100 Years of the International Confederation of Midwives: Empowering Midwives and Empowering Women

By Joyce Thompson

Midwives are essential for healthy nations! This narrative ‘herstory’ uncovers some of the mysteries and challenges during the past 100 years that surrounded a beleaguered profession and its global organisation, the International Confederation of Midwives (ICM). It tells the story of the power that a unified force of strong women leading the ICM and its midwifery associations did for Safe Motherhood and empowering women throughout the world. Their efforts resulted in today’s ICM being a vital standard-setting group for midwives and a respected advocate for the sexual and reproductive health and rights of adolescents and women, for healthy mothers and newborns, and, globally, for healthy nations.

• Language: English
• Publisher: Brown Dog Books
• Release date: Oct 4, 2022
• ISBN: 9781839525308

Book preview

100 YEARS OF THE INTERNATIONAL

CONFEDERATION OF MIDWIVES

First published 2022

Copyright © Joyce E Thompson, Joan Walker, Ann M Thomson & Margaret H Peters 2022

The right of Joyce E Thompson, Joan Walker, Ann M Thomson & Margaret H Peters to be identified as the authors of this work has been asserted in accordance with the Copyright, Designs & Patents Act 1988.

All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, electrostatic, magnetic tape, mechanical, photocopying, recording or otherwise, without the written permission of the copyright holder.

Published under licence by Brown Dog Books and

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ISBN printed book: 978-1-83952-529-2

ISBN e-book: 978-1-83952-530-8

Cover design by Kevin Rylands

Internal design by Andrew Easton

Printed and bound in the UK

This book is printed on FSC certified paper

100 YEARS OF THE INTERNATIONAL

CONFEDERATION OF MIDWIVES

EMPOWERING MIDWIVES AND

EMPOWERING WOMEN

1922–2022

Joyce E Thompson

Joan Walker

Ann M Thomson

Margaret H Peters

Dedication of the Book

This book is dedicated to the midwives and women of the world, the International Confederation of Midwives (ICM) and its member associations, the ICM’s Partners, and others interested in global midwifery. It is also written In Memoriam to all those wise women and midwives on whose shoulders we, the authors, stand.

100 YEARS OF THE INTERNATIONAL

CONFEDERATION OF MIDWIVES

EMPOWERING MIDWIVES AND

EMPOWERING WOMEN

1922–2022

Joyce E Thompson

Regional Representative,

Deputy Director & Director 1990–2005

International Confederation of Midwives

International Midwifery Consultant

Michigan, USA

Joan Walker

Secretary General 1990–1998

International Confederation of Midwives

International Midwifery Consultant

Reading, UK

Ann M Thomson

Professor (Emerita) of Midwifery

University of Manchester

Former Editor Midwifery

Margaret H Peters

President,

Deputy Director & Director 1981–1999

International Confederation of Midwives

Melbourne, Australia

Contributing Authors

Franka Cadée

President 2017–2023

International Confederation of Midwives

The Netherlands

Chapter 18

Katherine A Dawley

Midwife Historian

Philadelphia,

PA, USA

Chapter 2

Karen Guilliland

Regional Representative

International Confederation of Midwives

Midwifery Consultant

New Zealand College of Midwives

Chapter 14

ACKNOWLEDGEMENTS

Librarians/Archivists

Archivists at the Royal College of Obstetricians & Gynaecologists

Gertrude M Ayerle: Assisted in locating paper about the 1900 conference

Jan Ayres, Librarian (retired), Photographer

British Library Staff

Jill Caughley, researching history ICN in 2007 who sent key WHO documents to JET

Mary Dharmachandran, Librarian at the Royal College of Midwives

Wellcome Collection Archivists and Library staff: Obtained ICM files from catalogued and uncatalogued sources and assisted Joan Walker whilst she worked in the library.

Interviewees/Contributors¹

All the Midwives of the world who met with the Authors since 2014²

The ICM Headquarters’ Staff

Roa Altaweli (Saudi Arabia): ICM Eastern Mediterranean Regional Representative

Sabaratnam Arulkumaran: FIGO

Ruth Ashton (UK): ICM Treasurer

Luc de Bernis: WHO, FIGO

Judith Marie Brown (Australia): ICM Deputy Director, Director Board of Management

