 It's all with that when we're finishing up, but we're ready to welcome on virtual International Day of the Midwife I'm very honored and delighted to welcome Professor Bertha Hernandez-Triol. She's an internationally renowned human rights scholar who utilizes an interdisciplinary and international framework to promote human well-being around the globe. She's engaged in initiatives that seek to develop, expand and transform the human rights discourse with a focus on issues of gender, race, ethnicity, culture, sexuality, language and other vulnerabilities as well as their interconnections. She travels broadly to discuss human, to and teach human rights. She has made presentations and offered courses in countries around the world, including Argentina, Brazil, Colombia, Costa Rica, Cuba, Guatemala, France, Italy, Mexico, Peru, Spain and Uruguay. So it gives me great pleasure to welcome Bertha and I'm just going to turn over the microphone to her and mute myself. Over to you Bertha, I think. Thank you, Jane. Good afternoon. First of all, I want to thank the organizers of this conference, in particular, Dr. Jane Houston, after that lovely introduction for inviting me to participate in such an important and exciting conversation. It is a pleasure to be here today among women who do some of the most important work on the planet. The title of my talk is International Women's Human Rights, Women, Children and Families. I am going to focus my topic in three parts, using the lenses of localization and marginableness. Localization brings to the forefront that the global and the local are inextricably intertwined, especially with issues of women, children and life. We are witnessing this localization and stark relief with the current migration crisis. Marginableness, on the other hand, is a word that I have made up to fill the void of utilizing either vulnerable or marginalized, specifically with respect to women who are vulnerable and marginalized because of being well women, who often also are poor and racial, ethnic or religious minorities in their home or, for migrants, their destination country, or simply for just being mothers. With this framework in mind, I am first going to explore the substance of international human rights, that is, the existing legal structure that exists to protect individual rights. While this is a very broad field, I am going to focus on the existing regime that serves to protect women, children and families. Because migrant women and their families are such a significant marginable population today, I will talk about migrants considering the varied reasons for migration and the reality of the generally unsafe and unhealthy conditions migrants, especially mothers and children, endure, not only during their journey, but also in the entirety of migrant life. Second, I am going to shift my gaze at some specific health risks that plague women and their children. This will include a consideration of women who work in the fields, some migrants, some not. I will, in the end, look at the global reproductive realities, realities in which midwives play such a key role, such as the reproductive and other health risks for migrant women in their journey, migration for giving birth, and the disparate health outcomes in the U.S. of marginable pregnant women, regardless of migration status. But I need to pause to give context and clarity to my remarks. First, this conference celebrates the International Day of the Midwife, and this year it happens also to fall on Finko de Mayo, so it's a double celebration. So before I proceed to my substantive comments, I want to do some celebration and first engage the term midwife. There is no monolithic midwife. Midwives are multidimensional beings with varied sexual, gender, ethnic, religious, class, race, ability, and economic identities and realities, all of which are performed within various and varied cultural frameworks. But the term itself shows some consistent etymological foundations across languages. The word midwife in English means with woman and refers to the woman who is with the mother at childbirth. In Spanish, there are similar foundations. Comadrona means literally co-mother with the mother. My maternal grandmother, whom I never met, was a comadrona and very proud of it. The more commonly used Latin Spanish term, partera, comes from the Latin partus, to give birth, to bring forth. But there is more to the meaning of the words that also reflect the deep spiritual dimensions of midwife's work. Midwives are recognized as wise women, healers, who strive to work with mothers to bring children into this world safely, healthily, naturally, and with love. This larger sense of the midwife, as a wise woman, is captured in the French and German monikers, Sajfam and Vithvau, respectively. Second, there is no monolithic mother. Each birthing experience is unique and uniquely beautiful, even when challenging. Yet, migration creates a layer of complication. And while the migration experience is in itself difficult, it has distinct health and safety challenges for some populations. For example, the LGBT populations, who are also migrants and families. The challenges this population faces range from where transgendered persons are detained to a much higher likelihood of being sexually assaulted, to the lack of access to treatment, to rejection by their families, migrant community, and possibly the society in which they may be seeking refuge. Others within already othered communities are marginable, and with respect to LGBT migrants, they are often invisible or erased from the discourse, because they're not even counted. For justice to prevail, they must come out of the shadows. Last, and before I talk about the human rights system, I want to focus a bit on its origins and values, existing critiques of the regime, and how I re-envision its ideals and goals in order to draw robust rights and promote justice and equality for all. The human rights system, from which I draw rights for women, children, and families, often sees the rights it protects honored in the breach. For example, states and people worldwide agree that torture is prohibited, that