IDM RESOURCE PACK FEBRUARY 2015

INTRODUCTION Dear Midwives, The International Day of the Midwife (IDM) holds special significance in this target year of the Millennium Development Goals (MDGs). While important progress has been made toward the vision to reduce all preventable maternal and newborn deaths there is still unfinished business and new challenges that need attention as we transition from the MDGs to the new Sustainable Development Goals (SDGs). This is why we have chosen the 2015 theme “Midwives: for a better tomorrow”. It reminds us of the critical role of midwives in creating a brighter future for mothers, babies, and families. Continued progress and sustainable development will not be a reality unless mothers and babies survive and thrive. Investment in midwives is fundamental in accelerating progress toward these goals. The State of the World’s Midwifery Report 2014 (SoWMy), launched at the 30th ICM Triennial Congress in Prague, focuses on the urgent need to improve the availability, accessibility, accessibility and quality of midwifery services. Evidence from the Lancet Series on Midwifery also highlight midwifery’s contribution to the health and survival of women and their newborns. So as we shift our attention away from the MDGs this year, let us not forget that the world still needs more midwives. With this in mind, we recommend that you take time to plan your activity carefully and strategically. Be clear about your objective and what you wish to achieve this IDM. We have included suggestions and checklists in the 2015 IDM Resource Pack to help you plan your event. We also invite you to share this resource pack with your colleagues, such as other midwives or stakeholders in your country and region. Thank you for your continued efforts to raise awareness for all midwives who strive each day to create a better world. A world where no mother dies of pregnancy or childbirth related complications. A world where every mother has access to a midwife’s care. A world where the SDGs become reality. By joining forces to improve maternal-newborn care and strengthen midwifery globally, we will indeed help to ensure a better tomorrow.

Yours sincerely, Frances Ganges ICM Chief Executive

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Every year on May 5th midwives, Midwives Associations and supporters of midwives and midwifery globally develop their own keynote activities appropriate for the International Day of the Midwife. Your activity should meet one (or all) of the key objectives:

Inform everyone with an interest in health and justice that midwives are crucial to reducing maternal and neonatal mortality Celebrate the achievements of midwives and progress made in improving maternal and neonatal care and midwifery services Motivate policymakers to implement change by lobbying for adequate midwifery resources and recognition of the unique professional role of midwives.

When preparing your activity decide on your objective first: what do you want to achieve in the long term?

Sample objectives

Sample activities

Increase number of midwives

Arrange visits to secondary schools to talk about midwifery as a career and in the long term recruit new students. Arrange meeting with government officials to discuss retention strategies. Make sure to use SoWMy as advocacy tool.

Increase awareness for midwifery services

Offer free antenatal, postnatal or other reproductive health services to familiarize women with midwifery services Invite policy makers to visit midwifery services and give them insight into the daily life of a midwife

Improve coverage of midwifery issues in media

Invite journalists for a briefing/training session including a tour of a midwifery practice/maternity ward

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Ameliorate collaboration with other professionals

Organize a coffee break and create a good atmosphere. You decide how formal or informal your event should be. You could also show a film or have a round table on midwifery services.

Achieve a policy change

Invite government officials to a panel discussion and address the necessary changes.

Inform the general public about midwives

Organize a rally, flash mob, walk, marathon or other high visibility event.

Nourish the support system amongst midwives

Have a celebratory event where midwives can meet each other and learn about each other’s challenges and share coping mechanisms to support each other.

Based on your objective, decide what message is most relevant locally, and, who you will involve.

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Here are 5 steps to help you plan your event: Step 1: Planning  

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Set your objectives, be clear on what you want your IDM activity to achieve, for example improve recognition of midwifery services* see explanation above Decide who your audience is: mothers and families, doctors, policy makers, school girls etc. Select your event organizing committee, the more the merrier and the smaller the workload for one individual Identify and assign tasks

Step 2: Pick an activity  Have a participatory event with songs, marches, health fair, workshops,  Be creative, easily accessible, transparent and don’t forget: it’s fun!  Keep it relevant for your audience, for example offer free prenatal check-ups if you live in an appropriate area for such services

Step 3: Pick a location  Decide where your event is going to be  Decide what time and possibly what day  Book the location (if necessary)  Ensure you have all necessary permits  Find out what additional material you need for example chairs, tables, shades, flowers, food, sign-up sheets,

Step 4: Create the program     

Decide what topics you will address* see Key Messages in this pack Determine the order of activities Invite speakers Set timeframe for each activity and each speaker Recruit additional staff such as ushers, photographers etc.

