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The relationship of the legalisation of midwifery and safe motherhood
E D I TOR I A L
The relationship of the legalisation of midwifery and safe motherhood In the International News of the December 2002 issue of this journal, Elizabeth Duff made a brief mention of a conference held in London. The conference was one of a series of events that the Royal College of Midwives (RCM) held in 2002 to celebrate the centenary of the passing of the Midwives’ Act, which made the profession of midwifery legal in England and Wales -- Scotland and Northern Ireland followed on a bit later. There were speakers from around the world and throughout the three days legal recognition of midwifery was linked with safe motherhood. Dr Bocar Diallo, Regional Advisor for Reproductive Health at UNFPA reminded the audience of the statistics of childbirth -- that there are ten million pregnancies every year, that 600 000 women die as a consequence of a pregnancy and that two million women are disabled, a significant proportion of them permanently, as a result of a pregnancy. Dr Diallo reported on the various targets that have been set internationally until 2015 and the ones directly affecting midwives are the targets to reduce maternal mortality by three quarters, and to have 60% of women worldwide attended at birth by a skilled attendant. Whilst this latter point may seem a huge mountain to climb, like a mountain it is graded with 40% of women worldwide expected to have a skilled attendant at birth by 2005 and 50% in 2010. Continuing the theme of the obscenity of maternal mortality, Dr Lieve Fransen (see paper in full starting p. 79), Head of the Unit of Social and Human Development at the European Commission, asked why it was that the media made no mention of the 600 000 women a year who were dying as a result of a pregnancy. The public outpouring of grief for the seven people who died in the Challenger disaster would seem out of all proportion to the absence of comment on the death of over half a million women each year. Dr Fransen pointed out that other murders hit the headlines, and as speaker after speaker pointed out that 95% of maternal mortality could be prevented, participants appeared in sympathy with the idea that maternal mortality is murder. Dr Fransen is of the opinion that there is a lack of political will to stop women dying. She pointed out that a woman’s educational level is an indicator of whether she can obtain a skilled attendant at birth, those with the
Midwifery (2003) 19, 77^78 & 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0266 - 6138(03)00017-2/midw.2002.0352
lowest level, or no education being least likely to have skilled attendance. Dr Fransen reported that rich women have very little difficulty in obtaining a safe abortion whereas poor women are at risk of having an illicit illegal, unsafe abortion. Malaria is a disease that contributes to maternal mortality and it is a disease of the poor. Poor women do not receive services, they do not have the money to pay user fees, they cannot access transport and there are opportunity costs for them to attend appointments at health centres -- whilst attending the health centres they cannot tend their crops. The RCM are to be congratulated on having obtained the attendance of the Prime Minister, the Right Honourable Tony Blairs at the conference. The last time a Prime Minister attended such a conference in the UK was in 1936. He pointed out that the Blair family had had recent dealings with midwives and were grateful for their care. Dr Kyllike Christensson from the Karolinska Institute in Stockholm, Sweden demonstrated a relationship between the reduction of maternal mortality over the end of the 19th century and the requirement for birth attendants to be trained in Sweden. Between 1850 and 1890, each village was required to send a wise woman to be trained to care for childbearing women and the course included life-saving skills. Dr Christensson also told her audience that whilst currently in Sweden the median age of first intercourse was 17 years, the mean age for having a first baby was 28 years. This suggests that the contraceptive facilities are well used and respected by people in Sweden. Dame Mary Uprichard gave the audience a masterly presentation of the history of the legalisation of midwifery in England that we were celebrating at the conference. She told us of the perseverance of the women who fought for regulation and she wondered whether midwives today would have the tenacity to fight as those doughty women did. Suzanne Stromerova, from the Czech Republic, showed how doughty she and her colleagues are trying to be in their fight for recognition of midwifery. It is hoped that her paper will be published in a subsequent issue of this journal. Michael Mills, Principal Economist at the World Bank, described the World Bank’s mission to fight poverty. He reported that 25% of
78 Midwifery
