 Now, recording and I think the screen is now across to Caroline and Petra. Thank you. Thank you, Tim. Good morning, good afternoon, or good evening everybody, wherever you are in the world. I'm Caroline Homer and Petra Tenhoopbender and I are going to present this next session on State of the Worlds Midwifery. I hope you can all hear me clearly. I had some difficulties with my technology, ironically following my Papua New Guinea colleagues who managed to get online beautifully. It would be the same that in Sydney, it was not so simple. Happy International Midwives Day to you all. I hope wherever you are in the world, you are celebrating a beautiful International Midwives Day. Francis Day-Sturck started off this morning and mentioned the State of the Worlds Midwifery report which Petra and I have been part of the core group in developing this report and it's been an absolute privilege to be involved in this work and to understand the work that midwives are doing throughout the world. It's very humbling and quite astonishing what midwives are achieving around the world in 2014 and I've been very pleased to be part of it. At the outset I'd like to acknowledge the leadership of the International Confederation of Midwives of WHO and of UNFPA who have co-chaired the work that's led to the State of the World Midwifery since the 2011 report and further from this. But those three organisations have been absolutely key to making this happen. Tim, how do I go to the next slide? I'm really sorry. I don't know how to do that. There's a little button on the bottom of the slide there. Oh, I see. Sorry. Thank you. So this morning or this afternoon wherever you are we're going to cover these things in the presentation and Petra and I will to and fro a little bit. I'm going to start the first few slides and then Petra is going to start and do some of the rest of the presentation but we thought it was useful to talk about some of the background and for many of you this will be things that you know very much already. Why a State of the World's Midwifery report is needed, was needed, why another one is being done. Talk a little bit about the 2011 report. Some of you may not be familiar with the 2011 report. It's still available on the UNFPA website and it's a really useful document. We're then going to talk about how we've approached this 2014 report and talk about some of the challenges and issues that are coming up. The report will be released in June at ICM and at this stage we're going to present you some findings but I would like to have a caveat to those that they are draft findings at the moment. The report has not gone to the printer yet and it has not been launched so these are not official findings at this point in terms of what we can release publicly but we're going to share some of the work that has been happening just so that there obviously is something to talk about in this presentation. So in terms of the background to this report this slide will be very familiar to many of you. I'm hoping that every woman has the right to skilled high quality pregnancy and childbirth care and by that we also mean care before pregnancy, care after the baby's born so pre-pregnancy care and postnatal care obviously critical and that every woman has the right to care for her and her baby and that the principles around woman-centered care always of course include the baby. We know around the world that every two minutes a woman dies in pregnancy or childbirth and that's a pretty shattering statistic. In the one hour that Petra and I will talk with you this morning 30 women will die around the world. Most of those causes that they die from are preventable. We know that complications from pregnancy and childbirth are a leading cause of adolescent women worldwide and adolescent women must be a focus of all of our work globally and of course the newborn is a critical part of this whole picture and most of those deaths are preventable and most of those deaths occur around the time of birth in those first few hours after birth. We know that more than one third of births around the world take place without a midwife or a skilled health staff in attendance and I'm very pleased to have heard my colleagues from Papua New Guinea speaking in the last session and Papua New Guinea is a great example of why midwives are so important and I think if you listen to the last session you'll agree that those midwives who presented were terrific but they're working in an area that has less than 40% of skilled birth attendants at a birth and we know midwifery services are key to healthy and safe pregnancy and childbirth. So why do a state of the world's midwifery report? We know that midwives will help avert two-thirds of all maternal deaths and half of newborn deaths providing their well-educated, well-equipped, well-authorised, well-supported and authorised to do so and that competent midwives working with women can support them not only prevent their deaths but ensure that they have safe and healthy births and a healthy start to life. Midwives also provide many other services in different parts of the world and authorise to do different activities depending on the country that you live in so not only just pregnancy and birth care but also sexual reproductive health, family planning, post-abortion care, malaria and the important area of mother-to-child transmission of HIV. But knowing that midwives can do all these things means we need to know something about the workforce. We need to understand what is the workforce, where is it working, how is it educated, how is it supported, how is it regulated and what are the associations that support midwifery in all of the countries and so that is why the state of the world's midwifery report occurred in 2011 and why it's being repeated in 2014. I'm now going to hand over to Petra who's going to tell you a little bit about SOMI 2011. Thank you very much Caroline, good morning everybody and indeed happy International Day of the Midwife. In 2011, actually the work around 2011 report started earlier. It started at the time that we were realising that midwifery is called to saving all these mother's lives and it's not that they didn't know that before or that we weren't aware of that before but there was a real desire to get a better handle and to better understand what was happening and why, where the midwives were, how they were educated. So in 2011 with the new energy and impetus of the UN Secretary-General's Every Woman Every Child campaign which focuses on women's and children's health as a global strategy. A group of UN organisations, of course WHO, UNFPA, UNICEF, the World Bank came together and started to organise how to write this report. Obviously ICM was involved and included and many other non-governmental organisations, donor groups and an interested party. So we had a very large group of people collaborating on collecting data and as you see the cover of the 2011 report and Barbara Thunley's headline there that midwifery's deliver and not only babies. Caroline has already explained quite a lot of that, how that works and we all know that very much from our practices but to have that visible and audible in the international arena really made a large difference. They saved lives, they