A world of difference
Joy Kemp and Carmel Moran explain the RCM’s global mission to enhance the confidence, professional practice and influence of midwives across the globe.
Every year, an estimated 135 million women give birth worldwide, but more than 300,000 of them will die during pregnancy, childbirth or soon after (WHO, 2015). Around 2.6 million women will have a stillborn baby, and 2.9 million infants will die in the first month of life (Renfew et al, 2014). Of maternal deaths, 99% occur in low- and middle-income countries (WHO, 2016). Trained, competent and confident midwives are key to reducing maternal and newborn mortality and morbidity.
The International Confederation of Midwives (ICM) promotes twinning of its member midwifery associations, and the RCM has established twinning partnerships in countries with high burdens of maternal and newborn mortality and morbidity. Over the past five years, the RCM has worked to strengthen midwifery associations in Cambodia, Nepal, Uganda and Bangladesh to build their capacity to advocate for improved midwifery education and services, as well as create demand for midwifery services. We have also supported a midwifery education twinning project in northern Nigeria.
In 2017, the RCM developed an internal framework to guide its future global work. Partnership, twinning and reciprocity underpin everything we do to support global midwifery. The RCM’s global development work is limited in scope, tightly managed, closely evaluated and designed to deliver maximum mutual benefit to the midwives in the countries in which we work and to RCM members.
Bangladesh twinning project
The RCM is currently twinned with the Bangladesh Midwifery Society (BMS) to undertake a capacity-building project funded by the United Nations Population Fund. Since June 2017, we have been working closely with the BMS to strengthen it as a professional association, to advocate on behalf of midwives and create demand for midwifery services. Midwifery is a new profession in Bangladesh: the first cohort of health professionals specifically trained as midwives graduated only last year, so raising awareness about the role of midwives and their importance is essential.
Student midwives in Dhaka said why they welcomed the new twinning project: ‘We can share ideas, solve problems together, learn from each other and work together to make us strong. Twinning gives us a platform to present midwifery in Bangladesh to the world and to show people that we do a good job.’
In July 2017, the RCM, working with a consultant from the ICM, led the BMS through assessing its organisational capacity and developing a strategic plan for the next three years. Key achievements of the project so far have been the appointment of a full-time member of staff at the BMS to coordinate office administration and activities, the creation of a membership database and fee-paying mechanism, and field visits to all regional branches, as well as stakeholder engagement with bodies such as the Ministry of Health and Family Welfare and the Bangladesh Nursing and Midwifery Council. All this has laid the groundwork to allow the BMS to organise and hold an AGM and election in March 2018.
The RCM’s global team are directly involved in implementation of the project and visit Bangladesh regularly to facilitate workshops, provide technical support and monitor progress. We have also engaged RCM members with the relevant skills and experience to support the project. In December 2017, Aine Alam, a recently appointed RCM fellow, volunteered in Bangladesh for three weeks, helping the BMS map its divisional capacity. Terry Kana from the Liverpool School of Tropical Medicine, also an RCM member, has undertaken two consultancy placements to support the BMS with an AGM and election planning.
We have an exciting year of activities ahead. The project will support young midwives in Bangladesh in enrolling on the ICM’s Young Midwifery Leaders programme, and we will continue to support the BMS to develop policies and procedures essential to a functioning professional association.
MOMENTUM in Uganda
The RCM has worked in Uganda since 2012, through our twinned partner organisation the Uganda Private Midwives Association (UPMA). During our two UK-Aid funded projects, we placed 26 UK midwife volunteers to provide technical support for education, regulation and practice. We facilitated three exchange visits to the UK, conducted 13 workshops in partnership with Ugandan colleagues and made 12 monitoring visits. We have also co-published and co-presented our work in a number of different ways and are currently finishing a piece of research with our partners.
Our most recent project, MOMENTUM, helped develop a model of mentorship for Ugandan midwifery using an action research approach. The work had three strands: developing a national standard for mentorship, developing a work-based learning module to train midwives as mentors, and improving the clinical environment to support student learning in practice. External evaluation found the project to have met all its objectives and significantly impacted the wider healthcare system in Uganda (Adhikari and Nsubuga, 2017).
Seven UK midwives, all RCM members, were involved as volunteer consultants in the MOMENTUM project, all with significant experience in the development of professional standards, midwifery education or practice learning.
Sarah Mwanje, a Ugandan midwife who runs her own community-based maternity home, explains the benefits of being involved in the project: ‘MOMENTUM has improved my clinical skills and the standard of my clinic. Previously, my staff were not confident in their clinical skills or receptive to feedback. They had no experience of mentorship. My UK twin Sue and I observed the practice in our clinic together and made a plan to improve the learning environment. Now we are more organised and systematic, and teaching has become a core activity. Attitudes have improved, we handle the students more kindly and without shouting at them in front of the clients.’
Sarah’s twin Sue responds: ‘I have learned so much from Uganda. I see my own situation with different eyes and see things that I didn’t see before. This experience inspired me to return to university, and I am now working on a project to help asylum-seekers and refugees access maternity care in the UK. This would never have happened without the time I spent in Uganda and in turn at university.’
UPMA has also benefited from twinning with the RCM. Mary Musoke, UPMA’s president, explains: ‘It has strengthened our clinics and our midwives’ skills, improved the way in which we gather and use routine data, built our research capacity and enlarged our networks. Twinning is very important when you are running a project within countries of different cultures. At first we were scared to twin with the UK midwives, because of our different cultures, but now everyone is asking for a twin.’
- 75% of maternal deaths are caused by:
- Severe bleeding (mostly bleeding after childbirth)
- Infections (usually after childbirth)
- High blood pressure during pregnancy (pre-eclampsia and eclampsia)
- Complications from delivery
- Unsafe abortion (WHO, 2016)
The RCM will be focusing its 2018 activities on the four main areas outlined in the global framework:
Project delivery: We will continue to deliver our global projects in Bangladesh and Nigeria, and identify potential opportunities for future collaboration.
Capturing reciprocal learning: Both in partner countries and for our members in the UK. We are currently publishing a suite of papers from our projects and completing research in Uganda.
Engaging and involving members: We want to harness the expertise that exists within the UK midwife community by providing volunteer opportunities. We also want to raise the profile of our global work to promote the amazing achievements of our partner organisations.
Engaging and involving RCM staff: We want to strengthen the work we do in our partner countries and find opportunities to develop our staff through involvement with our global projects.
Joy Kemp is the RCM’s global professional advisor and Carmel Moran is the RCM’s global projects officer
Adhikari R, Nsubuga F. (2017) MOMENTUM end of project evaluation report. See: www.rcm.org.uk/global (available on request).
Renfrew MJ, Homer CSE, Downe S, McFadden A, Muir N, Prentice T, Hoope-Bender P. (2014) Midwifery: an executive summary for The Lancet’s series. See: www.thelancet.com/series/midwifery (accessed 25 January 2018).
World Health Organisation. (2016) Maternal mortality. See: www.who.int/mediacentre/factsheets/fs348/en (accessed 25 January 2018).
World Health Organisation. (2015). 10 facts on maternal health. See: www.who.int/features/factfiles/maternal_health/maternal_health_facts/en (accessed 25 January 2018).