Franka Cadée (The Netherlands): ICM President

Kim Campbell (British Columbia): ICM Treasurer, ICM Council member

Karin Christiani (Sweden): Director, ICM Board of Management

Alicia Cillo (Argentina): ICM Regional Representative

Dame Karlene Davis (UK): ICM Appointed President

Frances Day-Stirk (UK): ICM President

Jemima Dennis-Antwi (Ghana): ICM Anglophone Africa Regional Representative

Elizabeth Duff (UK): Editor of ICM newsletter

Vincent Fauveau: UNFPA

Judith Fullerton (USA): Consultant ICM Essential Competencies process

Frances Ganges (USA): ICM Secretary General/Executive Officer

German Midwives Association: Ingela Wiklund

Pandora Hartmann (USA): ICM Americas Regional Representative

Kathy Herschderfer (The Netherlands): ICM Secretary General

Petra ten Hoope-Bender (Netherlands): ICM Secretary General

Nicola King: Indexer

Ann Kinnear (Australia): Western Pacific Regional Representative

Anneka Knutsson: SIDA, UNFPA

Junko Kondo (Japan): ICM Asia-Pacific Regional Representative

Barbara E Kwast (Netherlands): WHO staff and ICM Liaison

Jerker Liljestrand: FIGO

Bridget Lynch (Ontario): ICM President

Nester T Moyo (Zimbabwe): ICM Programme Manager

Sandra Oyarzo (Chile): ICM Americas Regional Representative, ICM Vice President

Judith Oulton (Geneva): Executive Director, International Council of Nurses

Sally Pairman (New Zealand): ICM Chief Executive

Anja Peters (Germany): Author of IMU President Nanna Conti’s biography

Leah Phillips (UK): Timeline graphic

Julie Berry Foster (USA) Graphic Designer at Printex printing and graphics

Frances Prior-Reeves: Brown Dog Books Managing editor

Khama Rogo: World Bank; Co-Chair PSMNH

Anita Román (Chile): Latin American midwifery perspective

Kerri Schuiling (USA): Story of International Journal of Childbirth

Gloria Seguranyes (Spain): ICM European Regional Representative

Della Sherratt (UK): WHO staff and ICM liaison; Interim ICM Secretary

General Ann Starrs: Family Care International

Sister Anne Thompson (UK): ICM Treasurer, provided 75th ICM anniversary documents

Kim Updegrove (USA): Story of first ICM website

Paul Van Look: WHO

Caroline Weaver (Australia): ICM Appointed President

Reviewers

Roa Altaweli

Ruth Ashton

Franka Cadée

Frances Day-Stirk

Jemima Dennis-Antwi

Elizabeth Duff

Barbara Kwast

Bridget Lynch

Nester Moyo

Sandra Oyarzo

Sally Pairman

Della Sherratt

Ingela Wiklund

Table of Contents

List of Figures and Tables

Recurring Abbreviations

Preface by Her Royal Highness The Princess Royal

Foreword

Section I: Birth, Rebirth and Organisation of the ICM

Chapter 1: Introduction

a. Centuries of Midwifery Care

b. Approach to a Century of Collaboration and Empowerment Within the ICM

c. Key Themes During ICM’s 100-Year Journey

d. The Legacy of the ICM

e. Summary

Chapter 2: Gender, Socio-Economic Status and Racial Influences on the ICM’s Development

a. Introduction

b. Suffrage, Women Workers and Their Rights

c. Feminism, Social Class and Midwifery

d. Post-World Wars Concerns for Mothers and Babies

e. Socio-economic Status of Women Affecting the ICM

f. Gender-Based Decision Making

g. Changing Global Trends

h. Summary

Chapter 3: Birth of a Global Midwifery Organisation: The International Midwives’ Union

a. Introduction

b. European Midwives’ Efforts to Meet

i. Development of Midwifery Associations prior to 1922

ii. Local, National and International Midwifery Meetings prior to 1922

c. Overview of the International Midwives’ Union

d. When Did the IMU Begin?

e. What Was the Name of the Organisation?

i. What Did the Midwife Do?

f. What Was the Purpose of the Organisation?

g. How Did the IMU Function?

i. Secretariat

ii. Governance

iii. Subsequent Regulations

iv. Officers of the International Midwives’ Union

v. IMU Affiliated Midwifery Associations/Members

vi. Finances of the IMU

h. Conferences/Congresses/Meetings

i. Involvement of Obstetricians in the IMU

i. Midwives for Peace and Healthy Mothers and Babies

j. Summary

Chapter 4: Rebirth of IMU as the ICM

a. Introduction

b. Call for Rebirth of IMU

i. 1949 IFMO Meeting

ii. 1953 IFMO Meeting

c. WHO Expert Committee on Midwifery Training, July 1954

d. The ICM Congress in London: 4–11 September 1954

e. ICM Council Decisions 1954

f. 1955–1956 ICM Activities

g. The ICM Admitted into Official Relations with the World Health Organization – 1957

h. Other Early Partnerships

i. ICM World Congress in Stockholm – 1957

j. Summary

Chapter 5: ICM’s Constitutional Mandates and Structure

a. Introduction

b. Aims and Objects of the IMU/ICM Over Time (Purpose)

c. Major Constitutional Mandate Changes

i. The ICM Structure 1954–1981

ii. The ICM Structure 1981–2008

d. ICM Byelaws

e. Constitutional Mandates/Powers Affecting the Structure of the ICM

i. ICM Board: Qualifications and Responsibilities

ii. Responsibilities of the Board of Management (BoM)

iii. Executive Committee 1954–1981–2017; The Board 2017–present

iv. Responsibilities of the Executive Committee

f. Governance of the Confederation – the ICM Council

i. The ICM Structure from 2023

g. Actions and Responsibilities of the Council

i. Criteria for ICM Membership

ii. Setting Global Midwifery Policies and Standards

iii. Selection of Host Associations for Congresses

iv. The ICM Secretariat

v. Responsibilities of the Secretariat

h. Summary

Chapter 6: The Search for Financial Stability/Viability

a. Overview

b. Sources of ICM Income

i. Membership/Capitation Fees

ii. Congress Fees and Sharing of Proceeds/Profits from ICM Activities

iii. Core Funding

iv. Project Funding

v. Special Funds

c. Financial Support for Member Associations and Midwives

i. Support for Council and Congress Participation

d. Recurring Expenditures

e. Financial Ups and Downs

i. 1970s

ii. 1980s

iii. 1990s

iv. 2000s

v. 2010s

vi. 2020s

f. Summary

Chapter 7: Support of ICM Business by the Secretariat

a. Introduction

b. The ICM Secretariat (Headquarters/Head Office)

