 Alright well thank you for that bit of fun and now we're going to get down to the pre-conference information that we're all really looking forward to hearing from our amazing World Health Organization colleagues and I'd love to welcome Elizabeth and on to the campground as I'm going to introduce Mrs Eero and Fran the convo at the moment with their bios and then they're going to take it from here. Elizabeth Eero is the chief nurse of the World Health Organization appointed by the World Health Organization Director General Dr. Tedros Gabresas in 2017. Elizabeth is from the Cook Islands where she worked as Secretary of Health 2012 to 2017. She was the first woman a nurse would midlife to be appointed to this position in this country. Her top goals in this role were legislative reforms to enhance the country's health system as well as the development of national health strategic plans and a national health roadmap. Mrs Eero has a master's in health science and nursing and an MBA and was educated as a nurse and midwife in New Zealand. She worked as a nurse in different capacities including Chief Nursing Officer, Registrar of the Nursing Council and President of the Cook Islands Nurses Association and then thank you so much and then I'm going to introduce Fran. Fran McConville has been a midwifery advisor at the World Health Organization since 2013 and is usually based at the World Health Organization headquarters in Geneva. Fran's focus is on addressing how women newborns and their families can access quality, equitable and dignified midwifery care that strengthens women's own capabilities, prevents unnecessary interventions and ensures timely referral to emergency obstetric and newborn care if needed. Fran's work aims to support the 194 World Health Organization member states to improve evidence-based quality care for women newborns and their families everywhere. Fran initially gained experience in Bangladesh and then in Africa, Asia and the Middle East while being a lecturer in maternal and newborn health gender and reproductive health at the University of Wales in Swansea. Fran is a midwife, a nurse, has a MA in health economics and social policy and a BSc in life sciences. In 2020 Fran was awarded the title honorary professor of practice at Queen's University, Belfast, Northern Ireland. Let's all welcome Elizabeth and Fran to VIDM 2022. Thank you so much. The microphone is yours. Thank you very much Jane and thank you to you and the team for once again hosting another fantastic celebration of midwives. Greetings everyone, dear friends and colleagues. Welcome to this pre-International Day of the Midwife session with colleagues from the World Health Organization. I am really delighted to welcome you all to this virtual celebration for International Day of the Midwife and I welcome the opportunity to recognize the work of midwives around the world and to say thank you for the respectful care that she provides to women, newborns and families everywhere. As we face increasingly challenging times, whether through war, pandemic, environmental disasters, displacement or homelessness, the health of our worldwide communities presents us with the need for urgent action around the delivery of our health services, the education of our workforce and the compassionate leadership that is needed to guide and strengthen our valuable midwifery profession. Last year we were able to present the State of the Worlds Midwifery Report and the WHO Global Strategic Direction for Nursing and Midwifery. These documents gave us the data and evidence we needed to develop a roadmap to strengthen our profession and today we celebrate the valuable work that has begun to take place since then to implement these recommendations. These projects are starting to make a real difference to safer childbirth, safer abortion and safer care for women after childbirth at every step of the way in challenging and difficult environments. Midwives continue to learn, continue to leave and continue to support the health and well-being of mothers and children. I thank you all for all that you do and wish you a joyful celebration. Thank you everyone. I have to say that we have a really fantastic champion with the Director of Director General of the World Health Organization Dr Tedros who has remained really steadfast in championing this profession and I'm so pleased that he's able to join us through a message during this the celebration this year so I hand over to for everyone to hear his message. Thank you Chris. Dear colleagues and friends today we celebrate the extraordinary impact that midwives have on the lives of women newborns and their families. We're also celebrating 100 years of the International Confederation of Midwives which has grown to represent over a million midwives globally. On this day last year together with the International Confederation of Midwives and UNFPA we launched the third state of the world midwifery report and at the World Health Assembly 194 WHO member states unanimously endorsed the WHO strategic directions for nursing and midwifery 2021 to 2025. Both reports highlight the critical need to invest in midwifery leadership, education, midwife led service delivery and the midwifery workforce. This year you will hear from extraordinary midwifery leaders in countries that have already started to implement these recommendations. At the same time we must pose to acknowledge the many midwives who are not with us those who put their health at risk in the service of caring for women, babies and their families during the pandemic and other