to torture someone is a violation of human rights. Although there is no consensus as to what acts constitute torture, its prohibition is accepted. However, daily, we see, read, and hear about torture that is occurring across the globe, sometimes to pregnant women, sometimes to impregnate women, and eradicate a group. Similarly, every single human rights instrument prohibits discrimination against women. Yet, no matter where we search, what corner of the world we scrutinize, equality for women remains elusive in social, political, civil, economic, and cultural spheres. Without women's equality, all children's lives are at risk, particularly the lives of girl children. Moreover, when the system was created, starting with the Universal Declaration of Human Rights, the world looked much differently from the way it looks today. Because of the historical, economic, and colonial roots of the system, it has been subject to robust critiques, noting that, as it currently exists, it is far from perfect. It is challenged because of its Western, heteropatriarchal, colonialist, racialized, sexist foundations, and thus has been subjected to Asian, Southern, feminist, third world, and anti-colonialist critiques. But my vision, which is the foundation for the thoughts I'm sharing with you today, is of an inclusive system that serves us all well. An inclusive, intersectional, multidisciplinary, and egalitarian system. The human rights system, as it currently exists, sets up an immensely useful and desirable indivisibility and interdependence paradigm. One that recognizes that all types of rights, regardless of categorization, are necessary for the fulfillment of the human spirit, for the attainment of full personhood for maximizing human capabilities. For example, it understands that the right to vote means sorry little to a mother with ill or hungry children, without a roof over her family's head, without clean water, or in the midst of conflict. The indivisibility and interdependence paradigm can provide context for an analysis of the rights of women, children, and family, whose challenges are civil and political as well as cultural, economic, and social. With those thoughts in mind, let me proceed to the substance of my remarks. As I have suggested, the human rights system holds many promises for all persons to maximize their capabilities. The modern system was born of tragedy of the Second World War. In the beginning, the vision was for a holistic document that would protect individuals civil and political as well as economic, social, and cultural rights. The blueprint for such a document came in the form of the Universal Declaration of Human Rights. This non-binding declaration laid out the vision for the human rights system. Unfortunately, in part due to historical and economic realities, that single covenant vision was not to be. Thank back to 1948, the time of the adoption of the Declaration, and 1966, the time of adoption of not one but two covenants. The world was a much different place. It was divided into three categories of states, industrial, communist, and developing. These states had dramatically different interests and understandings of human rights, some differences that still prevail today. For the industrial states, the goal was to promote civil and political rights and freedoms. On the other hand, for the communist states and the developing states, many barely emerging from colonial rule. The goal was social, economic, and cultural development. Thus, instead of one holistic document, there emerged two covenants. One, the International Covenant on Civil and Political Rights, focused on civil and political rights. The other, the Economic Covenant, focused on economic, social, and cultural rights. Legally speaking, nonetheless, these and other existing human rights instrument prohibit many practices that plague the health and safety of women and childbirth in migration and their marginableness. The ICCPR protects the right to life, bodily integrity, including safety and liberty, privacy and family life, the right to movement, right to freedom from slavery, religion, and non-discrimination. Significantly, this covenant recognizes, without imposing any structural definition, that the family is the natural and fundamental group unit of society and is entitled to protection by society and the state. It also recognizes the special location of children and their entitlement to protection by family, society, and the state. The Economic Covenant protects a different set of rights that also are important to mothers and children. These include the rights to an adequate standard of living, including food and shelter, for the family, education, work, and a healthy work environment, the right to non-discrimination and social security, and many other rights. But of particular significance to our conversation today, the Covenants' protected rights include the right to health, both physical and mental. And this health provision explicitly includes an obligation on state parties to take measures to reduce the rate of stillbirths and infant mortality. And, similar to the ICCPR, the Economic Covenant, in the Economic Covenant, the state parties recognize that the family, again without any structural definition, is the natural and fundamental group of society and thus merits the widest protection and assistance. Noteworthy for midwives is the mandate that special protection should be accorded to mothers during a reasonable period before and after childbirth. And it continues to note that mothers who also work outside the home should be accorded pay, leave, or leave with adequate social security benefits for the reasonable period before and after childbirth. There are also a number of specialized treaties. One that is particularly relevant is the Convention on the Elimination of All Forms of Discrimination Against Women, which focuses on gender equality. With that focus beyond promoting equality between men and women in political and public life, such as the right to vote and hold public office, it also mandates equality in education and employment. It even mandates a change in cultural