i. Geographical Locations

ii. Leadership of the Secretariat

iii. Work of the Secretariat

iv. Ongoing Work

v. Staffing the Secretariat

c. Communication with Member Associations

i. Phone, Facsimile and Courier

ii. Newsletters

d. The International Journal of Childbirth

e. The ICM Websites

f. Representation of the ICM

g. Summary

Section II: ICM: A CATALYST FOR GLOBAL RESPECT FOR MIDWIVES AND WOMEN

Chapter 8: ICM Vision, Mission and Strategic Directions

a. Introduction

b. Vision Statements

c. Mission Statements

d. Strategy Documents

i. Need for Outside Consultant – 1997

ii. ‘Meeting of the Minds’ – 2001

iii. The Story Continues

iv. Strategic Planning during 2008 Council Meeting

v. New Approach in 2017

vi. Strategic Directions Summarised

e. Summary

Chapter 9: Updating Midwives’ Knowledge and Skills

a. Introduction

b. Triennial Congresses: Scientific Meetings

i. Locations of Congresses

ii. Management of Triennial Congresses

iii. Structure of Triennial Congresses

c. Safe Motherhood Pre-Congress Workshops

i. Purpose and Organisation of Pre-Congress Workshops

ii. Pre-Congress Collaborative Safe Motherhood Workshops (Table)

d. Mid-Triennium Executive Committee Meetings with Symposia

e. ICM-Led Workshops During Congresses

f. Regional Meetings/Conferences

g. Country Workshops

i. Burkina Faso

ii. Ghana

iii. Zimbabwe

iv. Specific Country Efforts: 2005 and Beyond

h. ICM Education for Midwifery Teachers

i. Competency-Based Education Workshops

ii. Strengthening Midwifery Education in French-speaking Africa

iii. Global Standards for Basic Midwifery Education with Guidelines

iv. Midwifery Education Accreditation Programme (MEAP)

v. Additional education resources

i. Summary of the ICM’s educational efforts

Chapter 10: Strengthening Member Associations

a. Introduction

b. The Work of the Confederation

c. Member Association Issues Addressed

i. Council Agreed ICM Policy, Position, Statement and Core Documents (Annex A)

ii. Challenging Balance of Member Concerns

d. Awards for Exemplary Midwives

i. Marie Goubran Memorial Leadership Award – 1991 (Annex I)

ii. Columbia University Award for Midwives and Their Associations – 2001

iii. Saving Newborn Lives from Save the Children Award for Midwives – 2005

e. Support for Country Activities

i. Working Parties

ii. Projects with Collaborative Partners/Donors

1) Johnson and Johnson International

2) Johns Hopkins Programme for International Education of Gynaecology and Obstetrics (Jhpiego)

3) Sanofi Espoir Foundation [France]

4) Laerdal Global Health

5) Bill & Melinda Gates Foundation

6) Direct Relief

7) Strengthening Midwifery Services (SMS) with UNFPA

8) Swedish International Development Agency (SIDA)

9) White Ribbon Alliance

10) MacArthur Foundation

11) New Venture Fund

f. Tools to strengthen Member Associations

i. Midwifery Association Strengthening

1) Twinning Member Associations

2) Young Midwifery Leaders Programme

3) Member Association Capacity Assessment Tool (MACAT)

4) Midwifery Services Framework (MSF)

5) ICM RESPECT Toolkit

6) ICM Advocacy Toolkits

7) ICM’s Inaugural Global Goodwill Ambassador

g. ICM Standing Committees (SC)

i. Professional Practice Committee (PPC)

ii. ICM Research Standing Committee (RSC) – 1996

iii. ICM Education Standing Committee (ESC) – 2002

iv. ICM Regulation Standing Committee (RegSC) – 2008

v. Recent Standing Committees

h. The International Day of The Midwife (5 May)

i. Summary

Chapter 11: ICM’s Core documents

a. Introduction

i. What is a Profession?

ii. Why Autonomy?

b. International Definition of the Midwife

i. Road to the First Joint ICM/FIGO/WHO International Definition of the Midwife – 1972

ii. Updated International Definition of the Midwife

c. Scope of Midwifery Practice

d. International Code of Ethics for Midwi ves (1993)

e. Philosophy & Model of Midwifery Care (2005)

f. Bill of Rights for Women and Midwives (2011)

g. Definition of Midwifery – 2017

h. Summary

Chapter 12: ICM’s Global Competencies and Standards

a. Introduction

b. Essential Competencies for Basic Midwifery Practice (2002)

i. Background

ii. ICM Council Adopts Provisional ICM Essential Competencies for Basic Midwifery Practice – 1999

iii. ICM Council Adopts ICM Essential Competencies for Basic Midwifery Practice – 2002

iv. Updated ICM Essential Competencies – 2010/2011

v. 2017 Update of ICM Essential Competencies

c. Midwifery Education Standards and Guidelines (2010)

i. Background

ii. Development of the Standards & Guidelines

iii. ICM Adopts Global Standards for Midwifery Education with Guidelines – 2011

d. Midwifery Regulation Standards and Toolkit

i. Background

ii. Development of Regulation Standards

iii. ICM Global Standards for Midwifery Regulation (2011)

e. Midwifery Regulation Toolkit (2016)

f. Summary

Chapter 13: Regional Member Associations’ Perspectives on the ICM

a. Introduction

i. Number of Regions

ii. Regional Survey Questions

b. Anglophone Africa

i. Historical Background

ii. Member Associations

iii. Value/Impact of ICM Membership on Anglophone Africa MAs

iv. Impact of Anglophone African MAs on the Growth and Development of ICM as an Organization

