 And now, it's my real pleasure to introduce Franca Cadet, an expert on midwifery and an advisor on international maternal health, with over 30 years of strategy and policy developments, advocacy, leadership, project management, and partnership. She is the current International Confederation of Midwives President. With her anthropological and midwifery background, Franca has lived and worked across a range of differently resourced countries and is well aware of the realities of midwifery practice in various cultural contexts. She is a strong proponent of humanized midwifery care and encourages midwives towards respectful care and a humans rights-based approach. Franca was most recently, Franca most recently, was the strategy and policy manager with the Royal Dutch Organization of Midwives. She is known to many for her work as the twin-to-twin project manager. Previously, Franca served in the ICN board as treasurer from 2002 to 2008, and on the ICN council as the Royal Dutch Organization of Midwives Delegate from 2008 to 2017. And now, I'm going to enable Franca so that she can do her presentation. Wonderful. Thank you so much for that. I just want to check with you. If I press the arrow, I go through the slides. That's right, isn't it? Yes. Yes. I can see it now. Wonderful. Hello, everyone, and happy International Day of the Midwife. It is such a thrill to be allowed to speak today and finalize this last session on the Virtual International Day of the Midwife, which I think is a real, real thrill to do. And I think it's such a wonderful tool. It's been great seeing so many people join. I've joined it a few times today myself, and it's been wonderful to hear. So the pleasure is all mine that I'm allowed to speak. It's a real honor. I would like to talk today about what the International Confederation of Midwives is doing to lead the way with quality care, because I think that it is the theme that we have, and I find it important to say that what is happening at ICN. Before I say that, I think what is important for us all to realize is when I say ICM, I actually mean all the members, because ICM is not the head office in the Hague and it's not me. ICM is everyone. ICM is all the midwives in the world that are members of ICM, and all the midwives in the world that are not members yet but will become members. All of us together are ICM. I would really like to thank you all for the great work that you're doing to protect the lives and the dignity of all of us who need us so much, and I think ICM is a really important day to harness our collective power to lead the way for all women and newborns through quality, equity and leadership, which are actually the three themes of our strategy for this trianum. May the 5th is the International Recognized Day for highlighting the work of midwives, and I'm not sure if some of you realize ICM actually established the idea of the International Day of the Midwife following all kinds of suggestions from midwifery associations in the late 80s, and it was formally launched in 1992. So we've been doing this for quite a long time. We know that midwives who are educated, trained, licensed and regulated to ICM standards work within the parameters of just that we don't work within the parameters of just one situation or one setting or a community or one country. We are able to lead the way towards improved maternal newborn health outcomes locally, internationally and globally, and we provide appropriate education, counselling and antenatal care that is adapted to the specific needs of the women and the babies that we serve. So as midwives, we know that leading with quality care means providing evidence-based and people-centered reproductive health care service, and I think it is such an amazing privilege to be allowed to do that, and I've been hearing it today as well in the presentations and I've heard it from so many midwives around us that we feel it's such a privilege to be allowed to do this work. So this picture shows us all the places where we have midwifery associations, and I think it's also quite good to realize where we don't have a midwifery associations, and I certainly hope that as ICM, all midwives in the world will come and join ICM. So as the Global Organization of Midwives Associations, we have members in 113 countries now, and we represent around about 500,000, sorry, midwives globally, and we're governed by an international council made up of delegates, and that's from 132 member associations. So that's quite a lot, and as I said, we are all ICM. And just a small reminder about the fact that over 340,000 women and more than 3 million infants around the world die each year from preventable complications from pregnancy and childbirth, and the majority of the deaths would be prevented if we were enough qualified and adequately resourced midwives available around the world. ICMs are skilled to provide 87% of childbirth-related services, and it makes us the ideal professional to support women through the whole continuum of care, and it is for this reason that we have this vision, which has been the vision of ICM for quite a while, but I feel that it's just as relevant as it has been for a long time, and it's so simple and basic. Invisions a world where every childbearing woman has access to a midwife's care for herself and her newborn, and I think this is such a, I think it's a very profound vision, and we have more and more evidence, and we'll be talking about that later. We have more and more evidence to show that it is actually a woman's right, I believe it's a woman's right, to have access to a midwife's care. Our mission supports the vision, and we as ICM want to strengthen midwifery associations and advance the professional midwives globally. We want to try to promote autonomous midwives to be the most appropriate caregivers for women, and to keep birth normal so that we can enhance the reproductive health of women and the health of their newborn and their families, and actually their communities as well. Midwives serve as one of the foundations for achieving the United Nations Sustainable Development Goals, and here you see all the Sustainable Development Goals, and mainly you could look at Sustainable Development Goal 3, which is about health, and 5, which is about gender equity, and