Russian midwives: 'they have strength and determination and they share a vision': Greta Beresford writes about the past and present of the Inter-regional League of Midwives of Russia, and her own involvement in their continued endeavours.

• Auteur: Beresford, Greta

Midwives in Russia have a professional association: the Inter-regional League of Midwives of Russia. Establishing this has been a massive step forward for Russian midwives, which will enable them to take their place in the international community of midwives. The League joined the International Confederation of Midwives in 1999.

History of the professional association

In pre-Soviet times midwifery in Russia was respected profession, and midwives practised with a great deal of autonomy in villages and small towns all over Russia, where doctors were scarce. As other midwives had done elsewhere, they realised that forming a national association would safeguard their profession and enable them to develop ties with colleagues worldwide, so in 1914 they formed a professional association. It was small, unregistered and members were few, but it attracted a great deal of interest among midwives.

However, before the association could develop further, the Soviets assumed power and all professional associations were dismantled. Educational opportunities for midwives declined and their right to practise autonomously was removed.. The state dictated the parameters of clinical care, putting in place protocols that were not always of benefit to patients. Both doctors and midwives found themselves isolated from the corpus of international knowledge, from colleagues outside the Soviet Union and with little hope of regaining their lost autonomy.

In the 1990s, President Gorbachov relaxed the state's control over the professions, and opened the way for contact with colleagues in the West. Change was slow, but midwives gradually began to reconsider the idea of a professional association.

Meanwhile, the Association for the Promotion of Health Care in the former Soviet Union--known as 'HealthProm'--a UK-based NGO, had been working in Russia since 1984 as part of a medical exchange programme. In 1995, HealthProm expanded its activities to include a safe childbirth programme, introducing seminars for doctors and midwives with the aim of improving skills and knowledge. Maternal and neonatal mortality and morbidity levels axe still considerably higher than in Western Europe, and one of Healthprom's goals is to assist in achieving a reduction in those rates.

Partnerships and funding

A small group of midwives set up the St Petersburg Association of Midwives and another group established the Moscow League of Midwives. Membership increased and groups were formed in other...