patterns that are gender subordinating. Indeed, it instructs parties to ensure that family education includes a proper understanding of maternity as a social function. Significantly, in its aim to attain women's equality in the field of healthcare, this convention specifically predicts reproduction and family planning. Further, the same article that protects reproduction and family planning mandates the state parties to ensure women appropriate services in connection with pregnancy, confinement, and the postnatal period, granting free services were necessary, as well as adequate nutrition during pregnancy and lactation. So you see, there are many lovely protections. Moreover, other specialized conventions on the right to the child, the right of migrant workers, their families, and of refugees exist, which provide adequate additional protections. The convention relating to the status of refugees enshrined the age-old concept of no-refoulement, which prohibits signatories from returning those seeking asylum on the basis of race, gender, sexual orientation, etc., to a place where their safety is going to be at issue. The International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families restates that migrants, regardless of status, should be afforded a minimum of protection equal to that given of national to the host state. And finally, I want to mention the Yogyakarta Principles. These principles elucidate the application of international human rights law, specifically in the context of sexual orientation and gender identity. The protections include the rights to life, personhood, security, privacy, health, family, and culture. The principles are significant because the thoughts I share with you today apply to lesbian, transgendered and gender non-conforming women and their families, although disaggregated data for these populations do not exist. So although we know they suffer many harms, they are hidden stories. One last observation on the legal structure is that each treaty has a committee in the UN in which applications can be filed in the event of a violation of the rights enshrined in the treaties. As we will see in the case of Alina Pimentel of Brazil, with which I will close this presentation, these committees can help correct breaches of rights. So please keep these rights in mind as we navigate through this talk. I have provided a litany of most impressive rights, yet all of you in your daily work see that these so-called rights are blatantly violated. This chart shows the many linkages of the general health and pregnancy and human rights violations. Women often are deprived of many of the rights that reduce vulnerability to ill health and negative pregnancy outcomes, such as the right to information, education, food and nutrition, water, free movement, non-discrimination, privacy, and maternal and child health. And often, they are subject to violations that result in ill health. Issues of violence, torture, slave-like conditions, harmful traditional practices, and lack of prenatal and maternity care are among them. To envision how these myriad protections are breached daily, let's turn to some of the specific issues that women face. And because we can view migrant women as a subset of women, though in a particularly difficult journey, the issues that arise in migration for women and children can elucidate the plight of women worldwide. Migration affects hundreds of millions every year. As you can see from this slide, there is not a continent that does not send or receive migrants, be it for labor or refuge. Some of the largest outgoing numbers originate in Asia and Europe, but these continents also receive the majority of migrants. Here, we would find populations in the less developed nations seeking work and opportunity in their richer neighbors. But one salient and significant factor is that women make up an increasing number of the migrant population. It is also important to note that the ages of migrants and reasons for migration vary. As of 2013, this is the latest data available, 150 million migrants were workers, and of those, 44% were women. 11.5 million of those migrant workers were working as domestic, and of those, 83% were women. For many women, migration offers a chance to access new opportunities for employment and development. However, for many, the risks outweigh the benefits that they may manage to gain. Migrant women especially lack safety nets to protect them from abuses. They are more likely targets of violence, often sexual, and of more oppressive work. And these risks are exacerbated if they are pregnant and or have children. They are also more likely to continue working in unsafe conditions as many women are working to support their families and children. Migrant women routinely lack access to social services and legal protection. While these are travesties in and of themselves, women face extra health risks that stem from these abuses. Migration alone has its dangers for women. The recent migration crisis in Europe has provided the world with far too many examples of women being forced to choose between giving themselves for sexual gratification of smugglers or risk of being stranded mid-journey, stranded with their young children. Women traveling alone or with children make particularly vulnerable targets for sexual predators. But even married women have been solicited and pressured for sex. Sometimes they agree for the sake of helping their families. Sometimes their husbands offer their wives sexual access in exchange for safety. Abuse of migrants, however, is by no means isolated to the European crisis. In the Western Hemisphere and right in the U.S.'s own backyard, it is common knowledge that the journey to Mexican border towns often to seek employment in factories is hazardous. Indeed, it has been documented that in transnational routes, houses of prostitution are set up utilizing migrant and sometimes trafficked women to provide sexual services to migrant men. These women are so desperate to leave the often lamentable and excruciating situations in which they and their families exist that they knowingly take the safety risk associated