c. Americas Region: North America/Caribbean

i. Historical Background

ii. Member Associations

iii. Value/Impact of ICM Membership on North American and Caribbean Midwifery Associations

iv. Impact of the North America/Caribbean MAs on the Growth and Development of ICM as an Organisation

d. Americas Region: Latin America and Mexico

i. Member Associations

ii. Value/Impact of ICM Membership on Latin American and Mexican Midwifery Associations

iii. Value/Impact of Latin American and Mexico MAs on the Growth and Development of ICM

iv. Conclusion

e. Asia-Pacific/Western Pacific Region

i. Introduction

ii. Historical Background

iii. Member Associations

iv. Value/Impact of ICM Membership on Asia-Pacific/Western Pacific Midwifery Associations

v. Value/Impact of Asia-Pacific/Western Pacific MAs on the Growth and Development of the ICM

f. Eastern Mediterranean Region

i. Historical Background

ii. Member Associations

iii. Value/Impact of ICM Membership on Eastern Mediterranean Midwifery Associations

iv. Impact of EMR MAs on the Growth and Development of ICM as an Organisation

g. Regional Expectations for the Future of the ICM

i. Future Expectations of the ICM from Anglophone Africa MAs

ii. Future Expectations of the ICM from North America and Caribbean MAs

iii. Future Expectations of the ICM from Spanish-speaking Latin America and Mexico MAs

iv. Future Expectations of the ICM from Western Pacific Region MAs

v. Future Expectations of ICM from Eastern Mediterranean Region MAs

vi. Common expectations from all Regions include

h. Summary

Chapter 14: Women, Midwives and the ICM

a. Introduction

b. Women’s Work

c. Women as Members of ICM Member Associations

d. The ICM’s Vision for Women and for Midwive

i. Listening to Women

ii. ICM’s Statement at the 4th World Conference on Women – 1995

iii. ICM’s Vision: Empowering Women, Empowering Midwives – 1993

e. ICM’s Commitment to Working with Women as Partners

i. ICM’s Midwives, Women and Human Rights – 2002

ii. ICM’s Philosophy and Model of Midwifery Care – 2005

iii. ICM’s Bill of Rights for Women and Midwives – 2011

iv. The ICM’s International Definition of the Midwife rev. 2011

f. Organisations Sharing a Common Vision of Women and Midwives as Partners

i. The White Ribbon Alliance

ii. Other ICM Partnership Efforts

iii. Partnerships with Global Health Groups/Agencies

g. The ICM’s Organisational Structure Supporting Women as Partners and Leaders

h. Summary

Chapter 15: United Nations (UN) Agencies and the ICM

a. Introduction

b. The World Health Organization (WHO)

i. The Who Expert Committee: The Midwife in Maternity Care – 1965

ii. The ICM and the WHO: An Ongoing Relationship

iii. Midwifery Technical Officers Within the WHO Assigned to the ICM

iv. Meeting Challenges directly for Health for All

c. The United Nations Children’s Fund (UNICEF)

d. The United Nation’s Fund for Population Development (UNFPA)

i. UNFPA-ICM Joint Initiative: Responding to a Decade of Action for Human Resources – 2008

ii. Mutual Respect between ICM and UNFPA

iii. Strengthening Midwifery Services

iv. UNFPA/ICM Electronic Newsletter 2021: A Moment for Midwives

e. The State of the World’s Midwifery Reports (SoWMy)

i. SoWMy 2011

ii. SoWMy 2014

iii. SoWMy 2021

iv. Summary UNFPA/ICM Activities

f. Midwifery Expertise Shared with Partners

g. Summary

Chapter 16: Health Professional Groups and the ICM

a. Introduction

b. International Federation of Gynecology and Obstetrics (FIGO)

i. The FIGO/ICM Joint Study Group: 1961–1979

1. Purpose of the FIGO/ICM Joint Study Group: 1961–1976

2. Maternity Care in the World , 1st Edition: 1966

3. Selected 1966 Outcomes Affecting ICM and Member Associations

4. Continued Joint Study Group Efforts

ii. European Working Party on Midwifery Training in European Countries – 1969

iii. Second FIGO/ICM Project Aim and Objectives – 1972

iv. Maternity Care in The World , 2nd Edition 1976

v. Impact of the FIGO/ICM Joint Study Group on the ICM

vi. The FIGO/ICM/WHO Definition of the Midwife

vii. Ongoing ICM and FIGO collaboration

c. The International Pediatric Association (IPA)

d. The International Council of Nurses (ICN)

i. Overview

ii. Joint Efforts at the World Health Assembly (WHA)

iii. Triad Meetings

iv. Other ICM and ICN Collaboration

e. Partnerships for Maternal, Newborn and Child Health

i. The Partnership for Safe Motherhood and Newborn Health (PSMNH) – 2004

ii. The Partnership for Maternal, Newborn and Child Health (PMNCH) –2005

iii. The Role of Health Professional Organisations in PMNCH

iv. The PMNCH Work Plan and Board Members

f. ICM Joint Statements

i. The Midwife as Prototype Skilled Attendant

ii. Midwives and Nurses Call for Increased Skilled Attendance at Birth (2000)

iii. Birth Registration (2003)

iv. Prevention of Post-partum Haemorrhage (2004/2006/2008)

v. Hammamet Call to Action: ‘Scaling-up Midwifery in the Community’ (2006)