I think we focus a lot on those too, but actually midwives impact all the development goals. And the World Health Organization and several United Nations agencies and other international bodies have identified midwives as key in reducing maternal and newborn deaths and disabilities globally. Actually midwives yield a 16-fold of return on investment, and it's quite interesting, my youngest child Benjamin is 18, and he's been investing in cryptocurrency, and I said to him the other day, you know Ben, if you had a cryptocurrency that would kind of get a 16-fold in investment, would you invest in it? And his eyes kind of became large and he said oh yeah mom, oh god if I could get 16 times my investment, I'd definitely do it, and I said you know invest in midwives. Midwives really have a huge investment, great return on investment, and the ripple effect of improved health outcomes is significant. We know that midwives save lives and ICM recognizes the strategic importance of advocating for midwives to work close to where women live and their families and give them access to equitable quality midwifery services because it's key in achieving universal health coverage. This is just some statistics that some of you will be aware of and others will not, but I find they are so profound and we get more and more and more evidence for these figures. So when empowered and authorized with essential skills, midwives can help avert over two-thirds of maternal deaths, which is a huge amount, and when we are educated within two international standards and we work with an enabling environment, so it means that we work in the environment whereby we can work to our potential, we are able to take care of 87% of the essential care of women and their newborns, and the midwifery series, the Lancet midwifery series showed that if you increase midwifery in development countries by 25%, it reduces the maternal deaths by 50%, and these are very, very serious figures. I find them really encouraging because we know that midwifery works and I do actually personally in my role and being at different meetings at the UN at WHO, I do hear people realizing this more and more, people realize that midwives really, really matter, and I find this extremely encouraging. Now this next slide is just to give you a bit of a view of the strategy of ICM for this triennial because this year's theme resonates with the first of ICM's three strategic directions established at the Council in Toronto, so it's quality, equity and leadership, and midwives leading the way with quality care is significant in highlighting the vital role that midwives play, not only ensuring women and the newborns navigate pregnancy and childbirth safely, but also that they receive respectful and well-resourced maternity care that can create a lifetime of good health and well-being far beyond the childbirth continuum, you know, it goes throughout their whole lives. And of course we're looking at quality this year, but for all of you to know that next year we will be focused on equity, so it will be midwives leading the way through equity, and then year after that, which will be our ICM Congress year of Bali, we'll be looking at leadership. And I'm sure you realize that even though we are focusing on quality this year, leadership is at the basis of quality and also equity is at the basis of quality. Within our ICM strategy we have looked at certain things that we demand as ICM and certain things that we will deliver as ICM, and when it comes to leadership we demand the participation of midwives at every single level, at the highest level of policy and decision making, so at the global level, at the regional level, at the local level, and by this I don't mean that they all have to be top leaders, I think we are all leaders and I think at every single level you are, we need to take the lead and speak for midwifery, and I really believe that governments need to have midwives at the table, because when you're actually employing midwives and increasing your midwifery workforce, you need to have midwives talk about what midwives need to do. So that's one thing that ICM demands and we as ICM will deliver effective midwifery leadership and expertise, and later on I'll tell you about the things that we're doing to actually be able to deliver that. And as I said, equity is also very, very important when it comes to delivering quality and in our ICM strategy, strategic objectives, we say that we demand equitable access for midwives to education and regulation and continuing professional development, and we also demand that women have access to midwifery led, midwifery services, and at the same time we will deliver access to the midwifery associations to ICM. So anything that we do at ICM is there for all of us, for all midwives, and we're working very hard on trying to make these things equitable for everyone. So when we focus on ICM again on the, sorry on quality, which is the theme of this year, in our strategic objectives it talks about two things, one thing we demand and two that we deliver, and I'm not talking about delivering as in birth in this case, I'm sure you understand because that's giving birth, this is what we will deliver as midwives. And we demand an enabling environment through which midwives can provide quality midwifery services and I think this enabling environment is something that is so important. Many, many midwives work under circumstances that are so difficult that that potential can't be shown. I think that you see it at all different levels in all different countries, so some midwives don't have water, they don't get salaries, they don't have medication, they don't have anyone to refer to, they don't have any way that their children could possibly go to school, there are all kinds of ways in which midwives are not able to work to their fullest capacity, and I think that midwives should demand that they can work within a good enabling environment. Then what will ICM deliver? Well ICM will deliver global standards and resources and tools for education and regulation, and I think these are extremely important worldwide to get us to a certain level all together. And we will also deliver experts on midwifery and midwives that are able to give quality advice to stakeholders. So when we are