crises. We honor those who paid the ultimate price. I send my heartfelt thanks and respect to every midwife everywhere for your tireless efforts every day. I thank you. So thanks everybody. I'm now just going to go through a snapshot of what's just been mentioned the state of world's midwifery report and SDNM recommendations because as Elizabeth and Dr Tread Ross has said we have this tremendous few years of international year of the nurse and midwife moving towards these big reports but now our job is to implement them in country and really make the change that they that they were there to do. So just to remind us what they're about why do we celebrate midwife? This is the state of world's midwifery report and I think especially for these next 24 hours it's because we promote the health and well-being of women adolescents and newborns in case anybody asks you which they may well do. It happens put safe and effective SRMNH care really within the reach of more people. The obstetricians and pediatricians don't get out to the remote areas that the midwives do and I'll show you soon how we could save an estimated model 4.3 million lives of women and newborns by 2035. We contribute to national and local economies through our work and we also contribute significantly to women's empowerment and gender equality because of course we are mostly women's profession. So just as a reminder because we don't remember everything all the time the state of world's midwifery report as Dr Tedros has said has these big four priorities so education and training health workforce and planning. I think really importantly this year we have new language and this is this midwifery leadership work which you're going to hear a lot more about and this midwife led we didn't have that before so these are really significant changes in the policy language that we're using and are using at country level and similarly in the strategic directions of nursing midwifery which the 194 member state signed up to again we have education and leadership so it's coming up very strongly as well as really much more jobs 900 000 short of midwives we are at the moment and service delivery so that's just a little reminder. Now feeding into all of that I hope some of you remember that in 2019 at the World Health Assembly we had this tremendous event where we launched this framework for action for strengthening quality midwifery education for universal health coverage 2030 now really importantly is this is not WHO sitting on its own in a room it took up to about three years several hundred people midwives and others were involved economists social scientists and it brought together UNFPA, UNICEF and ICM with WHO really for the first time so that we have this joint document now what was so different we've done education for many many years and what really is so very different is that education often people think more midwives quantity curriculum and that's where we've kind of got stuck and then there's a lot of training and that can be effective or not effective but we haven't really understood how effective it's been we haven't really measured but this seven step cycle really made a big difference and to our thinking and you'll see how it's making a difference in countries for a start we didn't put the midwife in the middle we put women and newborns and this comes out of the Lancet series of midwifery in 2014 because we really need to respond to what it is that women and newborns need in the countries where we're working so really importantly and this is what fed into the SOMI in the SDM reports but step one is strength and leadership we often have things happening on midwifery but we're not leading it it's been led by somebody else as you'll find out and look at the policies carefully what is working what isn't get the right data and evidence in step two we have some increasingly improved evidence on maternal mortality newborn mortality still birth but we know very little about midwifery and in these countries we're going to be talking about we're finding out extraordinary things that we didn't know before that we think we can just move forward but really we can't we need the public we need women newborns families and their men on board at grandmothers the people who control the purse strings and other things we need parliamentarians on board and we of course need the obstetricians pediatricians nurses with us so a lot of advocacy to bring the right team to change this whole system then it's not just about start training in an educational institute we know that 50 percent have no water and sanitation how can you teach or learn in an institute like that many don't have materials many don't have midwives who are their teachers many don't have a practice setting they're just purely theory and many don't have any clinical mentors a lot of work to do then we move on and make sure the faculty are strengthened the standards reflect that the international confederation midwives standards reflect the needs of the country it could be that malaria or tb is the biggest killer these midwives need to know how you deal with malaria in pregnancy for example and then you educate and you can see we haven't oh the curriculum is just a bit hidden off that slide the curriculum comes out of all these discussions and you educate so you have all of this before you educate then you of course monitor evaluate review and adjust and this is a cycle and of course you don't not educate while you're doing the other things you keep doing everything at once but you're continuously improving so easier