Step 5: Publicize your event     

Send out an invitation to your target audience Promote your event through the use of social media* see Social Media in this pack and traditional media Invite selected journalists to your event * see tools to engage with the media Distribute the information in your newsletter Put up posters and flyers in your area

Suggestions for events: -

School visits Journalist briefings Guided tours Coffee event Free Antenatal Care Karaoke Concert Health Fair Walks Marathons Workshops Conferences Market stalls Pick nicks Etc. etc. etc.

Step 6: Evaluate and follow-up      

Decide if you achieved your objective Collect the media coverage, save and share with your network Call the journalist(s) and thank them for their work Gather the participants data and send them a personal thank you note Identify follow-up steps such as next meeting with government officials, establishing (virtual) support groups for midwives or mothers, next article in a particular magazine or newspaper, Write down lessons learned and share with your organizing committee

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Key Messages Key messages are the most important things you wish to communicate about a subject. Whether you want to inform, discuss, promote or advocate, key messages are the messages you want your audience to remember and/or react to. They are easy to say and easy to understand. They are memorable and persuasive. They are clear, concise, bite-sized chunks of information that may stand alone, but more likely are used to develop other materials, such as press releases, statements, speeches, fact sheets, and other documents. The four highlighted messages below are the IDM 2015 key messages. Below is a set of supporting points (supporting messages) and explanatory statements. You can use these key messages to build a message map together with the supporting points, and the facts and figures in the next section to create customized resources to address your IDM audience. Midwives: for a better tomorrow    

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Midwives significantly contribute to a better future by providing quality reproductive, maternal and newborn health By caring for women and babies, midwives help ensure that they are healthy and thriving in their communities. Midwives that are educated and regulated to international standards can provide 87% of the essential care needed for women and newborns. Improving access to midwifery care has led to a reduction of maternal mortality ratio in 72 high-burden countries by an average annual rate of 3% since 1990, which demonstrates that midwives are the key to create a better future with zero preventable maternal and newborn deaths. The Lancet Series on Midwifery identified 56 outcomes improved by midwifery care such as:  Less preterm birth  Reduced interventions in labor  Increased birth-spacing, contraceptive use  Increased breastfeeding, initiation and duration  Shorter hospital stays Midwives must take action to seize the opportunities and More Resources Advocacy drive the agenda for improvement in providing effective Toolkit: health coverage and create a better tomorrow www.bitly.com/MidwifeAdvocacy 5|Page

The World Needs Midwives Now more than Ever

 The global number of pregnancies each year is expected to remain constant at about 166

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million. Today, only 22% of countries have potentially enough adequately educated midwives to meet the basic needs of the world’s women and newborns As the MDG target period comes to a close, the world needs midwives more than ever because the child mortality rate has only halved, thereby missing the goal of a 60% reduction; and the maternal mortality rate has decreased by only 45% instead of the set goal of 75% Research shows that midwifery has specific contributions to make in regards to skilled supportive and preventive care for all, promotion of normal reproductive processes and skilled emergency care Midwifery is associated with more efficient use of resources and improved outcomes when provided by midwives who are educated, trained, licensed, regulated, and integrated into the health system in the context of effective teamwork, referral mechanisms and sufficient resources High-quality midwifery care for women and newborns saves lives and contributes to healthy families and more productive communities Four domains determine if a health system and its health workforce provides effective coverage: Availability, Accessibility, Acceptability and Quality of Care. Midwives need to be at the forefront of the initiatives to improve More Resources: these four domains State of the World’s Midwifery Report Midwifery2030 focuses on increasing the AAAQ of health services and health providers aligned with the three components of UHC: reaching www.sowmy.org a greater proportion of the population (increasing coverage), extending the basic and essential health package (increasing services) while protecting against financial hardship (increasing financial protection).

Investing in Midwives 

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Investing in midwifery education could yield a 16-fold return on investment in terms of lives saved and costs of caesarian sections avoided. The returns on investment are a “best buy” in primary health care. Investing in midwives means investing in a better future with effective health services for all women and their families. Investments need to address availability, accessibility, acceptability and quality of midwifery care. Evidence exists that midwifery services can be cost-effective, affordable and sustainable, and should thus be included in national health plans and budget, in all countries. Investing in midwives frees doctors, nurses and other health cadres to focus on other health needs, and lets midwives focus on ending preventable maternal and newborn deaths. 6|Page

Availability  

Comparing the number of midwives to health outcomes is inadequate. By calculating the number of midwives available according to “full-time equivalent”, data can provide a better sense of access to midwives. Midwifery services have to be better available to cover the needs of all women and their families. Investment needs to take workforce planning in each country into account to ensure that midwives can focus on midwifery interventions.