with sexual predation. They seek to mitigate these health risks and even prepare their bodies to defend against possible rape by taking consequences to, by taking, I'm sorry, contraceptives to avoid getting pregnant from the assault. That, of course, does not take care of the possible sexually transmitted infections they might contract or the failure of contraceptives. Sadly, even in government detention, families face dangers. Centers are overcrowded and often lack the basics to promote sanitary health and safety. At a refuge center in Germany, women are held with men and dozens share a single toilet that does not lock. Sleeping areas also lack locks and leave women and children open to assault. Women interviewed by Amnesty International have reported that some women took extreme measures such as not eating or drinking to avoid having to go to the toilet where they felt unsafe. And that way they too would avoid being exposed to predators. Sexual assault aside, malnourishment and dehydration also frequently occur. These dangers and their consequences are highlighted and worse for pregnant women. At the same time, shelters segregated by sex create difficulties. They cause harms and raise fears as families become separated. Single sex shelters also create challenges for transgendered migrants who get placed based upon their biological sex rather than their own gender identity and those are forced into hostile environments. Even once the migration journey ends and persons establish a new place to live, it can rarely become a home as women and children continue to face disproportionate safety concerns. For one, women who arrive at a new locale without papers live in constant fear of deportation with its own possibly unsafe and violent consequences. Moreover, women are pigeonholed into traditional work sectors which are low paying and keep them isolated. Nannies and domestic workers face some of the worst abuses. Often isolated and locked up at homes, denied contact with anyone outside their employment, stripped of their documents and denied the basic necessities of life. Alone in a foreign country responsible for the care of their families and often dispossessed of their documents, they have few avenues of recourse. These violations of rights occur around the world including in the United States where female migrant agricultural workers, mostly foreign and armed documented, face frightful hazards. An estimated 560,000 women work on U.S. farms. Among the fastest growing population of farm workers are migrants from indigenous communities in Mexico and Central America. Farm workers' vulnerability is exacerbated by low wages and poverty. Like all women migrants, women in agriculture face sexual violence, rape and the possible result in pregnancy. But their plight is heightened by the additional exposure to chemicals and once pregnant, either voluntarily or from rapes, complications from lack of reproductive services and rest. Migrant women's children face a special kind of martinableness. Because the mothers might not be documented, children may be often illegally denied equal or even adequate access to medical facilities. One Texas judge even denied a baby born in the U.S. of a birth certificate because the mother was undocumented. Whether documented or undocumented, migrants are negatives. Martinable populations face discrimination when attempting to access health services, especially maternity health services in the U.S. Many women remain unable to claim any state assistance and might be forbidden from purchasing it even if they have the funds. Fortunately, under these circumstances, many women can turn to the promise of midwives and supportive local charities for prenatal care and pediatrics. Of course, the positive in this is that even in countries such as the U.S., with the most beautiful and natural of events, pregnancy and childbirth are medicalized, the WIFRI community provides the necessary care in a loving, gentle way for those who so much need the human touch. Localizing maternal health issues, let me point out that in the U.S. there are some serious concerns. To be sure, 99% of maternal deaths occur in developing countries. The majority of such deaths can be prevented through accepted interventions as we have heard throughout this conference, and the midwifery community is intervening to do just that. Nonetheless, the stark reality is that worldwide, preventable maternal deaths occur with most frequency among marginable populations that we are addressing. Pregnancy is the leading cause of death for young women ages 15 to 19. This group is twice as likely to die during pregnancy or childbirth. Young women under 15 are five times more likely to die in childbirth. The reasons are biological, economic, social, and cultural, including gender inequities. Because it is always important to look at one's own backyard, I will turn to some facts and figures about childbirth in the United States. Significantly, notwithstanding the United States' aspiration to be number one in everything, the reality in healthcare and maternal health is far from that. In general quality of healthcare, the United States ranks an embarrassing 37th in the world. Although the total spent in healthcare is greater than in any other country in the world. If we turn specifically to figures on maternal mortality, the United States ranks 41st in the world. Although hospitalization related to pregnancy and childbirth costs are the highest in medicine, and I have already told you that that is the highest in the world in the U.S. For maternal mortality and childbirth costs is around 86 billion a year. The likelihood of a woman dying in childbirth in the United States is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain. More than two women die every day in the United States from pregnancy related causes. Equally as unacceptable as these maternal mortality figures is the U.S.'s rank of 31st in infant mortality rates. These, I'm sorry, infant survival rates. These figures alone, of course, do not tell the whole story as the slide that you have been looking at for a couple of moments says, these are aggregated