 I'm not sure if I hear you all now. Okay. Do you want me to just start, Annette? Sorry, Sarah. So, good morning, good afternoon, good evening, everybody. It's really a great pleasure for me to be back on Virtual International Day of the Midwife and to be able to present to you the Lancet series on Midwifery. It's been an interesting three, four years in the making and two papers are still being completed as we speak. So, bear with me as I go through the presentation. There are quite a number of slides, many of which I won't kind of discuss in detail, but just have there so that you can read for yourselves. So, the series has really put out and provided an evidence base that shows that Midwifery is a vital solution. And that vital solution is something that many countries, many development agencies and obviously women and families are needing and are looking for. So, we're very pleased that we have now the opportunity and the evidence base to show what makes the difference and why it's so important. So, I just wanted to start out with a context within which we're discussing this at this point in time. As you all know, we're at the end of the Millennium Development Goals. They'll be ending at the end of this year. They started in 2000. So, we've had 15 years of high level focus and financial focus as well on two Millennium Development Goals that are specifically interesting for our area of work, which are the maternal health one to reduce maternal mortality and the child health one, which includes reducing the death of newborn children. Now, those are of course for some areas in the world more important than for others, but the series was written for the entire, for all countries for the entire population. So, moving from the Millennium Development Goals, we're now looking at the developing and agreeing the Sustainable Development Goals and those will go way beyond what was in the MDGs. They're going to be including not only issues around health and education and poverty reduction but they're also going to be looking at sustainable development, at economic empowerment, at gender equity and at human rights. So, they are much, much larger and there will be 17 of them as opposed to the eight that were in the Millennium Development Goals. So, within the whole portfolio of activities, health is going to only be one among 17 goals instead of at least half of the Millennium Development Goals and within health, maternal health is going to be a part of the entire health goal. So, you can see how the focus is going to seriously change which makes a lot of sense because, you know, if we don't have a planet, we don't need maternal health to be really kind of direct and blunt about it. In addition to that, there's, in the health arena, a push for universal health coverage which means everybody should have access to quality services that don't make them lead them to bankruptcy. So, that works very much in our favor or in the favor of maternal health because it's one of the, you know, standard things that are always covered in these kind of universal health packages. But it also, again, dilutes the focus that used to be or has been quite exclusively on maternal health and then turned my newborn health into a wider set of issues. And then on top of that, there's a revision of the UN Secretary General's Global Strategy for Women's and Children's Health. So, that's a focused piece that's been put in place to help achieve the Millennium Development Goals 4 and 5 and it's being rethought and redeveloped and strengthened and again broadened so that there will be a continuation under the Sustainable Development Goals and there will be an add-on of adolescence. So, it will be this global strategy for women's, children's and adolescent health. There's also a global strategy for the health workforce. So, the WHO workforce department has developed, is developing a strategy together with the Global Health Workforce Alliance to really make people, make countries, make development agencies, make donors understand that there is no health without a health workforce. So, that it's actually going to strengthen in a large part the global strategy but also the Sustainable Development Goals and specifically the one on health. There's an increased focus on quality of care. We've had accessibility. People needed to be able to get to care. So, there's been ways to make that easier. They needed, it needs to be acceptable. So, there's been a lot of work done, for example, around respectful care during childbirth and it needs to be affordable. But the quality of care is always the most difficult one and it's dropped off the radar for a while but it's now back with a vengeance and I think that's really, really good. So, within that, we need to really, really understand very well what the realities are of women and children and make sure that what we're delivering and how we're working really fits with their needs rather than what a health system needs or what the financial capacities are. So, these are just a couple of examples of the big initiatives that we've had to date. This is the MDG456 activity which brought together maternal newborn health and HIV AIDS and there are very many of these kinds of initiatives that have happened. We've had launches of an every newborn action plan of the count out to 2015 information about 75 countries, low-middle income countries and then, for example, saving mothers' lives. All these initiatives and these foci have created good progress and results but there are still enormous differences and there are countries where it seems that we're still just, there's still just a drop that we've been able to do and so we mentioned here in the area but there are many others that are not as large as Nigeria and still facing enormous difficulty. So we also need to make sure that any of the sustainable development goals we're more focused, we're more pushed towards what the different needs are. So these numbers will probably not be very strange to you. You'll probably