Accessibility  

Governments need to invest in midwifery services being affordable for all women Midwives salaries are among the lowest in low and middle income countries. To increase the number of midwives governments need to make the profession more attractive by giving midwives the recognition they deserve including providing an enabling work environment and better compensation for their work.

Acceptability 

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Midwifery care must be acceptable to women, their More resources: A Guide to families and communities. It must be culturally appropriate Respectful Maternity Care and sensitive to the individual’s need. In order for midwives to do their job most effectively, facilities need to be appropriately staffed and stocked with necessary equipment and supplies to offer appropriate services, including for emergencies

Quality 

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Quality improvements in RMNH care and increases in coverage are equally important for achieving better health outcomes for women and newborn infants. Investment in midwives, their work environment, education, regulation, and management can improve the quality of care in all countries. More Resources: Since 1990 the annual number of pregnancies has increased Lancet Series on Midwifery by 50% across African countries, which means the midwifery Solution 98 workforce in these countries needs to increase significantly just to maintain current levels of population coverage To improve access to midwives in low resource countries, governments need to take action in midwifery education as well as regulation, provision of infrastructure and information Investment in midwives means commitment to a healthy and wealthy nation

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Facts and Figures Maternal Mortality

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Every day, approximately 800 women die from preventable causes related to pregnancy and childbirthi. This accounts to 289,000 women per yearii.

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The major direct causes of maternal death in developing countries are severe bleeding, infections, high blood pressure during pregnancy, obstructed labour and unsafe abortion, accounting for 75% of maternal deathsiii.

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For every woman who dies, another 30 women suffer long-lasting injury such as obstetric fistula or illness that can result in lifelong pain, disability and socio-economic exclusioniv.

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The risk of maternal mortality is highest for adolescent girls under 15 years old. Complications in pregnancy and childbirth are the leading cause of death among adolescent girls in most developing countriesv.

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11% of girls are married before they turn 15, jeopardizing their rights to health, education and protectionvi.

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16 million adolescent girls give birth each year, the vast majority in developing countries, which accounts for roughly 11% of all pregnancies. They often miss out on years of education, which reduces their chances for adequate income and opportunity to escape povertyvii

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About 70,000 adolescent girls in developing countries die each year due to pregnancy and childbirth complicationsviii.

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9.5% of all maternal deaths are among adolescents aged 15-19 years old ix

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Allowing women to plan their pregnancies leads to healthier outcomes for children. A recent study showed that if all births were spaced at least two years apart, the number of deaths among children younger than five would decline by 13%. The number would decline by 25% if there were a three-year gap between birthsx.

Neonatal mortality 

More than 7,300 babies are stillborn every day that is 2.6 million every year. 99% of these deaths take place in developing countries, and most can be preventedxi.

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Every year 3 million infants die in the first month of life. Among those, nearly 3/4 die in their first week, and 1/3 die on their day of birthxii. 8|Page

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Adolescent pregnancies put newborns at risk. Deaths during the first month of life are 50 to 100 per cent more frequent if the mother is an adolescent than if she is older. The younger a mother is, the higher the risk for the babyxiii.

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Three causes accounted for more than 80% of neonatal mortality in 2012: complications of prematurity, intrapartum-related neonatal deaths (including birth asphyxia) and neonatal infections (sepsis, meningitis, pneumonia, and diarrhoea)xiv

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Half of the world's newborn babies do not get a birth certificate, and most neonatal deaths and almost all stillbirths have no death certificate. To count deaths is crucial to change themxv

Inequality 

99% of all maternal deaths occur in developing countries, in sub-Saharan Africa and South Asiaxvi.

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Maternal mortality is higher in rural areas and among poorer and less educated communitiesxvii.

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Less than 60% of all women in developing countries and only 34% in the least developed countries have access to a midwife when giving birth, and even fewer are delivering in a health facility providing skilled carexviii.

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The risk of a woman dying as a result of pregnancy or childbirth complication during her lifetime is about 1 in 7 in Afghanistan and Sierra Leone compared with about 1 in 29,800 in Swedenxix.

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The average Maternal Mortality Rate (MMR) for women living in developing regions is 16 deaths per 100,000 live births, yet the average MMR for women living in developing regions is 240 deaths per 100,000 live birthsxx.

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South Sudan is has the world’s highest MMR, with 956.8 maternal deaths per 100,000 live birthsxxi.