saying that ICM will lead with quality care, what do we actually truly mean by that? I think one of the things that we mean is that we will carry on with what we are already doing. I think we need to realise that there is a lot of quality out there which we will maintain. So we will maintain our high quality work, globally, nationally, locally, and we already do that in all kinds of ways. For example, we offer support and assistance to survivors of gender-based violence. We provide reproductive health services to adolescents who are often denied access to services at a great cost to their health and human rights. Or we campaign against unnecessary medical interventions. And I think that midwives play a key role in the empowerment of women so that we can build most equitable and sustainable societies. And that's something we are already doing. We provide support and services to all women anywhere without discrimination of any kind. And I think that's again something that we have to maintain and be proud of and really stand for together. And of course we provide women and their families with education concerning immediate and future health considerations like family planning and spacing future pregnancies. So that's what we're doing and what we're trying to maintain. Then another thing which I think is very, very important is that we ensure unity in our messaging. And that one is something that I think is very important for all of us to do together. And that's also the reason why I'm talking about our strategy. Because I think all of us need to realize what our joint strategy actually is. At ICM at the council we did decide this together. But of course the dissemination for all of us to feel it and move together is so much stronger. And the unity in messaging is extremely important because we need to make sure that people know that the midwifery workforce has to be supported by quality education and regulation and safe working conditions. And we all have to say this time and time again at every level in every single country. I think that midwives we are the key advocates and supporters of women during pregnancy and childbirth. And this is why for example the World Health Organization encouraged every childbearing woman to see a midwife at least four times during her pregnancy. So these kinds of messages do get changed to happen. Another thing that ICM does is to review and update and expand our resources. For example our core documents are updated regularly and our position statements are updated regularly. And at the moment we're working very hard on reviewing and updating our governance and management structures. So for example within the board we are working in a more equitable way whereby we for example represent ICM over the world more equitably. So you will find that for example the regional board members of South America as an example would actually represent ICM in that region and not for example the president or someone else. And that way we're trying to really show a diversity and use our diversity in a wide way. And I think very similarly that's happening in the office. And so I think in that way we really are trying to adapt to what is necessary in this modern world. And with the small capacity that ICM has because the ICM head office are such only 10 people. So it's quite small. We have to really really be very careful how we use ICM's capacity in that way. So we have to use the capacity of our members. That's half a million people. And I do find that midwifery is really emancipating. I don't know how you look at this but I certainly see midwifery is really emancipated over the years and there is so much capacity out there that we can use. And I think as ICM we are realizing the capacity and we're using the capacity more and more. Then the fourth thing that we're doing concerning our quality is strengthening our midwifery education accreditation and continued education. And I think that ensuring effective communication with women is very important so that they can receive care of respect and so that they can preserve their dignity. Really they need to be provided with emotional support that is sensitive to their needs and strengthens their capabilities. And I think it's extremely important that we strengthen midwifery to be able to do that. And last but definitely not least I think we need to encourage governments to support midwives and we do that through the association. I think healthcare systems must enable responsive and accessible quality midwifery service delivery and midwife scanner must inform policies related to the composition, development, distribution of the health workforce in all countries to reflect the diverse needs of the women who benefit from their care. We all know that midwives are at the heart of quality, equity and dignity in healthcare provision and governments must invest in midwives in alignment with the ICM standards so that women can have access to more midwives and more women focused care and fewer adverse outcomes for pregnancy and childbirth. And I certainly see that providing women-centered reproductive health services is extremely important and midwifery is vital, a vital solution to challenging and providing high quality maternal newborn care for all women and newborns and infants in all countries. And we know the evidence, it's in the Lancet, it's in all kinds of documents. One way in which you can actually do that yourselves as well locally is through our lobby toolkit. I'm not sure if any of you have actually seen the lobby toolkit that ICM brings out. We have a lobby toolkit for IDM but we also have a lobby toolkit that comes out in our newsletter every single month and we've started with that at the beginning of this year. And midwives leading the way with quality care lobby toolkit tries to concentrate on two aspects and that's high quality midwifery care for every woman and every newborn and lobbying for midwife-led care that that is the first choice for all women. I'm trying to, sorry, I'm just going back to this slide because I think that we, oh yeah, sorry. When I go back to the lobby toolkit, what the lobby toolkit tries to do is to inform the public about midwives and I've seen today kind of looking through Twitter and social media that midwives are organizing rallies, for