have seen them repeatedly and I think the important thing is that we're now through the quality of care lens moving not only to look at maternal deaths but also at mobility and specifically at well-being and satisfaction and the strength and the building of capabilities of women as they go through pregnancy and childbirth to take care of themselves and their families. So the challenges that we're seeing and we've talked about some of those already are quite large and they, excuse me, and they have, we've talked about some of these already but the longer term, the one in the middle, psychosocial and cost-effectiveness outcomes that have not been taken into consideration have been specifically addressed in our theories. We really know that and we've compared and you'll hear later on how that's happened. We've looked at lots and lots of studies looking at what are the psychosocial and the cultural impacts and effects of pregnancy and childbirth on women and doing a cesarean section really is not the best option and definitely shouldn't be proposed as the only option which is happening in more and more places in the world at this point in time. And there have been lots of responses to this. A lot of people have kind of thought, so doing midwifery is actually a bit too complicated because it takes a long time to educate them and they're expensive and all those kind of things. So let's just do a bunch of obstetric care or let's put everybody in facilities or let's make sure that we have emergency availability or let's just train a community health worker. But in principle, the thing that we should have done and if we done it in 1987 when the Safe World Initiative started would be to implement and to strengthen midwifery and midwives around the world. So there are a lot of essential elements needed for saving lives, so it's not only the workforce, it's not only the midwife, I won't read them all out to you but you can see what are other things that need to be focused on. But the challenges then for the series which is really what I'm going to talk to you about now are the different kinds of countries that we needed to address, the very limited numbers of studies that were available needing to focus on women and newborn and infant or into their early weeks, months, years of life and again, not just hospitals and healthcare providers balancing mortality with morbidity and well-being, presenting midwifery and midwives, trying to find kind of untie those knots around what those two are and seeking collaboration and consensus with other disciplines and with international organizations and we had several rounds of review of the papers by other disciplines, obstetricians, gynecologists, nurses, pediatricians and international organizations like WHO and UNICEF and UNIFDA because we wanted to make sure that once the series came out they would all kind of back it and work with us to make it available widely. And then of course there are also the challenges for midwives and many of you will recognize these, over medicalization, the ease with which people just kind of decide that they will have a cesarean section, but also things like an unsafe working environment, places where midwives can't safely go from where they're staying or where they're spending their night as they're on the call to the facility where they should be working and limitations to the practice of things that they can do are not sometimes covered in regulation but that doesn't translate into anything real. So the series started and kind of came to the conclusion before it started that the only way to address these issues would be to start with from the basis of women and their children and families. So we couldn't say we were gonna be describing what the midwife does or how important midwifery is without starting from what this is all about and why we're doing it. We used a human rights-based approach. We used loads of different sources of evidence and we used all relevant outcomes. So survival but also health, well-being, creating health, maintaining well-being, strengthening capabilities, also very important, the different kind of income settings, quality care as well as service provision and all these different kind of perspectives that we talked about earlier. We needed to specifically talk about the value and the importance of integrated services as difficult as that sometimes is because there can be a lot of strife and difficulty in these mixed teams of professionals working together but really the only way to secure the continuum of care is if people play and do their part to their full competence. And then at the end we examined the specific contribution of midwives using the ICM competencies. So the first paper was led by Mary Renfrew and it's called Midwifery and Quality Care. And you'll see that there are lots and lots of sources of evidence. So if the total number of studies is around 800 if you add up these numbers. Three big case studies that we looked at specifically to be able to tease out some of the issues in middle income countries with growing, starkly growing economies and then mapping the competency of the midwife. And that led us to a framework for quality maternal and newborn care. And this framework at the top lists out all the kind of practice categories all the things that we do as we provide care to women and their families. So moving from education and health information through assessment screening to the promotion of normal processes and also first line management of complications. So those are the things that we all think and that we do and that we know and that are visible. But beneath that, there are several other important areas that needed to be addressed in our series and that kind of came out of the work that we were doing. And one of those is how care is organized so that where there are enough work for there's enough workforce, there's enough equipment that there is a continuity in that they're both from household to hospital as well as from one group of service