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India and Nigeria contribute more maternal deaths each year to the global burden than any other country. India’s 56,000 and Nigeria’s 40,000 maternal death annually comprise one-third of the global burden. The other highest-burden countries are Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of Congoxxii.

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2/3 of all newborn mortality occurs in 12 countries, 6 of which are in sub-Saharan Africaxxiii.

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Access to essential midwifery services 

Every year, 40 million women give birth at home without access to any carexxiv.

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On average, in the least developed countries 59% of births have no midwife present; in Ethiopia the figure is 94% and in Bangladesh 76%. By comparison, only 1% of women in the United Kingdom give birth without a midwifexxv.

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Nearly all newborn and maternal deaths (98 and 99% respectively) occur in developing countries where pregnant women and newborn babies lack access to health care services – before, during, and after deliveryxxvi.

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Currently less than 1 in 6 countries with the highest burden of maternal and newborn mortality reaches the minimum benchmark of 23 doctors, midwives and nurses per 10, 000 population that is necessary to provide a basic package of carexxvii. Severe shortages of midwives exist in at least 38 countriesxxviii.

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Women who have access to midwife-led care are less likely to experience preterm birth and fetal loss before 24 weeks’ gestationxxix.

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New research across 142 countries finds that some 50% of reduction in under-five child mortality in those countries is attributable to high impact health interventions such as skilled birth attendance and early immunizationxxx

Effects of skilled attendance in pregnancy and birth 

Skilled midwives, with the equipment and support they need, can spell the difference between life and death for close to 300,000 women each year, and ten times that many infantsxxxi.

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In countries with the lowest Human Development Index 61% of maternal, fetal and neonatal deaths could be prevented if there was universal midwifery coverage. Family planning alone could prevent 57% of all deaths. Midwifery with family planning and interventions could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deathsxxxii

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Evidence identified 50 short-term, medium-term, long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychological and public health outcomesxxxiii.

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Midwives are trained to help babies start breathing immediately after birth, and help prevent one of the major causes of newborn deaths. Birth asphyxia kills 710,000 babies each yearxxxiv.

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If all women delivered with a midwife in a facility capable of providing basic emergency care, is it estimated that 56% of maternal, fetal, and newborn deaths could be prevented. This estimate is based on reductions of 61% of maternal deaths, 49% of fetal deaths, and 60% of newborn deaths, which equates to as many as 3.6 million lives savedxxxv.

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The presence of a well-trained midwife can prevent many cases of infection, including neonatal sepsis, which kills 521,000 newborns a yearxxxvi.

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Engage with the Media Mothers, babies, birth, families are all on the news agenda. Every event is of interest to local media. But they can’t report it if you don’t tell them about it.   

send a media release two weeks before the event make sure all the details are included, especially contact details telephone a reporter/broadcaster 7 days before the event

Just provide the facts, let the journalists write the story, it is, after all their business. Media need to know:

Who, What, Why, When, Where.

Journalists need a couple of good quotations to make the story human. This can be from a local midwife, or mother. If you can get a celebrity to be quoted, or a significant civic leader, all the better. The media will want to talk to someone for further information so make sure you give a contact number for follow-up.

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Four top tips for your Press Release Target your media Decide whether you’re going for newspaper, local radio or TV. Find out what kind of stories they like. Phone them and ask which journalist will cover this issue, their deadlines, and contact details. Give them a brief outline of your planned event.

Short and sweet Your Press Release should be short and to the point. No more than one page long.

Keep it in the email If you’re sending an email, put the Press Release in the body of the email, following the outline below. Attachments often get rejected by computers.

Follow up Phone the newsdesk or the journalist you sent the email/PR to. Ask if they received it and if they need any more information. Mid-morning is a good time to ring as most journalists have deadlines for their articles/broadcast in the evening. The closer to the deadline the journalist is, the busier and less interested he/she is in your event.

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Social Media In our globalized world it often does not seem enough to organize an event and involve the media as people want to be engaged support and participate virtually. There are different tools that can help you reach an even bigger audience than usual. This section is divided into two parts: part one provides you with tips and ideas of how to use social media to spread the word about the International Day of the Midwife AND midwives & midwifery in general. The second part is developed for all those that do not have a profile on social media but would like to start using it.