numbers. Race and ethnicity play a major role in the figures. Not because of biology or culture, but because of the structural disparities that perpetuate unequal delivery of health services to these populations. Thus, in order to ensure that maternal and child health services are improved for all persons, it is imperative not only that the medical condition be considered, but also that social, political, economic, cultural conditions which are the root causes of such disparities be addressed. African American women are especially highly risked. They are nearly four times more likely to die of pregnancy related complications than white women. This is in the context in which even for white women in the U.S., the maternal mortality ratios are higher than for women in 24 other industrialized countries. These rates and disparities have not improved in more than 20 years. Maternal mortality ratios have actually increased from below 6.6 deaths per 100,000 live births in 87 to 13.3 deaths per 100 live births in 2006. Child health and infant mortality disparities based on race also exist. Black babies are still nearly two and a half times more likely than white babies to die before their first birthday. In some states, black infant mortality is increasing. Factors for these outcomes include socioeconomic status, nutrition, prenatal care, cuts in programs that assist the poor, and jobs that don't include medical benefits. And all this data is from before the new administration. The maternal and child health disparities do not exist only in the black community. They also exist for other women of color. An amnesty report provides that Native American and Alaskan Native women are 3.6 times as likely as white women to receive late or no prenatal care. They are also more likely to experience poor quality of care, discrimination, or culturally inappropriate treatment. Concluding observations of the United Nations Committee on the Convention on the Elimination of All Forms of Racial Discrimination show that healthcare disparities of marginable populations are due to such lack of health insurance, unequal distribution of healthcare resources, persistent racial discrimination in the provision of healthcare services, and poor quality of public health services. I would add to this list the lack of cultural competence of many healthcare providers and other social, economic, and political factors. Childbirth is not a finished line for women or for motherhood. Even when expected mothers manage to receive some degree of prenatal care, many women work until childbirth, often in labor-intensive jobs, and then return to work as soon as possible. This reduces the amount of time newborns can nurse and the healing time afforded before returning to the fields. The repetitive motions involved in harvesting crops, for example, include squatting and bending over and lifting great weights. These women risk injury to themselves when they do not take the time to recover from their labor. Children also face risks past birth. Their mothers and fathers come home with chemicals clinging to their clothes, and thus the children, even infants, receive dangerous second-hand exposure to pesticides. To bring you full circle, I am going to close with one case from the Committee on the Convention on the Elimination of All Forms of Discrimination Against Women. That shows how the human rights regime and rights do matter and should be utilized in promoting maternal and child health. The 2011 decision of the Committee in Alina de Silva Pimentel vs. Brazil was the first human rights decision issued by a human rights body on maternal mortality issues, as human rights concerns. Before looking at the case itself, however, it is noteworthy that in Brazil, as in the U.S., there are immense health disparities along racial lines. As the graph shows, maternal mortality rates correlate to race, with black women being at much greater risk of dying in childbirth than brown or mixed Brazilians or white Brazilians. So the case. Alina de Silva Pimentel was a Brazilian woman of African descent. Her mother brought the case to the Committee because Alina died of pregnancy-related causes. The local health provider had failed to provide timely obstetric care after diagnosing her symptoms. There were various visits to the local health provider and serious delays in sending Alina to the higher-level care hospital because there was a dispute between the local health provider and the hospital as to whose ambulance she was entitled to use for the transport. She ultimately died, and when her mother took the case to the Committee, the Committee concluded that states have an obligation under the human rights provisions of the Convention on the Elimination of All Forms of Discrimination Against Women to guarantee women of all racial and economic backgrounds adequate and nondiscriminatory access to maternal health services. The Committee made recommendations aimed at affecting a reduction in maternal deaths, including the obligation that a state has to ensure a women's right to safe motherhood and affordable access to emergency obstetric care. This case shows how states' obligations to provide health care generally and maternal health care in particular can serve to improve the health and safety and marketable women's and children's lives. The human rights regime mattered, and we should take more advantage of it. Particularly in considering marginal populations and their disproportionate exposure to safety and health risks, the human rights' indivisibility and interdependence of rights model is hugely attractive. Beyond providing specific rights to the marginal populations I've addressed, it provides a methodological approach that embraces the multidimensional levels at which marginal women of color experience disproportionate exposure to harm because of the intersection of race, sex, ethnicity, class, sexuality, gender identity and immigration status. All these classifications constitute prohibited bases of discrimination. And now this is where our hands are really needed to promote these ideas, to let people know that these rights exist, to convince the