vi. A Global Call to Action (2010)

vii. WHO/UNFPA/UNICEF/ICM/ICN/FIGO/IPA Definition of Skilled Health Personnel Providing Care during Childbirth (2018)

g. The Lancet Series on Midwifery – 2014

h. Summary

Chapter 17: ICM’s Importance to Midwives, Women and World Health

a. Introduction

b. ICM’s Value/Importance to the Health of Women

i. International Midwives’ Perspectives

ii. International Obstetricians’ Perspectives

c. Value of the ICM to Midwives and Midwifery Associations

i. International Midwives’ Perspectives

ii. International Obstetricians’ Perspectives

iii. International Partners’ Perspectives

d. Importance/Value of the ICM to its Global Partners

e. Lessons Learnt from History

f. The ICM’s Challenges Moving Forward

g. Summary

Chapter 18: A Vision for the Future of the ICM and Midwifery

a. Introduction

b. Strengthening Midwife Associations Is ICM’s Core Business

c. Autonomy of Women, Midwives and the ICM

i. Women

ii. Midwives

d. ICM’s Global Strategy 2020–2023: The Way Forward

e. Summary

Annexes

A. Member Association issues and resulting ICM Position Statements/Documents

B. Countries Represented at each IMU Congress/Conference/Meeting 1922–1938

C. Table of ICM Congresses and Themes 1954–2021

D. Table of ICM Partners and Projects 1951–2022

E. Wording of Objects/Aims in Constitutions of the IMU/ICM 1925–2022

F. Table of ICM Appointed and Elected Officers 1954–2023

G. Tables of ICM Member Associations by Regions 1934–2021

H. Geographical Location of ICM Headquarters 1939–2022

I. Winners of the Marie Goubran Memorial Leadership Award 1993–2020

Index

List of Figures and Tables

Table 3.1 IMU Congress Locations, Dates and Officers/Honorary Officers

Figure 5.1 The ICM Structure 1954–1981

Figure 5.2 The ICM Structure 1981-2008

Figure 5.3 The ICM Structure from 2023

Table 7.1 I CM Secretary Generals & Chief Executive Officers 1922–2022

Table 8.1 ICM Strategic Directions 2008–2022 ICM Strategic Directions with Objectives 2017–2023

Table 9.1 Pre-Congress Collaborative Safe Motherhood Workshops

Table 9.2 ICM Mid-Triennium Workshops/Symposia

Table 13.1 Anglophone Africa: Country, Name and Year Midwifery Associations Accepted for ICM Membership

Table 13.2 North America & Caribbean: Country, Name and Year Midwifery Associations Accepted for ICM Membership

Table 13.3 Latin America & Mexico: Country, Name and Year Midwifery Associations Accepted for ICM Membership

Table 13.4 Asia–Pacific: Country, Name and Year Midwifery Associations Accepted for ICM Membership

Table 13.5 Eastern Mediterranean: Country, Name and Year Midwifery Associations Accepted for ICM Membership

Table 15.1 WHO Midwife Technical Liaison Officers for the ICM

Recurring Abbreviations

ACMI = The Australian College of Midwives, Inc.

ACNM = The American College of Nurse-Midwives

BOM or Board = refers to a group of elected officers of the ICM

CBE = Competency-Based Education

CE = Chief Executive

Communications = Communications of the International Midwives’ Union journal

Confederation = shortened for International Confederation of Midwives

Constitution = refers to the Constitution of the ICM

Council = Decision making body of the ICM consisting of two delegates from each Member Association plus elected Officers

DFID = UK government Department for International Development

EC = The ICM Executive Committee, i.e., Board of Management plus elected Regional Representatives from 1981 to 2005

ERA = ICM’s three Pillars of Education, Regulation and Associations

FCI = Family Care International

FIGO = The International Federation of Gynecology and Obstetrics

GAGNM = Global Advisory Group of Nurses and Midwives to the WHO Director General

HQ = The ICM Headquarters, also referred to as Head Office

IAMANEH = International Association for Maternal and Neonatal Health

ICM = The International Confederation of Midwives

ICN = The International Council of Nurses

IDM = The International Day of the Midwife (5 May)

IMU = The International Midwives’ Union

IPA = The International Pediatric Association

IPAS = International group that promotes safe abortion care and safe reproductive health

Jhpiego = originally known as the Johns Hopkins Program for International Education in Gynecology and Obstetrics; only the initials used now

JSG = The ICM/FIGO Joint Study Group

KSB = knowledge, skills, behaviour

MACAT = ICM’s Member Association Capacity Assessment Tool

MA = An ICM Member Association as distinct from a country’s midwifery association that is not an ICM member

MDGs = The United Nations’ Millennium Development Goals (2000–2015)

MEAP = ICM’s Midwifery Education Accreditation Programme

MEDPath = ICM’s Midwifery education development pathway programme

MSF = ICM’s Midwifery Services Framework

MMR = Maternal Mortality Rate

MNH = Maternal Neonatal Health

NGO = A Non-Governmental Organisation (more recently Civil Societies)

NZCOM = The New Zealand College of Midwives

PCWs = ICM’s Collaborative Pre-Congress Workshops

PMNCH = The Partnership for Maternal, Newborn and Child Health

POPPHI = USAID’s Prevention of Post-Partum Haemorrhage Initiative

PSMNH = The Partnership for Safe Motherhood and Newborn Health

PT = Part-time

Regions = the designated geographic regions of the ICM

RCM = The Royal College of Midwives

RMC = Respectful Maternity Care

SC = An ICM Standing Committee: e.g., R – being Research; E – being education; PP – being Professional Practice; Reg – being Regulation