providers or care providers to others. And along the life course and the course of pregnancy and childbirth. And then there are the values that really kind of need that all people that are working in the area of maternal newborn health need to provide not only midwives but everybody else which our respects to communicate openly and fairly to understand what women need and where they come from and what their background is and how their cultural and religious and social circumstances can be and how that can influence their decisions. And then one of the ones that's most important to me is the philosophy which is about optimizing normal physiological, psychological, social and cultural processes that then strengthen a woman that give her in this one special period in her life the capacity to learn and to get to know herself and her strength and to take care of herself later and her family. And then that we do that or we've kind of put that in the words of expectant management using interventions only when it indicated. And the last piece that we discussed or looked at in the series are the practitioners who could be doing and should be doing this work because of course it's not only midwives. There are a lot of others that need to be providing care as per this framework. So then you see that in the blue card here that everything except the highly technical, medical, et cetera, Canadian services can be and are provided by midwives. So there is a large number of outcomes that have improved by midwifery and you can find a much fuller list of that in the series itself as specifically on the web annex I won't read them all out to you. But there is also a good value for money analysis that was done and is recorded in paper four that shows that investing in midwifery really gives value for money. The numbers of cesarean sections avoided and lives saved from a group of midwives in Bangladesh over their 30 year career shows a 16 fold return on investment. So the numbers if you turn those cesarean sections saved and lives saved into numbers you get a return on investment after 16 times what you put into their education program. So then we came up with defining midwifery which is the thing that we do rather than the person that we are as skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum. And with core characteristics that include as I was saying, optimizing normal biological, psychological, social and cultural processes of reproduction in early life. Intervention management of complications, consultation and referral, respecting women's individual circumstances and views and working in partnership with them. So those are other things that we also then have the evidence base for. The research that has been done shows that these are outcomes that women value and that midwives can deliver and that midwifery can deliver and should include. So in essence that this paper really means that we need to change our thinking, that we need to shift things, not just individually, but as a whole maternity care system away from looking at pathology and interventions and moving towards skilled midwifery care for all. So everybody should have access and should be provided this kind of care before any interventions get discussed. So then the second article took the list of interventions, essential interventions that have been set up by the partnership from Terniwone and Child Health and the live saved tool and looked at 78 low income countries to estimate the value of, or to see what the impact is of midwifery on the number of lives that could be saved. And again, this is the language that is used a lot in the international development arena, the list of those used a lot. So those are things that people can relate to. And we use those essential interventions and put them next to the competencies of the midwife and the definition of the midwife. So we used ICM as the basis and had the essential interventions next to that. And that kind of showed that if, for example, we had a small increase in midwifery, including family planning. So for example, a country would have 10% more access to midwifery, maternal mortality would already reduce by 27% and if you see them, if we could increase the number of midwives or the way midwifery is provided by 25%, maternal mortality reduces by 50%. And if we get universal coverage, which is 95 to 100%, maternal mortality reduces to 82%. And those, we can reduce maternal mortality by 82%. And those reductions are the same for stillbirth and neonatal birth. So this was a very important paper so that helped us show that there is a value and an impact, which of course a lot of us know, but you need to be able to make it visible. So these are the same numbers again. Contribution of family planning in that was included because it is important, of course, if there are less pregnancies, then of course there is less death. We put in a special, we added on a specific area where we looked at the effect of the specialist and we looked also at the impact of preventative measures. So it wasn't only looking at the interventions, there were also preventative measures in there. So the conclusion is that in principle, the maternal newborn and stillbirths can be reduced significantly, specifically in low-middle income countries. And that midwife as a healthcare worker can really effectively and efficiently deliver the entire package of interventions. And that has a lot of impact on regulation, of course. Then the third article, and I'm afraid that my slides are not complete for this article, was to look at, so in countries where maternal mortality has been reduced and it has to be done by midwives, what happened? How did they do this? And are there ways that we can learn lessons from what's happened in those countries? The lead author on this was Professor von Lärberger and they really looked at country experience first and foremost. So they showed that, there should be something coming in here. Okay, there should be a table here, which is not visible, that