people in power, in states and internationally to give effect to the rights that are already enshrined in the law. We have laws in place to address issues of marginalization, of disempowerment. We have laws that protect the health of mothers and children. We have laws that recognize the importance of maternity, maternal care, prenatal and postnatal care. We need to disseminate the information about the existence of these rights, and we have to get active to make sure the rights are not honored in the breach. Barteras, so central to the circle of life, can and do protect the rights of women and children. We all need to join our hands and efforts together to help us all protect the rights of women and children in all populations. Thank you. So it looks like there's some questions over here in the text box or some comments, Bertha. So can you talk a bit about, I know we don't want to get too political, but one of our, I think she's from South Africa has mentioned about the repeal of Obamacare. So do you feel comfortable talking about if you think if it is repealed what the implications of that might be for marginalized women and families? Absolutely. First of all, thankfully it has not yet been repealed. The vote was 217 to 214, and that is a very slim margin in the House of Representatives. The Senate also has to approve the bill, and there are many opportunities in the Senate not to engage it. For one, there are vulnerable Republican senators for the next elections who know because their constituents told them that they wanted healthcare. And so there are the Democrats who are not going to let this go. And there is the President himself helping, fascinated that Australia has a better healthcare system than the United States has, and Bernie Sanders' brilliant retort that of course they do, they have universal healthcare. So now the President is supporting single-payer healthcare. I'm ready to work on that. The bill that was passed by the House is hateful. It is horrible. It picks on the most vulnerable populations, the most marginable populations, the poor, the elderly, mothers, anyone with a preexisting condition, and there is a wonderful piece that I saw on a Facebook post on how being female can be a preexisting condition, that is just not believable. I mean that such a thing was passed and they opened kegs of beer to celebrate is quite a travesty. But I am hopeful that the Senate is not going to go along with this. And so let's keep hope alive and I hope that this stops soon. Well I thought it was significant, Bertha, that you actually mentioned that Eileen, the lady in Brazil, had a problem with an ambulance because I was seeing one of the things that may be a problem now is for marginalized people to be able to receive a timely ambulance to get them to a situation. So there you go. So if you want to write in some more questions or if anyone would like to ask Bertha a question with a microphone, we've got a couple of minutes until we have to get ready for the next person. Just a comment on Jane's observation on the ambulance. This happened in a major urban center in Brazil. So if there can be these disputes about ambulance access or transport access, it is exacerbated in rural areas. And we also know of course that there are particular realities associated with rural areas in terms of health and safety. So particularly in childbirth, so it is to be sure disconcerting that these issues still exist. That's why I suggest that we learn about rights and use them, talk loudly, disseminate them and say, hey, state, what's happening? It doesn't mean that we're always going to get the results, but there are big values to moral successes because it tells the state that there's something they have to do. And in case of children, the responsibles are not only the families but also the state for the well-being of children. And I would argue that prenatal and postnatal care is key to the well-being of children. And Chris B. says it's particularly disturbing that we are in a developed world that we'd only do marginally better than in poorer areas. It's very disturbing and we do think that hopefully somebody said one, you know, midwifery is the key. And I think it really circles back to the first speech last night, the first talk last night about the importance of midwifery care for every woman and every family in every setting because it really is the key to solving some of these appears intractable issues where midwives, the women is at the centre with her baby and midwifery is surrounding her to help her access, as Berta pointed out, all these other agencies that she's required to use so that she'll have a successful and healthy birth. So what Linda says, that is because we have disempowered women by managing a natural process. The world needs midwives. So thank you so much, Berta. We'll just wait for another minute or so. Susanna mentions a previous presenter also mentioned that even midwives from poorer areas are moving or not practicing because it's not safe for them to practice. That is a tragedy. We can talk about tragedies upon tragedies and we know they exist. It is sad that in many states midwives themselves are marginalised when they can be such a wonderful first point of access, such a natural and life force point of access to women who need care and will otherwise get none. Well, thank you so much, Berta. It's really been an honour and a pleasure and this is really come full circle for us talking about all the issues we've had today. We've had many talks about migrant and refugee women and this really encompasses all that and pushes us forward really to do better as midwives and healthcare providers that we can do better for each women that we take care of every day. So thank you very much, Berta. We really appreciate all your work on this and all your time. So thank you so much. Okay, I'll go ahead and close out this presentation so we can get ready for our final, I believe, closing section for our conference. And thank you so much to everyone that's attending and hopefully you can take some ideas and thoughts away from this programme we've put together this year. Thank you.