Last month, the World Health Organization published the "Global Standards in Nursing and Midwifery Education". In this document the WHO suggests universal standardization of midwifery education, and raising the standard to university level education. Below you can read the MANA Board response to this document, which you can read at:
As someone who works in a region where female education is complicated, stressful, financially straining and a far priority from cultural values I am curious about the realistic application of these standards. I'd love to hear comments about this initiative.
August 1, 2009
Task Force on Global Standards in Nursing and Midwifery Education
Nursing and Midwifery Resources for Health
World Health Organization
Attached you will find the CPM Issue Brief which we are sending to you for your consideration in response to the “Global Standards for the Initial Education of Professional Nurses and Midwives.” This document was developed by a coalition of four midwifery organizations, including the Midwives Alliance of North America describing the role, expertise and educational
model of the Certified Professional Midwife. This competency based model of Direct Entry Midwifery has been developed successfully in a country noted for its economic, social, racial and geographic disparities in access to health care services and perinatal outcomes.
Certified Professional Midwives have proven to be a viable, safe and cost effective route of not only competency-based midwifery education but also for providing evidence-based care with excellent outcomes. This model is currently being replicated or considered for replication in a number of countries including Germany, Australia, New Zealand, Mexico and Guatemala.
We would like to point out that, although you state that the Standards were developed by a long list of experts in the field, there is a surprising lack of midwives on the Task Force. Most notably there is a blatant lack of participation of the International Confederation of Midwives, as well as a lack of participation from other midwifery councils including the Midwives Alliance of North America, the American College of Nurse Midwives, the Royal College of Midwives among others.
We question why internationally established and recognized councils were not consulted and included within the task force created by an organization that represents global health interests. We would also like to point out that most members on the Task Force are not midwives themselves.
Another important concern we have with the document is regarding the standards themselves. Global Standards in midwifery education assume global standards in opportunity. Our countries and regions are a far cry from being able to offer women equal access to educational and economic opportunities. Global Standards also assume a global standard in health,
reproductive history and risk. The World Health Organization is fully aware that many women in rural indigenous communities lack access to educational opportunities and to the economic resources to complete formal and university level education. It is completely unrealistic to expect women from poor, marginalized and indigenous communities from around the world to be able to complete a university degree in nursing and midwifery. It is also known that health providers who complete university degrees generally do not serve poor and marginalized communities, especially if these are rural.
Around the world in developed and developing nations, successful models of inter-cultural and integrated care have proven positive outcomes. Within the U.S. for example, the Certified Professional Midwife is skilled at attending normal, low risk, out of hospital births, and is skilled at referring to specialized care when the need arises. In rural Guatemala and Mexico, traditional midwives learn to refer high-risk women to professional midwives and family physicians who in turn may refer to specialized care. Diversity in economic and cultural realities requires diversity in health care provision.
We are concerned that the standardization of Midwifery education to a University level would leave millions of women around the world without access to skilled birth attendants, resulting in an immediate impact in the increase of maternal and infant mortality and morbidity rates. Furthermore, this would leave the poorest, most marginalized and most vulnerable
women and infants far from care provided by competency based care providers. Through the implementation of the Standards of Education health promoters, trained traditional midwives, direct entry midwives and Certified Professional Midwives would be left outside of the health system leaving millions of mothers and babies vulnerable to unassisted birth and no primary care at all. We do not believe this is in the interest of the World Health Organization or of the general public.
We hope that you will appreciate and embrace the important contributions to accessible high-quality maternity care provided by competency based health care providers. In addition, we encourage you to carefully consider the low cost model that has been successfully developed by the Midwives Alliance of North America and our partner organizations to enhance
our vision of “one midwife for every woman”.
Geradine Simkins, RN, CNM, MSN
Midwives Alliance of North America
MANA Board of Directors
Maria Iorillo CPM, 1st Vice President
Christy Tashjian CPM, 2nd Vice President
Angy Nixon CNM, MSN, Secretary
Audra Phillips CPM, Treasurer
Pam Dyer Stewart CPM, Region 1
Regina Willette CM, Region 2
Tamara Taitt DEM, PhDc Region 3
Sherry DeVries CPM, CNM Region 4
Elizabeth Moore CPM, Region 5
Colleen Donovan-Batson CNM, Region 6
Dinah Waranch CNM, Region 9
Cristina Alonso Midwife, Region 10 Mexico
Michelle Peixnho CPM, Midwives of Color Section