shows that increasing access to facility birthing in those countries actually was one of the large components of reducing maternal mortality. And the second picture that you should have had in here and I don't know why it's not here, I apologize for that, is to show that in the countries that kind of came out with having successfully implemented midwifery to reduce maternal mortality in their Burkina Faso, Morocco, Indonesia, and one more. They had a similar sequence. So it all started with bringing out further, giving better access to a network of healthcare facilities, not only focused on maternal newborn health, but on all other things. And the second issue that, or the second thing that's happened in those countries was to reduce the financial barriers. So to make sure that there was, that women could easily and without a lot of, without having to sell the family house or something big access services. Chris, do you have a hand up? Can't see that. And then the third thing that happened is that they then start, then they kind of expanded the numbers of midwives and only at the last, the last of the four issues was that they looked at quality of care. So the facilities that kind of, not easy things to do, but the kind of tangible things to do happened first. The facilities came out, the financial barriers were decreased, the midwives became more accessible and people started looking at quality of care. And I think that's an important sequence to keep in mind. So, let's see which ones. So this means, and that was the outcome of the third paper, is that it's important to continue to talk at a national level about what women and care seekers need and the quality that they expect. And to focus and make sure that the optimizing processes and the physiology of pregnancy and childbirth are at the heart of that. They're part and parcel of that discussion. We elaborated in the fourth paper, which is the paper that I led, what the investment cases for education, the education and recruitment of midwives. And that's what I explained to you earlier, that investing in 30 midwives, sorry, 500 midwives over the 30-year career gave a 16-fold return on investment, which is enormous. And though it was only in one country, those are interesting and well-founded pieces of work to use to make the case. Now, that means that education, a regulation and the development and strengthening of competencies need to be pushed further into the area of quality of care. And one of the things that we've been doing with the International Confederation of Midwives is develop a midwifery services framework. So a framework, a step-wise approach in which countries can strengthen and push in for what midwifery should be or how midwifery services can be, sorry, can be strengthened. My voice is starting to go, so I'm going to rush a little bit more. So the end of our presentation and the end of our series really showed that the midwifery has contributed to the Millennium Development Goals and will contribute and should contribute more to the Sustainable Development Goals. And it is, at this point in time, in many areas and in many of these strategies and action plans, a core element. Making sure that all midwives can provide family planning specifically in high mortality areas is extremely important. And then making the economic case for midwifery services continues to be an element that we should further develop, but that we really have very good and strong evidence for. So to conclude that the services that we provide or that midwifery services should be providing, should be responsive to the needs of women and infants. And that's really, really, really a difference of looking at the way that we've worked and that we're working now. And it should be in all countries, not just the developing countries that we've been working with a lot in these development programs. And that means that there are a lot of systemic barriers, health systems, but also education systems barriers that need to be addressed and that women in communities need to be included in that discussion. And then just to say that there are two more papers that are going to be coming out that belong to the series, even though they weren't ready by the time that the first four were launched. And one of those is being led by Holly Kennedy, who was just speaking before me, and that's on the research agenda for midwifery. So the investment is needed in relevant research and we're writing a paper on what that relevant research would then be. And the last paper is a paper. On the clue of NC, the quality maternal newborn care framework and the human rights. So how does it strengthen human rights and how do human rights strengthen it? So I think that we've got a large strong series here. It's well evidenced and well evidence-based. It's completed and supported by people from all over the world, from large numbers of different disciplines and professional groups and categories. So this is something that there is an executive summary for, which is also available online in that you can work with to strengthen the case for yourselves. So I'd like to hand over to Jan to take on the section about midwifery for all. Thank you, Petra. I work for the Swedish Foreign Ministry or the Swedish Ministry for Foreign Affairs in Stockholm with communications and public diplomacy. So I come from a completely different field than health and investigation. But Sweden has a long tradition in working with midwifery and long, strong history of midwifery. And also through its development cooperation has invested a lot in training of midwives and various different programs to support midwifery worldwide. And from our point of view, working with the field called digital diplomacy, which tries to use the potential of the transforming communications landscape where digital and social media and the new connections and networks that are the result of this digital revolution make it possible to reach out in new ways. We have identified this very topic as an important