New global midwifery initiatives and why 2014 should be a good year for women and newborns

Global evidence demonstrates that countries which have prioritised skilled midwifery care within an enabling health systems environment, have achieved the most significant improvements in the survival of women and newborns (Graham et al., 2001). Recently, evidence from a Cochrane systematic review of midwife-led continuity of care versus other models of maternity care (Sandall et al., 2013) shows that women and newborns who receive midwife-led continuity of care experience positive maternal outcomes with fewer interventions with no statistically significant difference betweenmidwifery-led and other models of care in fetal loss or neonatal death (Sandall et al., 2013). Midwifery services are unique in that they combine public health and clinical health, combining access to professional care for all women and newborns in both the community and clinical facilities, and across the continuum of care. As such, midwifery services are extraordinarily well positioned to move forward in the post-2015 global health agendawith its evolving focus on universal access to care (UHC) (WHO, 2012). There are positive signs that the value of midwifery services, provided mainly by midwives in teams of professionals with a range of skills including advanced obstetrics and paediatrics, are increasingly being acknowledged as essential to the improvement of quality, not only coverage, of care provided to women, their newborns and families. We are in a good place. Several global initiatives are taking hold that that will progress this agenda. Firstly, a Global Midwifery symposium took place in May 2013 in Kuala Lumpur. This second symposium united midwives and key partners including government representatives, UN agencies, donors, the private sector, and the media in a focus on quality midwifery services. The main messages of the symposium were that we have more work to do before we can truly ensure that all those providing midwifery services have the skills needed, and that we must get better at defining and measuring the quality of care that women and newborns receive. The symposium closed with a strong global commitment to seven critical priorities needed to improve the quality of midwifery services. This ‘Declaration’ includes strengthening: investment; education; deployment; being women centred; regulation; support to midwives and nurses associations, and the evidence base to justify increased investment (The Second Global Midwifery Symposium, 2013). Secondly, UNFPA, WHO and the ICM are co-chairing a process that will launch the second State of the World's Midwifery (SOWMy) Report at the ICM Triennial Congress in Prague, June 2014. The first SOWMy report (UNFPA, 2011) was ground-breaking because it was the first document providing evidence about the global situation of midwifery. The absence of previous documentation on global midwifery underlies what has been a worrying lack of investment in critical midwifery services, despite the past two decades of support for reducing maternal and newborn deaths. This second report aims to go a long way to redress that imbalance. The third, much welcomed, initiative is the first ever Lancet Series on Midwifery (LSM). Due to be published in early 2014, the LSM will add to other landmark contributions to maternal and newborn health made by The Lancet including those on newborn survival, stillbirths, and nutrition. The LSM will set out a new maternal and newborn health framework centred on the needs of women and newborns and what skills are needed to provide the best quality care to women with both straightforward and complicated pregnancies. The LSM will call for significantly increased investment in research on the impact of midwives and midwifery services. This is much needed to provide the evidence on the uniqueness, and effectiveness, of midwifery services in terms of quality care. The fourth is the exciting Global ‘Every Newborn’ Action Plan (ENAP) led by WHO and UNICEF and anticipated in mid-2014. The ICM President is engaged in the process and midwives are already involved in global consultations. There is a dynamic website open to all who want to have a voice in how the role of midwives is reflected in this global document, as well as how the quality of newborn care can be improved through midwifery services at home and in facilities (http://dx.doi.org/www.everynewborn.org). The fifth initiative is all about stronger global co-ordination and financing mechanisms being applied to investing in midwifery services. The H4þ (health four ‘plus’) refers to the coming together of the key UN agencies responsible for maternal, newborn, adolescent and child health (UNFPA, UNICEF, WB and UNAIDS) ‘plus’ other partners. The H4þ is supporting the incountry development, with and through Ministries of Health, of one national plan for midwifery based within existing national