example, flash mob marches, public performances, there have been walks and so in these ways you inform the public about midwives. Social media campaigns I think are also very very important and you have seen many social media campaigns today but and in general I think midwives are becoming more active on social media. I think it's also important that we increase increase the awareness of midwifery services and you have seen a few midwives worldwide that have for example offered free antenatal or postnatal reproductive health services so that women are aware what actually their rights are and what's and how they can benefit from midwifery services and in that way I think the public is becoming much more aware of what we are able to offer. I think it's also very important to improve the coverage of midwifery issues in the media and certainly through social media and just before I had last yesterday I think it was I spoke to a French journalist and you do see the media being more and more interested in midwifery in general and I think we need to bring out midwifery into the media as a strong profession that stands next to women and that is there for women and this will definitely help midwifery to be recognized worldwide. I think that midwives are connecting with journalists more and more and also that mothers are connecting with journalists and other people within the media more than they used to and this certainly helps to profile midwifery. Another thing we need to do is to nourish the support system amongst midwives. I think we need to make sure that we celebrate each other and that we do everything we can to lift each other up to recognize each other's capacity and to do everything we can to use all the capacity we have and nourish each other because I think many of us have hard work, we work long hours, we often have very little pay and the best we can do is to at least support and encourage each other. Another thing which I think we need to do is to collaborate with healthcare professionals and again in the lobby toolkit you'll find that there's all kinds of tips about how you can collaborate with other healthcare professionals by for example bringing together stakeholders. I saw a meeting I think of the Moroccan midwives that met stakeholders today for the IDM or organizing social events. You've seen many social events and videos and things like that whereby collaboration with healthcare professionals makes other healthcare professionals more aware of midwives. I think there's also been some attention about for increasing the numbers of midwives. You see that for example that some midwives have gone to secondary schools to talk to students about the fact that becoming a midwife could be something that they would really love to do and help them to understand what it's about and also arrange meetings with government officials to discuss retention strategies and of course what we all want to do is to achieve policy change and we do that by inviting government officials to panel discussions and things like that and you have I have seen quite a few things today where again there have been government officials present in panels to discuss midwifery and of course to share the findings from different reports that we have like the midwives voices midwives realities report the state of the world midwifery the Lancet series all these reports that we have to try to share them as much as we can so that policymakers can use them and you would be surprised how often it is that people are actually not aware of some of these reports when they could be so I think it's important for all of us to be aware and to show those people that are able to change policy the real the real evidence this next slide gives you just a bit of a overview of all the information that there is a lot of this you can find on the ICM website but if you do want more information you have visit the ICM website you can also find the ICM strategy there and it's really worth reading the strategy because I think it gets an overview of the next three years with quality being the focus this year but the focus on quality equity and leadership within these three years I really believe will bring us further another report that I think is very very insightful is the report midwives voices midwives realities of course you have the WHO global health observatory data the state of the mid-world midwifery report and there's also a state of the world midwifery report from east and southern Africa and some of you might like to know that the state of the world midwifery report was done in 2014 but we've just started a new state of the world with midwifery report which will come out which will be launched in barley 2020 at the ICM conference I think the Lancet series has had a lot of Lancet series on midwifery has had a lot of impact and I think again it's very important material to read but also the World Bank health data is interesting and I think many of us can contact our ministries of health UNFPA UNICEF and representatives in your countries because there's also often lots and lots of local data that you can use this here is a picture of my granddaughter it's my youngest grandchild and I think actually the main thing that I've been trying to say that really helps midwives to give the quality that we need is to be proud of what you are I am extremely proud to be a midwife and people often say to me oh you must be wonderful being the president of ICM but I really promise you it is so much more meaningful to feel that I'm a midwife and that I'm a midwife in part of a huge midwifery community so be proud to be a midwife and celebrate the leadership and quality care that midwives contribute to the miracle of birth because a miracle it is and I think that we should celebrate that together just like we have done today on this international day of the midwife I want to really thank you all for taking part in the day today and doing all your different activities celebrations and I want to thank you even more for the work that you do every single day 24 hours a day every single day of the month every single month in the year year in year out for women and babies and I'm so extremely proud to be a midwife with all of you thank you thank you Franca I'm I'm so touched here at the end of