one to support. And we also think that it's a topic where Sweden can contribute thanks to the long traditions that we already have in this field. So when the Lancet series came out last year, we noticed that and started to work around the campaign called Midwives for All. And we started with the very name of that as it is suitable for complications in social media. And we reached out to the team behind the Lancet series with Petra and Mary and have been in close conversation throughout the process and designed the campaign on our side together with our embassies and other stakeholders. So as I just explained, we think it's crucial with an evidence-based practice and we think it's crucial to use the new technologies to reach out and create engagement in new ways around the science that supports the Midwives for All practice. And we want to contribute to the rising movement of global midwifery through working as a connector between various fields. And this is actually part of this. This online conference is a very good example of how communication technology makes it possible to connect around evidence like this. What we can also do is to add our own networks into this field and have a completely different angle than some of the health experts might have because we come from our field of foreign policy and might identify different opportunities which is good if you want to make an impact. So we started thinking when the last report came out in the state of the world of midwifery and worked throughout the autumn and then we launched the campaign in Geneva in February at a conference with seven different foreign missions and the WHO was there and UNFPA and the ICM. Then we launched this web page where we tried to source best practice and also direct experiences from people who have different stories to share about the benefits of midwifery in various ways. And that's an ongoing project that we have that we try to use to reach out with content about midwifery in the whole world, not least in low and middle countries. And this is kind of the basis of the campaign. But we have also engaged with various different nodes as we believe that everything is almost like large network now. So we are not partners but more nodes in the same network and we support the same philosophy and here are some of these nodes. And we have also engaged our own nodes that are embassies. The actual campaign has had this reach. We have reached over 3 million people on Twitter and we have had many people joining the conversation. And then we have alongside designed co-creative events with our embassies on our own together with the Lancer team and at the London School of Tropical Medicine and Hygiene in March. And we have asked our embassies to do what we are trying to do ourselves, which is to do something on platforms where you are not normally present together with stakeholders that you don't normally work with because we think that midwifery, as well as many other similar topics, could benefit from unexpected collaborations and that will in turn create some extra attention but also help spreading the knowledge and creating more engagement and thus increase demand for these services, we hope. So the theory of change would be that we as a foreign ministry can help keeping this topic high on the agenda and help driving more engagement to the field of maternal health and newborn health. And in one of the examples of this campaign was in Uganda where they have been collaborating with the First Lady but they have also reached out in local languages through radio. In Angola, they are collaborating with a music group to work around this topic. And we have another campaign coming up on the 5th in Bangladesh and so forth. So these are kind of specific events and at the same time our foreign minister wrote an article on the launch or on the 8th of March in the Hapington Post. So this is summing that part up, really, that we try to collaborate in various ways through our networks. And here's an example of the press that we have got in Uganda and it's really interesting to see what happens when people reach out and connect in new ways because this is a specific result of that instruction, really, to move out of your own comfort zone and do something around the topic that you want to highlight and raise awareness about. And we just came back from Washington, D.C., where we took part in a panel on campaigns for social good together with the campaign Hipposhii, which is a given run campaign where men support women's rights and so forth. And that's also kind of an example of how a campaign like this can reach out with an agenda in new fields and create a discussion around this specific agenda. And we hope that we can evaluate it soon and be able to see whether we have been making any substantial contribution to this movement. But we definitely hope that the engagement from our side and our ministers and so forth at least helps keeping this topic on the agenda. I think that's me. And we always look for contributions from different stakeholders. So short texts and even films from not least from the field where people are trying to do something new about the benefits of midwifery. So you're all welcome to contact us and also suggest other forms for collaboration and also cross-tweet and use the hashtag in any ways that you find suitable to share knowledge really. That's I think the core message that we have that we need to spread the best practice knowledge and not least the evidence as presented in the last series. So, out. Thank you so much for that. And we'll just open up the floor for some questions. I think there's a lot of positive feedback about the Lancet series. I know that many of us have used that to support our evidence-based practice. Yeah, and Lynn points out it is about spreading the word. Spreading the word. Join Twitter, Facebook. Use those hashtags and get these things out there. I think you've just recruited a lot of people there, John. That's good to hear. I managed to do