WHO director general promises 'active outreach' to reduce health inequalities: Petra ten Hoope-Bender, Secretary General of the ICM, summarises the topics relating to midwifery debated at the World Health Assembly, May 2003.

• Auteur: ten Hoope-Bender, Petra
• Tenlastelegging: World Health Organization

The worldwide problem of shortages of midwives directly impacts on the wellbeing of women and babies during pregnancy and childbirth, and therefore is of over-riding concern not only to midwifery organisations but to all those involved with women's health and family health.

Strengthening nursing and midwifery

The World Health Organisation has recognised the crisis--along with that of lack of nurses in many areas--and is placing increasing priority on 'Strengthening nursing and midwifery'. The World Health Assembly, which met in Geneva in May this year, received a report on the strategy's progress. The ICM and ICN also together presented an intervention to the Assembly on 'Strengthening Health Systems in Developing Countries', of which more details will be given in a later issue of IM.

In the report to the WHA, progress is outlined under five headings: human resources planning and capacity building; management of personnel; evidence-based practice; education; and stewardship.

As is well known to midwives, the report makes clear that 'the single most critical intervention for ensuring safe motherhood--having a skilled attendant present at every birth--is far from being achieved: in the developing world today, only 58% of all deliveries are attended by a midwife or other skilled health personnel'. Other examples of poor outcomes related to lack of personnel are also given, and the conclusion is that 'the continuing decline in staffing levels and recruitment of nurses and midwives will seriously compromise the delivery of future interventions, and has already shown to be jeopardizing the quality of patient care, leading to an increase in adverse events in hospitals'.

There are a number of strategies in place to address these problems, among which 'WHO aims to standardize definitions across regions, and to design and test a standardized analytical tool for assessing the complexity of education, practice, regulation and other aspects of service organization in nursing and midwifery ... [In] parallel to these efforts, WHO is working with countries to map midwifery services in the world and to establish staffing norms and models of maternity care in different health care contexts.'

The ICM is in close touch with the latter project, whose aims accord closely with priority activities already identified by ICM, particularly at its 2001 'Meeting of the Minds' (reported in IM January/February 2001).

The promotion of leaders and leadership in midwifery...