the world’s population lived in absolute poverty earning less than $1 a day, and public spending on health was skewed to the rich with the poor, and particularly women, being neglected. Dr Mohga Kamul Smith, Health Policy Advisor to Oxfam continued the themes of the disadvantages that women experience. Some of their experiences are not just disadvantages but threats to their lives. She reported that now there are more women in the world who are HIV positive and she also commented on the gender inequality that women experience and the gender-based violence. She asked why there was very little respect for women and why policy was not evidence based. The UK Secretary of State for International Development, the Right Honourable Clare Short, MP, listed in detail the International development targets that are to be met by 2015. It was disturbing to hear her say that even if all drugs were free in developing countries they would not get to the people who need them because there are no relevant health services. Unfortunately, Stella Mpanda of the Africa Midwives Research Network and the Tanzania Midwives Association was unable to attend the conference but the contents of her paper on female genital mutilation (FGM) was presented by Gaynor Maclean. A lively debate followed with members of the audience participating. Conference participants were reminded that as tragic as FGM was, in some communities it was
seen as a right of passage and if it was to be removed then something would have to be put in its place. Dr Jo Murphy-Lawless from the Department of Social Policy at University College, Dublin used research that she had undertaken in South America to demonstrate that indigenous midwifery is vital in isolated communities. She suggested that what we, midwives, should be doing is research to collect the effective techniques and skills of indigenous midwives so that they can be shared, to women’s advantage, around the world. The theme of the conference was the legalisation of midwifery. Margaret Peters, previous Director of the Board of Management of the International Confederation of Midwives gave an overview of midwifery legislation throughout the world. She told the audience that she suspected that British midwives did not realise how lucky they were that the profession of ‘midwife’ was recognised and protected in law. She said that this was worthy of being housed in the Tower of London with the Crown Jewels. British midwives present at the conference were grateful to have that point brought to their attention. WHO have stated that for safe motherhood to be provided women need childbirth attendants with midwifery skills. For people with midwifery skills to function effectively they need the protection of the law. Ann Thomson
The relationship of the legalisation of midwifery and safe motherhood In the International News of the December 2002 issue of this journal, Elizabeth Duff made a brief mention of a conference held in London. The conference was one of a series of events that the Royal College of Midwives (RCM) held in 2002 to celebrate the centenary of the passing of the Midwives’ Act, which made the profession of midwifery legal in England and Wales -- Scotland and Northern Ireland followed on a bit later. There were speakers from around the world and throughout the three days legal recognition of midwifery was linked with safe motherhood. Dr Bocar Diallo, Regional Advisor for Reproductive Health at UNFPA reminded the audience of the statistics of childbirth -- that there are ten million pregnancies every year, that 600 000 women die as a consequence of a pregnancy and that two million women are disabled, a significant proportion of them permanently, as a result of a pregnancy. Dr Diallo reported on the various targets that have been set internationally until 2015 and the ones directly affecting midwives are the targets to reduce maternal mortality by three quarters, and to have 60% of women worldwide attended at birth by a skilled attendant. Whilst this latter point may seem a huge mountain to climb, like a mountain it is graded with 40% of women worldwide expected to have a skilled attendant at birth by 2005 and 50% in 2010. Continuing the theme of the obscenity of maternal mortality, Dr Lieve Fransen (see paper in full starting p. 79), Head of the Unit of Social and Human Development at the European Commission, asked why it was that the media made no mention of the 600 000 women a year who were dying as a result of a pregnancy. The public outpouring of grief for the seven people who died in the Challenger disaster would seem out of all proportion to the absence of comment on the death of over half a million women each year. Dr Fransen pointed out that other murders hit the headlines, and as speaker after speaker pointed out that 95% of maternal mortality could be prevented, participants appeared in sympathy with the idea that maternal mortality is murder. Dr Fransen is of the opinion that there is a lack of political will to stop women dying. She pointed out that a woman’s educational level is an indicator of whether she can obtain a skilled attendant at birth, those with the
Midwifery (2003) 19, 77^78 & 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0266 - 6138(03)00017-2/midw.2002.0352