provide good health in societies as a whole working close to women as many of us do and are an essential workforce in an effective healthcare system. So that already that introduction gave us two hooks for the follow-up of work on this and covering those areas. In the first report the essential workforce and the effective healthcare system both of which have a large impact on what happens and how effective midwives in midwifery can be. So SOMI 2011 really laid the baseline, showed us exactly where midwives are, how they're working, what education they're getting and how it should be, what regulation exists, how their midwives associations are working and it came out with a large, with a kind of a conclusion or an overview of the areas the issues, the problems that there are for making midwifery stronger, more visible, more available to women and closer to where they live and how they live. So there was an identification of a triple gap. There were not enough competencies in many cases in the countries where we assessed midwifery. There was a lack of coverage of midwifery services and women couldn't reach midwifery services. So the lack of competencies really was an issue to do with education and regulation and we worked to write up a lot of what the issues were and how they could be solved in 2011. Coverage is really an issue that has to do with policies, with health system capacity to deploy people very close to women and to make them accessible. And then access is of course something that has to do with how women can reach the services, not only geographically but also if they can reach them in time and if they can financially allow themselves to access their services. So there are three layers in which we looked at how what would need to be changed and what would need to be further strengthened in order for all women to have a qualified midwife who is working in an enabled environment next to her at the time that she is pregnant and gives birth. So the education and regulation and association that were existing at the time obviously a lot has changed since then, we're three days down the road had insufficient focus on the quality of care. So there were education and regulation were not the primary focus of the strengthening of the midwifery services and internal newborn health services. Over the past many years the focus has very much been on saving lives in the riskiest time. So looking at emergency, et cetera interventions and making those accessible but paying attention to the 85% of women who usually don't develop a complication was not at the forefront of the mind of the developing development partners of many countries. So that's where the message around there needs to be more focus on quality of care was very strong. And as I said before the policy coherence didn't work so there was a focus on emergency, et cetera care without further looking at the care that all women need and that will help many women not have to access emergency, et cetera care. So in this figure you will see what the story is really that in the 58 countries that were contributing to the 2011 report together they carry 91% of the global burden of maternal mortality. They have 80% of stillbirths and 82% of neonatal mortality. So those are the large numbers making a difference in those countries will make a massive dent in those 287,000. But only 50% of the world's births are attended in those countries and only with less than 70%, 17% of the world's midwives nurses and physicians. So the report looked at how we can improve those numbers and how we can improve the kind of quality and their capacity to deliver the services that are needed. And looking at the midwifery workforce in a larger sense of the word includes midwives, nurses and physicians who all work in maternal newborn health services. And that actually was the point of entry for developing 2013-14. So if we look at the picture here we made a suggestion as to how it would be possible to increase the numbers of birth. If we projected for 2015 how many we would need given that based on the number of births that a midwife could normally do. You see that with the percentage of births that are being cared for in some of these areas. So South Saharan Africa, Southeast Asia, Middle East, North Africa and Latin America and the Caribbean. There are areas where the projections show that a lot of difference and change can be made if the increase that's happened between 2000 and 2005 continues into 2015. But if you look in South Saharan Africa where the large number of women are under difficulty you can clearly see that there is a need for stronger input for more activity on getting more midwives available. If we don't make a big dent in the number of midwives available there we're not going to be able to do a lot with regard to reducing maternal mortality in those countries. So SOMI 2011 showed that there came out with a set of bold steps. It really asked lots of groups and you see the ones that we've listed here, governments, regulatory bodies, schools, international organizations to push and to find a way to make things better. So schools for example were asked to review their curriculum and use the ICM education and competencies and standards to inform their curricula. They were asked to work closer with maternity units and communities to allow for practical training so that midwives would go into the field having had, having physically assisted on the supervision and without supervision but in a safe setting several births. Governments were asked to recognize midwifery as a distinct profession so that it could actually make sure that there would be specific professional regulations for midwives that there could be support for the setting up and strengthening of the associations that there would be active data connection which now in 2014 we are still finding is not strong enough and that there would be a lot of, that it would be clear that midwifery is a core component of the maternal newborn health strategy and a national health plan. Regulatory bodies were asked to put forward a professional title to protect that title of midwifery to establish the standards and the practice competencies that were needed and to license and re-license midwives for two reasons to make sure that they are absolutely 100% aware of who is practising and aware but also that they are practising to the best capacities and the best standards of care. Professional organizations were supported or encouraged to promote the standards for training and knowledge updates to give, to ensure that there is respect for patients' rights and respectful care and to collaborate with other health professional associations to strengthen the input into health plans on behalf of maternal newborn health care professional workers. So there is a kind of a multiple approach to making this agenda stronger and specifically to putting it towards implementation in the country and then finally the international organizations and the global partnerships and civil society were really asked to promote the recognition of midwifery to provide financial and in-kind support to build capacity of associations to monitor and measure quality and results and make strategic intelligence available so not just numbers but also