ICM - keeping our members in touch: ICM Secretary General Kathy Herschderfer writes on lessons learned, looks forward and gives midwives some questions to consider in her farewell message.

• Auteur: Herschderfer, Kathy

As I start writing this column, the last one as ICM Secretary General, I am thinking about all the experiences I have had over the past four years. I have been privileged to represent the midwifery profession in many venues throughout the world, where I have spoken with midwives and heard about both their struggles and their triumphs.

I have collaborated with other groups of health care professionals, showing the strength in numbers, in bringing forward the message--that those who provide the care, do care--and I have worked with UN agencies and other organisations towards achieving the global goals set out to reduce poverty in the world. I have been honoured to speak with ministers and officials who are dedicated to creating government policies and strategies that will bring a greater focus on midwifery services and lead to reduction of the health risks associated with pregnancy and childbirth.

These experiences have added to my knowledge and understanding of the issues and influences that affect midwives, midwifery and the health of childbearing women. During the past four years, the concept of midwifery care as a strategy towards the reduction of death and disability in childbearing women and their children has grown considerably, and yes, we have become popular--at least in the global development arena. ICM is now frequently invited to participate in global partnerships, in high level meetings, in technical consultancies.

Yet, despite all these opportunities and despite the myriad of programmes and schemes, the fact remains that too many women and newborn still die or are disabled through childbirth. There is vast inequity, both between countries and within each country, in the quality of care provision to women and children. Those providing care for mothers and babies are far too often not involved in decision- and policy-making and two out of every five women in the world give birth without a midwife or other provider with midwifery skills.

I will not be able to leave a universal solution behind when I leave the Confederation and although in my own language, midwife means 'wise woman', this wise woman leaves ICM with more questions than answers.

What is a midwife?

The ICM Definition of the Midwife provides a clear universal description and the ICM Competencies for Midwifery Practice summarise the knowledge, skills and behaviour that define midwifery care. Outside of ICM circles, however, there is a tendency to fragment this large...