FACEBOOK This social media tool is ideal to inform your fans in a more personal way about your IDM. It is like a workshop where you have invited the participants and know that they support you and your cause. You can: -

post key messages create an event invite your fans to attend this event upload photos of your event engage with your fans by asking questions share and like ICM’s posts about IDM

TWITTER This social media tool is shorter, faster, and more impersonal. It is like a big market place where everyone is shouting to sell their products, news and, messages. You can: -

“shout” out your key messages using #midwives or #midwivesmatter You can filter messages using # You can announce your event You can upload your best photo You can see what others are saying You can reply, share and like messages

BLOGS Blogs are little notes you can write and publish online. They are particularly good if you want to tell a more personal story. This year we are again looking for blogs that we can post on the ICM website. Send in short reports (max. 500 words) about your IDM to publish on the ICM blog. Similar to the press release (see page xx) start your report by writing: Where your event took place When your event took place What you planned A favorite moment at your IDM A “Lesson learned” to do different next year You can write using your own perspective with personal pronouns such as “I” or “we” or you can use a more general perspective and write in the name of your organization. In general a blogpost is more narrative than a report, more like a friendly chat with your colleague. Your article should be no longer than 500 words and should be sent to ICM as soon as possible after the IDM but not later than the 12th of May. Please send it to: [email protected]

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How to use Social Media

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IDM ARTWORK You can download all IDM artwork on the ICM website here.

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REFERENCES i

Say L, Chou D, Gemmil A, Tuncalp O et al. Global causes of maternal death: a WHO systematic analysis. Lancet, 2014. DOI: http://dx.doi.org/10.1016/S2214-109X(14)70227-X ii WHO, UNICEF, UNFPA, The World Bank, Trends in Maternal Mortality: 1990 to 2013 iii Say L, Chou D, Gemmil A, Tuncalp O et al. Global causes of maternal death: a WHO systematic analysis. Lancet, 2014. DOI: http://dx.doi.org/10.1016/S2214-109X(14)70227-X iv PMNCH Factsheet: Maternal Mortality (updated September 2011) v Conde-Agudelo A, Belizan JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American Journal of Obstetrics and Gynecology, 2004. 192:342–349. Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet, 2009, 374:881–892. vi UNICEF, State of the World’s Children 2014: Every Child Counts. vii WHO Fact sheet on adolescent health 2011 viii UNFPA, State of the World Population Report, 2013 ix Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2014, 14 x Guttmacher Institute, “Costs and Benefits of Investing in Contraceptive services in the Developing World,” June 2012 xi Healthy Newborn Network, 2014 xii Save the Children, State of the World’s Mothers Report, 2013 xiii WHO Fact sheet on adolescent health 2011 xiv WHO Global Health Observatory, 2014. xv Lawn JE, Blencowe H, Oza S, You D, et al. Every Newborn: progress, priorities, and potential beyond survival. Lancet, 2014. DOI: http://dx.doi.org/10.1016/S0140-6736(14)60496-7 xvi PMNCH Factsheet: Maternal Mortality (updated September 2011) xvii WHO, Maternal Mortality, Fact sheet N°348, May 2014. xviii PMNCH Factsheet: Maternal Mortality (updated September 2011) xix WHO, UNICEF, UNFPA, The World Bank, Trends in Maternal Mortality: 1990 to 2013 xx Thomas T, Gausman J, Lattof S et al. Improved maternal health since the ICPD: 20 years of progress, MHTF at the Harvard School of Public Health xxi Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2014 xxii Thomas T, Gausman J, Lattof S et al. Improved maternal health since the ICPD: 20 years of progress, MHTF at the Harvard School of Public Health xxiii Every Newborn Action Plan, 2014 xxiv Save the Children, State of the World’s Mothers Report, 2013 xxv Unicef, The State of the World’s Children 2011. xxvi Save the Children, State of the World’s Mothers Report, 2013 xxvii WHO. Global Health Atlas of the Health Workforce, 2013 xxviii UNFPA. State of the World's Midwifery Report: A Universal Pathway. A Woman’s Right to Health. 2014 xxix Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub3. xxx Every Woman Every Child, 69th UN General Assembly, September 2014

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UNFPA, Statement for IDM 2013. Homer CSE, Friberg IK, Bastos Dias MA, et al. The projected effect of scaling up midwifery. Lancet 2014, DOI: 10.1016/S0140-6736(14)60790-XS xxxiii Renfrew MJ, McFadden A, Bastos MH, et al. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet 2014, DOI: 10.1016/S01406736(14)60789-3 xxxiv Save the Children, State of the World’s Mothers Report, 2013 xxxv UNFPA. State of the World's Midwifery Report: A Universal Pathway. A Woman’s Right to Health. 2014 xxxvi Black, R E et al (2010), ‘Global, regional and national causes of child mortality in 2008: a systemic analysis’, The Lancet, vol 375, issue 9730. xxxii

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