SDGs = The United Nations’ Sustainable Development Goals (2015–2030)

Secretariat = includes the ICM office location and staff

SG = Secretary General of the ICM

SIDA = The Swedish International Development (Cooperation) Agency

SM = Safe Motherhood

SMI = The WHO’s Safe Motherhood Initiatives

SoWMy = The State of the World’s Midwifery (reports)

UK = United Kingdom

UN = The United Nations

UNFPA = The United Nations Population Fund

UNICEF/Unicef = The United Nations Children’s Fund

USA = United States of America

USAID = The United States’ Agency for International Development

WHO = The World Health Organisation

WWI = World War I

WWII = World War II

YML = Young Midwifery Leaders

BUCKINGHAM PALACE

I have had the honour of following in my Grandmother’s footsteps as Patron of The Royal College of Midwives. In visits to countries across the world I have seen first-hand the esteem in which midwives are held and the care they are able to give to mothers and babies. This book sets out how, from small international beginnings, midwives across the world have worked together during the past 100 years to be better able to improve the health of women during their reproductive years and support them and their babies.

When three Midwives’ Associations decided to work together in 1922, they could never have dreamed of how their collaboration has today helped midwives and childbearing women and their newborns in more than 120 countries. The Midwives Institute, forerunner of The Royal College of Midwives (UK), worked alongside midwives’ associations in Belgium and the Netherlands in establishing the International Midwives’ Union. Despite two world wars the midwives stayed strong and, in 1954, with The Royal College of Midwives playing a lead role, revitalised the international midwives’ organisation as the International Confederation of Midwives (ICM).

I wish to applaud the International Confederation of Midwives and its leaders who accepted all the challenges that arose by being a female led organisation with a predominantly female workforce working for and with women in all corners of the world to become a valued health professional partner across the globe.

This book focuses on the value and impact of the International Confederation of Midwives, the only midwifery organisation representing midwives and the midwifery profession both individually and collectively, on the health of women and childbearing families. The Confederation has worked tirelessly with its member associations in countries, directly helping them with midwifery education, extending midwifery services to cover family planning, social and nutritional aspects as well as establishing legal frameworks. The help that associations give to each other has enabled a strong bond to develop, one of friendship as well as a professional one.

To understand this history is important to developing the future where midwives and midwifery can continue to progress and make a significant contribution to the health and wellbeing of nations.

Foreword

This book is a labour of love. It began in the 1990s shortly before the 75th anniversary with the bulk of archival searches beginning in earnest five years ago. Joan Walker is a UK midwife well-known to the Wellcome Collection Library staff¹ where she spent years searching through the archived International Confederation of Midwives’ (ICM) papers and photos and putting those details in chronological order. Ann Thomson, also a UK midwife, was creative in her search of the archives at the Royal College of Midwives, The British Library, multiple nursing journals, many European country conference proceedings and conversations with individuals in order to reconstruct the history of the International Midwives’ Union (IMU), the forerunner (grandmother) of the ICM. Her primary source documents were several issues of the Communications of the International Midwives’ Union from 1925.² It was known that a significant number of documents pertaining to midwives and their associations were lost when libraries became collateral damage in the bombings throughout Europe during World War II (1939–1945).³

Margaret Peters, an Australian midwife, searched her own ICM files and directed the writers to key sources of information on the ICM, offering comments and insight on each chapter. Joyce Thompson, a USA midwife, searched her own files for ICM papers from 1990 to the present. Her writing was complemented by the archival material, personal papers and writings from Joan Walker.⁴ In addition, interviews with key individuals and vignettes from former and current ICM leaders and partners provided much of the human-interest aspects. Additional primary source documents have been used when available, including Board and Council minutes, conference and workshop reports and correspondence. Three chapters are contributed by midwives recognised for their expertise in those topics.

What this Book Is

This book is a brief narrative history of the International Confederation of Midwives (ICM) that, in 2022, completed 100 years of representing the world’s midwives through strengthening and supporting its midwifery Member Associations (MAs) in order to protect and promote healthy newborns and empower women. The essence of this ‘herstory’ of the ICM revolves around a century of organisational development, growth and influence, especially related to women’s reproductive health, rights and safe childbearing care.

Social Context

The 100-year history of the ICM would be incomplete without helping the reader understand the ICM’s beginnings and ongoing development within the social context of what was happening, especially the challenges of gender, socioeconomic status and race faced by its leaders and MAs. Though many of these challenges are woven throughout the book, Chapter 2 is included to offer insight into the social context of the International Midwives’ Union (IMU) during 1922–1939, the forerunner of the ICM. Other discussion of social context is woven throughout later chapters.

Organisation of the Book

This content of the book is organised into two sections that address two major goals:

1) the description of the organisation beginning in 1922, and

2) the growth, accomplishments, and impact of the organisation globally.

The first section, titled Birth, Rebirth and Organisation of the ICM, is a chronological narrative beginning in 1922 of the ongoing development of the ICM as a female-led, female-oriented global health organisation. Content includes its efforts to address its dual aims to 1) promote and protect the health and well-being of women and childbearing families and 2) support its Member Associations to strengthen the education, regulation and practice of their midwives in order to attain the first Aim. A brief overview of the structure of the organisation and its financial ups and downs are included.