the international day of the midlife that I could I could almost have a little cry because I've I'm so proud to be part of the international community of midwives are there questions Franca might be able to answer for you all so very quiet I but look at the hands clapping over at the side okay that's wonderful that's wonderful I would like to hear can everyone still hear me or not yes I was just wondering personally I feel that there is a buzz coming back in midwifery but maybe it's also I'm very positive I really do believe in midwifery and I believe that we will get there slowly but surely together we'll get there but I am seriously feeling a buzz I would like to hear from the people that are listening now do they experience this do they feel a buzz coming back in midwifery worldwide or in the countries where they live well that's great I see I think it's so important that we do realize it it's interesting she says Canada too oh joy would you like to use the microphone let me enable your microphone let's see joy oh wonderful you have a march for mums in Washington on the 6th of May wonderful that sounds fantastic joy are you able to talk now it's interesting what Tina is saying here about there's a definite buzz in New Zealand but we have to be careful not to lose our way yes I think we do have to be careful of each other and keep each other strong heaven's in an eight I'm not able to enable joy Linda can you help me with that or maybe a net oh joy have you enabled your microphone up at the top there's a little microphone icon tap it until it turns blue Franka I can say while joy is trying to turn on her micro her oh it has been a long day I wanted to say turn on her microscope microphone that we've been growing midwifery here in the United States for almost 100 years and I know that Canada is following a similar path of repersonalizing midwifery and growing numbers so that it's available to all women that's that's just wonderful and I think I think it is happening in many countries and I know that many countries are also having conflicts at the moment with with other members in the team but sometimes that's also an indicator of growth it's an indicator that actually midwifery matters so I think that at times you know it disheartens us but I think it is so important that now midwives stand up and that we don't feel that we are we are vulnerable in some way but I think we need to stand strong because if we stand strong and move forward in a strong way we'll really make the change that's been waiting to happen for such a long time agreed joy do you think you have sound now do you want to ask your question yeah can you hear me okay we can okay great thank you thank you so much that was such an inspiring presentation and I've been writing notes furiously all the time that you've been talking I wanted to ask you about countries like the UK because I think there are really encouraging signs in lots of countries as people have been saying but I think in our country midwives have lost the vision for what midwives are and I think we've we've become complacent because we've had this strong midwifery service but actually now we're losing some of the things which which were the foundation stones of midwifery so I was wondering if you could give us some ideas about how we can reinvigorate midwifery in countries where midwives have become complacent and no longer realize what a privilege they have yeah yeah yeah I understand what you're saying yet at the same time I can't agree with you that I mean I'm sure you're you're feeling these midwives around you who who are complacent but I don't think I think I think actually the UK is doing great because you're developing a lot of academia and I think you need to use the path you need to use the door that you have in each situation and I think in the UK certainly academia is one part that's extremely strong I think you have a lot of midwife lead care and midwifery lead care and yes I think that when uh the Netherlands is also an example where things have been very very good for a long time so midwives have not had to fight and sometimes I think oh well you know maybe Dutch midwives they haven't had it bad enough yet and that's why they need to stand up but you do see midwives standing up and you also see women standing up and I also noticed that in the UK I think women are standing up and are saying that they that they want respectful care and I think things like for example the me too campaign it also has something to do with midwifery and we might not see it that way but I think in society in general women are standing up and saying we are deciding for ourselves what's good for us and that will have repercussions on midwifery as well so I can understand what you're saying and I think it's at times difficult to to think that your profession is slowly becoming less strong because we are being complacent but I would look where your strengths are and try to use those strengths specifically and the first thing that comes into my head is your excellent midwife academics and all the research you've done on normal birth which I think is absolutely excellent and maybe that would be a way in which you could do that. Yeah thank you I guess I'm just feeling discouraged because I went to an event today where three women shared their birth stories and they were all dreadful and it really made me think are we really that bad? Yeah yeah it's interesting this thing about you know births about birth stories I think somehow at times certainly again from the Netherlands point of view but I think that's in quite a lot of countries it's the same thing that we mustn't get the idea that a good birth means that you give birth at home by candlelight that doesn't have to be a good birth I think a good birth is a birth where a woman is able to choose the birth that she needs she has skilled and loving care and then you could even have a caesarean section it can be a good birth and I think somehow that's something we need to realize as midwives as well that we of course we want to keep birth as normal as possible but at the same time a good birth is a birth where the woman is in control in the end it's the woman who we are only about the women without women there is not a place for midwives and I think maybe we need to