that. Yeah. So I put a link to the website up and you can just follow that. There's also a Facebook page you can like and they're on Twitter, so just start using those hashtags. And Petra's also put up a link I see to the Lancet series. It's interesting with the Lancet series that it's being translated now into various languages. It's in French and coming out in Portuguese and I think that in itself, the evidence in the series being translated is a very good thing to work around because currently some countries have a very active debate about this, but in many places you still need to reach out. So I think that's a very good opportunity to start doing things around the evidence and getting the discussion started and with policymakers in various countries. And making it accessible as well for midwives in every country so that they can access it and read it in their own language and it's for free, which is wonderful. It is free, isn't it? So I think one problem that we see is that we need to engage finance departments, we need education departments and other parts of the political system to highlight this field. And having the evidence as a basis for that is very crucial, but also having platforms that make, create new access into this topic for more stakeholders. And I think that's what we aim to do with our project and I see that there are various initiatives doing the same thing in some ways, but I think that we benefit a lot from collaborating even more broadly around this. Okay, so last call for questions. I think Petra, would you like to say anything? Add anything? Just to say what working with Midwives for All has really done for the series. And it's given us the opportunity to think also a little bit differently around about what the series means and how it works and the things that we could do to make it more accessible and to build a momentum for it from it. And we had what they call, what Jons calls an ideathon in New York, in London a couple of months ago, weeks ago. And we came up with some really interesting and new ideas about how to award people for the work that they're doing in rural areas and give that extra publicity. And there with also just talk about the practice rather than only the evidence base and make the Lancet series really applicable and kind of part of life rather than this thing that's in a very high level medical journal. So it's really kind of made it more popularized the series and given people opportunity to send in their thoughts and their support or their questions around what the series means and what it's done. So to me, it's a wonderful way to share and to bring together different groups or different areas of interest, different points of view. So the other thing that would be great is if you would be interested in sending us a blog of maybe of what you've experienced today on the virtual IBM day or just other things that you're experiencing with regard to midwifery and midwives in your day to day and send them to the midwives for all websites so that they can go up. That would be great. And thank you all very much for your attention for spending time with us today. Thank you so much for me Espan. Yeah, and thank you so much. It's been just absolutely wonderful and we've got some really great feedback coming through on the Lancet series. I think, yeah, it's just been absolutely wonderful. Okay, I'm going to run through the last few slides. Thank you. So I don't think I'm gonna turn off record but if you do have any photos of yourself please upload them onto Facebook, share them on Twitter. We'd love to see you or email them through to admin at vidm.org. Thank you for attending. Please feel free to download a certificate of attendance and fill out our feedback form. We would love to know what you thought of this conference and I will now be handing over. I'd just like to echo Sarah's play about the feedback so it's really important to us that we get your feedback so we can work out how to make next year's conference better than this year's. So definitely your thoughts on what you've seen taking part in over the last 24 hours. We're definitely interested in what you think we can do to increase attendance because that's something we like to do year on year. So if you have any ideas about that, please include that too. Hi there, it's Deborah Davis here, Professor of Midwifery in Canberra and 24 hours ago I was opening this e-conference and can you hear me okay? Yep. Yes. Okay, sorry. And the time's just absolutely flown and I've seen some people in the audience here who I know were here most of yesterday and here again early this morning for Australia anyway. So I'd just like to bring the e-conference to a close. First of all by thanking our organizing committee who I know have put in an enormous amount of hours to bring this to you and are absolutely committed to it and we get re-energized every year after we've done it because we just feel so inspired by the comments of the attendees and also by the amazing presenters. To everybody who presented and put in an abstract it has been an absolutely fabulous program. Covered so many different topics from nutrition and clinical practice through to the bigger picture that we've just had in this wonderful presentation. So thank you to everybody. And finally thank you everybody for coming. We come to learn something new. We come to feel inspired but most of all and especially for me I gain a real sense of connection with everybody around the globe who's working so hard for women. So thank you. Thank you for coming. Give us some feedback and we hope we see you again next year. Goodbye. Oh, we've got a video. I'm going to pop up a link. Thank you to everyone who sent their photos through. We've made a YouTube video of the attendees and I'm putting that in a link in the comment box and please go and have a look at it and look at all those beautiful faces of the people that have come and who are working for women in midwifery. Thank you. That was the link for the video. I'll do that.