The second section of the book, titled ICM: A Catalyst for Global Respect for Midwives and Women, includes selected narrative details of the ICM’s strategic activities and accomplishments that have strengthened its member associations and individual midwives. The ICM’s reputation as a vital, collaborative partner in promoting reproductive health and rights, especially related to women and childbearing care, has been repeatedly supported by inclusion in several global reports contributing to Health for All.⁵ The ICM has been a catalyst for change that has been and continues to influence major global organisations to take notice of the vital role that women and their health play in the health of all nations.

Language Used in Text

For the most part, the authors chose to use the generic ‘midwife’ throughout the text without attaching any gender. The word midwife in the original old English means with woman describing the work of midwifery and not the gender of the midwife. Therefore, midwife is a term that men in the midwifery profession can proudly use.

The newest challenge arose in the 21st century related to use of inclusive language.⁶ As terminologies changed over the years the ICM has tried to be respectful of these. The ICM has always referred to adolescents or women when referring to those who give birth. The authors were advised recently that in some countries ‘birthing people’ is now a term used for those giving birth. In continuing to use the terms ‘adolescents’ and ‘women’ throughout this text when referring to childbearing, the authors accept that this now includes those who prefer to use ‘birthing people’.

What this Book is Not

This book, however, is not the history of midwifery in the world, or in individual countries or regions, though some of that history is reflected in the narrative. It is also not an anthropological analysis or in-depth critique of the ICM as an organisation, though there will be some discussion of strengths, weaknesses and challenges faced. This book will not discuss all midwife leaders through the years, though a few who heavily influenced the development of the ICM and its global remit will be highlighted. Likewise, the book will not discuss every ICM position statement and core document, though a few will be highlighted. Annexes are provided that list these along with other ICM activities. Current documents can be found on the ICM website: www.internationalmidwives.org.

Authors’ Biases

The authors acknowledge but do not apologise for our inherent biases as authors/editors of this history because of our personal involvement and leadership within the Confederation since the late 1960s. The writing style and content have been heavily influenced by the authors’ interpretation of primary sources. The involvement of key players as authors brings many positives, including a passion and enthusiasm for the subject. The authors’ personal involvement in many of the activities and issues/challenges discussed has resulted in more detail in some areas than others as is often the case in narrative writing. While the primary authorship is White/Caucasian, details and stories from the African, Asia-Pacific and Eastern Mediterranean regions are also included. However, the authors are not historians. We have done our best to tell the ICM ‘story’ as viewed through the lens of primary sources, interviews and our own personal experiences in an effort to highlight the significance, influence and global impact of the ICM on midwives and midwifery services that improve the sexual and reproductive health and rights of women, newborns and childbearing families in every corner of the world. Thus, the authors accept full responsibility for the content of this book based on available documents.

History is often written for learning so that mistakes are not repeated in the future to the detriment of the ICM, but positives are built upon. This book was also written to provide information for the current and future leaders of the ICM who will continue to demonstrate the ICM’s strong and vibrant efforts to improve the health of young girls and women globally with well-qualified midwives supported by strong midwifery associations to benefit families and countries.

The Authors

100 YEARS OF THE INTERNATIONAL

CONFEDERATION OF MIDWIVES

EMPOWERING MIDWIVES AND

EMPOWERING WOMEN

Section I: Birth, Rebirth and Organisation of the ICM

Chapter 1: Introduction

‘The global community owes a huge debt of gratitude to ICM for establishing midwifery as a respected profession, for standardization of [education], for being the voice of women for pregnancy and childbirth.’

Sabaratnam Arulkumaran (FIGO) – 18 March 2019

CENTURIES OF MIDWIFERY CARE

Midwives have been ‘with women’ for centuries, attending to their childbearing needs as well as providing birth-to-death care within the family and community, what today might be called primary health-care based on a public health model of health promotion and disease prevention.¹ Midwives were trusted members of their communities, held in high esteem by the people they served², yet sometimes feared and mistreated by those who did not understand the value of midwifery care and the ‘mysteries’ surrounding menstruation, birth and menopause. Midwifery work was frequently hard and challenging under difficult circumstances. It was also rewarding to the midwives who spent long hours, days and many years carrying out the mandate of their ‘calling’/profession to promote the health and well-being of every woman and childbearing family they touched, and, whenever possible, to secure a safe outcome for every mother and newborn.³ In other words, ‘midwifery was a vital service for women at a critical moment in their lives, in the intimacy of their own homes’⁴.

Midwives strived to do the best they could with the knowledge and skills available to them at the time, but never gave up on learning more. During different eras of feminism, the work of women, including midwifery, was highlighted along with the suffrage movements. Women’s movements in many countries led to increasing demands for justice and basic human rights for adolescent girls and women. These movements affected midwives’ roles and practise throughout the past 100 years, with a few instances addressed in this book. In addition, many women, particularly in resource rich countries, demanded their right to be more involved in decisions about their care. They identified actions needed to offset the lack of respectful care that modern technology and hospital births often brought about, and often sought the advice and support of midwives in their communities for a more humanised birthing experience.

Midwifery itself changed over the years with new demands for providing expanded services to save maternal and newborn lives (life-saving skills) beginning with family planning and other aspects of reproductive health care beyond childbearing. The search for new knowledge led to midwives’ gathering in small and large groups to share stories, to learn from one another and to seek ways to improve the health of the women and families in their care.⁵ However, until the end of the 19th and beginning of the 20th century, midwifery and midwives managed very well for thousands of years without the structures and complexity of a formal organisation.