lowest level, or no education being least likely to have skilled attendance. Dr Fransen reported that rich women have very little difficulty in obtaining a safe abortion whereas poor women are at risk of having an illicit illegal, unsafe abortion. Malaria is a disease that contributes to maternal mortality and it is a disease of the poor. Poor women do not receive services, they do not have the money to pay user fees, they cannot access transport and there are opportunity costs for them to attend appointments at health centres -- whilst attending the health centres they cannot tend their crops. The RCM are to be congratulated on having obtained the attendance of the Prime Minister, the Right Honourable Tony Blairs at the conference. The last time a Prime Minister attended such a conference in the UK was in 1936. He pointed out that the Blair family had had recent dealings with midwives and were grateful for their care. Dr Kyllike Christensson from the Karolinska Institute in Stockholm, Sweden demonstrated a relationship between the reduction of maternal mortality over the end of the 19th century and the requirement for birth attendants to be trained in Sweden. Between 1850 and 1890, each village was required to send a wise woman to be trained to care for childbearing women and the course included life-saving skills. Dr Christensson also told her audience that whilst currently in Sweden the median age of first intercourse was 17 years, the mean age for having a first baby was 28 years. This suggests that the contraceptive facilities are well used and respected by people in Sweden. Dame Mary Uprichard gave the audience a masterly presentation of the history of the legalisation of midwifery in England that we were celebrating at the conference. She told us of the perseverance of the women who fought for regulation and she wondered whether midwives today would have the tenacity to fight as those doughty women did. Suzanne Stromerova, from the Czech Republic, showed how doughty she and her colleagues are trying to be in their fight for recognition of midwifery. It is hoped that her paper will be published in a subsequent issue of this journal. Michael Mills, Principal Economist at the World Bank, described the World Bank’s mission to fight poverty. He reported that 25% of
78 Midwifery
the world’s population lived in absolute poverty earning less than $1 a day, and public spending on health was skewed to the rich with the poor, and particularly women, being neglected. Dr Mohga Kamul Smith, Health Policy Advisor to Oxfam continued the themes of the disadvantages that women experience. Some of their experiences are not just disadvantages but threats to their lives. She reported that now there are more women in the world who are HIV positive and she also commented on the gender inequality that women experience and the gender-based violence. She asked why there was very little respect for women and why policy was not evidence based. The UK Secretary of State for International Development, the Right Honourable Clare Short, MP, listed in detail the International development targets that are to be met by 2015. It was disturbing to hear her say that even if all drugs were free in developing countries they would not get to the people who need them because there are no relevant health services. Unfortunately, Stella Mpanda of the Africa Midwives Research Network and the Tanzania Midwives Association was unable to attend the conference but the contents of her paper on female genital mutilation (FGM) was presented by Gaynor Maclean. A lively debate followed with members of the audience participating. Conference participants were reminded that as tragic as FGM was, in some communities it was
seen as a right of passage and if it was to be removed then something would have to be put in its place. Dr Jo Murphy-Lawless from the Department of Social Policy at University College, Dublin used research that she had undertaken in South America to demonstrate that indigenous midwifery is vital in isolated communities. She suggested that what we, midwives, should be doing is research to collect the effective techniques and skills of indigenous midwives so that they can be shared, to women’s advantage, around the world. The theme of the conference was the legalisation of midwifery. Margaret Peters, previous Director of the Board of Management of the International Confederation of Midwives gave an overview of midwifery legislation throughout the world. She told the audience that she suspected that British midwives did not realise how lucky they were that the profession of ‘midwife’ was recognised and protected in law. She said that this was worthy of being housed in the Tower of London with the Crown Jewels. British midwives present at the conference were grateful to have that point brought to their attention. WHO have stated that for safe motherhood to be provided women need childbirth attendants with midwifery skills. For people with midwifery skills to function effectively they need the protection of the law. Ann Thomson