listen to women more and more and at times women might say things that we don't like but we are there for women so we are going to have to have the dialogue with women and try to understand if we do find it difficult can you say something about these birth stories yeah it was so difficult it was a very interesting event I was at the association of Greek midwives in the UK so there's a diaspora midwives who are Greek in ethnic origin but who work in the UK and they had invited some Greek women who had birthed in the UK so I think it was it was partly about their experience of the cultural difference and not being understood but it was I think for me it was that the midwives had not tried to connect with the women there wasn't an emotional connection it was about ticking boxes so actually it wasn't about whether they had a caesarean section or not it was the fact they didn't feel they had actually connected with the midwives and that they mattered to anybody yeah yeah yeah yeah and I think that that's something we need to listen to and it's extremely important and maybe it isn't disheartening but sometimes we need to as midwives be in an uncomfortable space to learn we're also human beings and I think at times we're under great pressure we know that midwives don't always behave well either and we have to support each other to do that and try I think also to keep standing up straight and supporting each other instead of becoming disheartened or feeling to be victims I do think that's something that has happened in the past that we've looked upon ourselves as victims and we need to stand up and if if we find it uncomfortable what women are saying then we need to have those discussions together yeah thank you Franca thank you too Joy other comments or questions for Franca it's interesting I'm just watching the seeing a comment here about from Celine Lemay be careful about the medicalization and sometimes nurse nurseization of the profession I think when it comes to ICM I think we very much realize that over medicalization and under medicalization are all the same indicator of women not getting the appropriate care and in that way I do feel that the world of midwives is much more connected than ever because I think for a long time ICM concentrated her attention on those women who didn't get enough care and we are still doing that but we do realize as well that women who get too much care also have an issue so we are in that way we can kind of bridge that same problem of too little too late too much too soon together and find that and try to concentrate on giving women appropriate care and yes I totally agree with you Celine that we have to be extremely careful about medicalization in general and also medicalization of birth I think it's very I think it is a very difficult dilemma because I think the more medicalization you see the more less able you are to understand that you are medicalizing at times you just don't see it any longer and you need practice you need practice to keep birth normal I mean sometimes sometimes I feel that what midwives are really really skilled at is at doing nothing which is an extremely difficult thing to do and I think sometimes we don't learn because our societies teach us that doing something is always the right thing and so I think what we need to do is to try to well use the evidence I think the evidence is really extremely strong so use the evidence maybe have exchanges try to have exchanges between countries where we try to learn from each other and and get tips from each other and how we can try to keep the art and science of midwifery because it is both an art and a science and maybe even specifically look at those countries where the medicalization is strongest and and try to find out how we could specifically support that country with all these kinds of ways like exchanges evidence and see if we can make a difference and use that example for another country but I think the evidence actually is one that is extremely strong at the moment and we really need to say it out loud all together because I think it really does support women to get the best care but it is a difficult one I think it is it is one that's extremely challenging and just as challenging as those women who don't don't get any care I mean it is very strange that in the world and sometimes even within one country I think the United States is a very good example where you see maternal mortality rising and you know our world is changing and sometimes within the same country you can have the poorest and the richest and you see it reflected in maternal mortality and you'll find that yes I know that black women in the United States often get very very little inappropriate care and at the same time other women get highly medicalized care which is just as inappropriate so yeah I think we need to learn try to learn from each other and pinpoint those countries where the medicalization is the biggest and and link that country or find ways in which you can support those midwives to regain the art and science of their of midwifery. Thank you Franca any other questions I see Selene is saying evidence-based medicine needs to be constructed a little bit it often just confirms the status quo which is another way of saying midwifery needs to do its own fine research about yeah absolutely absolutely and I think we are doing our own research and sadly we know that it often research and and academia is also politicized and we need to stick to our guns agreed all right Jane has put up a link in the chat box to our posters we want to remind you all to look at the posters so we have this long 24 hours and it's almost as if the party's over now what do you do well if you need a gradual withdrawal go back and check the posters Franca we want to thank you so much so so much for participating with our virtual international day of the midwives today and can I just be a little cheeky and say as somebody from the United States I'm so proud to be represented by such an articulate and compassionate president in my career thank you so much but the honor is all mine it feels wonderful to be allowed to do it actually every day I think why me thank you well we thank you for taking the time from your career and your family to lead the ICM and us Franca thank you so much