What changed? European midwives’ desire to formalise their efforts to share information as the demands for healthy childbearing increased following World War I (WWI) resulted in a decision to group together. The ICM’s story organisationally began in 1922 in Belgium following WW1 when midwives when midwives from Belgium, England and the Netherlands met during a Flemish Scientific Conference and were encouraged by obstetrician Frans Daels to form an organisation (Chapter 2). World War II (WWII) ‘silenced’ organisational efforts from 1939 to 1948, with renewal of activities in the form of a Congress in 1954 in London. Initially, the organisation grew throughout Western Europe during the 1920s and 1930s. The ICM gradually expanded to include midwifery associations in high resource countries (United States, Australia) during the 1950s–1970s along with a few African groups. It was not until the 1980s that Midwifery Associations in Asia-Pacific and more recently in the Eastern Mediterranean region became members.

The ICM’s dual aims throughout its history have been:

to promote and protect the health and well-being of women and childbearing families. to support its member associations to strengthen the education, regulation and practise of their midwives in order to attain the first Aim.

Though these aims have been addressed primarily through its member associations, ICM leaders and members also agreed to support country midwives who did not yet have the benefits of an official midwifery association, often with the support of international health partners such as the World Health Organization (WHO), other United Nations’ agencies, governmental aid organisations, global professional groups and private foundations.

Thus, the International Confederation of Midwives (ICM) was established (initially named the International Midwives’ Union) in 1922 with the goal of midwifery associations working together to strengthen the profession of midwifery and protect and promote the reproductive health of childbearing women and their newborns. During the past 100 years, the ICM’s efforts/activities have placed midwives and midwifery on the global reproductive health agenda throughout this narrative story as illustrated by the current ICM logo⁶.

Current ICM logos – Used with permission of the ICM.

APPROACH TO A CENTURY OF COLLABORATION AND EMPOWERMENT WITHIN THE ICM

The content of this book focuses on key milestones (see Timeline) during the first 100 years of the ICM that have led to the modern-day organisation. Sentinel successes are part of the ICM story, including important global partnerships that share a common vision for healthy women and families. In many ways, the story of ICM reflects the story of women throughout the century who struggled for recognition, voting rights, respect and decision authority.⁷

The ICM’s story reflects the influence of ICM leaders and its member associations over the past 100 years as they worked together to make sure women and childbearing families received evidence-based care from well-qualified, caring midwives in all corners of the world. ICM leaders also collaborated with international health partners in securing the ICM as a truly international, well-respected health professional organisation representing the profession of midwifery as distinct from other health professions.

Section One content begins with a brief overview of the social context into which the International Midwives’ Union (IMU) was born in 1922. It includes the individuals who established the IMU and their struggles to maintain the organisation between two world wars. Content also briefly addresses the constitutional mandates of aims, vision and mission of the ICM that have remained relatively constant since 1954, along with its organisational framework, the struggle for financial viability and the vital role of the paid central office staff.

Section Two content addresses the ICM’s educational and standard-setting role for midwives throughout the world leading to increased autonomy of the profession and its midwives and increased global respect for the role of the midwife in global health efforts. It includes educational workshops, Congress sessions and core documents that solidified the role of well-prepared midwives as primary care providers for women during their reproductive years. Of particular note for understanding ICM’s development is that the period 1981-2000 was one of sustaining and stabilising the organisation financially, growing its membership into one that was more global, and gaining recognition from potential international agency partners that midwifery skills can and do provide the ways and means to improved outcomes for women in their reproductive years, especially in resource limited nations. This establishment of ICM’s credibility provided the base from which in the next decades the ICM could move forward to develop standards and demonstrate its capacity to respond to needs of member associations with the ‘tools’ to more accurately measure the effectiveness of midwifery education and practice.

As the reader follows the ICM journey it is important to note that many of the successes of this global organisation were the result of thousands of volunteer hours and financial support from visionary midwife leaders at global and regional levels supported by a small paid staff of dedicated midwives/individuals. Financial support from governments and private foundations also contributed to the growth and development of the ICM as an organisation.

Midwives of the world understood that they alone could not meet the sexual and reproductive health needs of adolescents and women, nor could they save the lives of all mothers and newborns. Hence the emphasis during the ICM’s journey on the importance of partnerships, beginning with the women themselves. Other key partners, such as the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Fund for Population Assistance (UNFPA) and professional associations such as the International Federation of Gynecology and Obstetrics (FIGO), the International Pediatric Association and the International Council of Nurses, contributed both technical and/or financial support to the ICM’s efforts in strengthening midwives and midwifery associations worldwide. This meant that the reproductive health of adolescents and women would be improved with well-qualified midwives and midwifery care. A few of these important partnerships are discussed briefly and illustrate the expanding remit of the organisation in sexual and reproductive health while maintaining a clear focus on strengthening midwifery associations and midwives providing evidence-based childbearing services where the need is greatest.

The closing chapter of the book reflects the 2022 ICM President Franka Cadée’s view of the future of the ICM as an international health professional organisation committed to well-educated and appropriately regulated midwives who are empowered to lead global efforts in maternal, newborn, adolescent and Women’s health and rights.

Key Definitions

In an effort to increase the reader’s understanding of the ICM and its journey of empowering midwives and empowering women, three key questions are addressed.

WHO IS A MIDWIFE?

This book uses the title ‘midwife’ and ‘midwifery practice’ throughout representing a common understanding of both words and titles from the perspective