwife, the International Confederation of Midwives (ICM)