said than done but very importantly this is the first time we have ever had a results framework for strengthening the twigry and it's joined with unicef who lead on monitoring with maternity born child health with wHO with UNFPA and with ICM so I won't go through there are actually seven you can't see it all on this slide but there are the seven steps have seven indicators there are activities for each output for each short term outcomes and long term outcome so we need to build this framework to be able to help governments monitor get the baseline monitor the progress and say to the donors look what's working look how much it actually cost us or actually that didn't work so well but we tried something different and it's better and it's cheaper so we've really got to keep this discussion going so just to mention the five countries we didn't just say these are where we're going to work because we like them we went through a process with ministries with our regional offices to look at where these countries are in the transition to a midwifery model of care they're all very interesting and our regional offices worked with us to make sure there was capacity and that the government was absolutely on on board so the first one is Bolivia it's still nurse midwives but they are open to the discussion which is amazing Sierra Leone amazingly coming out of conflict and Ebola has moved to a direct entry midwifery curriculum looking good but they don't have the systems around it yet that's what was supporting Malawi well known for being a leader in midwifery in Africa good PhDs master's degrees but the mortality rates are not going down you need to get the midwives out to those rural areas how do we do that to save the lives that are needed Pakistan's never had midwifery it's nearly all obstetrics or nothing so you're lucky if you live in a town and there's an obstetrician or a doctor if you live in the rural areas it's a traditional birth attendant your sister your mother or you cross your fingers so you know huge mortality rates there but they're ready to move so we're helping them with a strategy for how they could move to a midwifery model of care and finally India is a rising star a few two years ago the government launched with the support of WHO the first ever national strategy will move into midwives and we're at the beginning of that but it is happening so I'm going to hand over now to Adetoro Adekoki and Adetoro is our WHO consultant who's our project coordinator for these five countries and we're really so pleased to have Adetoro she knows them all been there done it and she's got good relationships in many of them and as well as our project coordinator she has been a senior lecturer in sexual reproductive health in the University of Liverpool so without more ado Adetoro over to you thank you thank you very much I'm Fran and hello everyone you're welcome to this panel session and may I say happy international day of the midwife to of course all in this session today we will be looking at how these global policies and strategies that Fran mentioned the state of the world a midwifery report the SDNM strategic direction for nursing and midwifery as well as the framework for action that was published in 2019 how these global policies and strategies are being implemented in various countries the in the five project countries each country will be sharing with us today on the various interventions that they have implemented and that are critical to having a sustainable midwifery program and their workforce especially as it relates to midwifery leadership and education I have a very fantastic panel here from four countries I don't know if you can show our panelists please yeah so we have a speaker from Pakistan we are from Malawi we are from Syria alone and also from Bolivia so I'll quickly introduce them to you they are four speaker today is Dr Sabin Afzal Dr Sabin is a medical doctor and a public professional she's the director at the ministry of national health service regulation and coordination of the government of Pakistan where she's the director for technical and health system she has been working with the ministry for a number of years across various positions and portfolios and we set an award and a letter of appreciation for outstanding service to the government of Pakistan our second speaker is madam Mary Augusta Fuller from Syria alone Mary Fuller is a midwife and has worked as matron in the government hospital for several years before she moved into the ministry of health and sanitation in 1998 in 2016 Mary became the deputy chief nursing and midwifery officer and in 2018 became the chief nursing and midwifery officer Mary has a registered nursing certificate registered midwifery diploma in community medicine and health and an mph our third speaker is mrs Lenny Kamwendo from Malawi Lenny is the founder of the association association of Malawi midwives amami she is a senior lecturer with a kamosu college of nursing university of Malawi as well as the external examiner for the faculty of nursing at the mumbili university college of health sciences in the islam tanzania last but not the least we have our professor Lorena Binfa Lorena is a professor with the university of Chile the department of women and newborn health promotion the specifically the school of midwifery there she is a regional consultant for the WHO on this project and she's working in Bolivia my professor Binfa will be telling us the experience of Bolivia with this project thank you very much so you all welcome welcome to our panelists and welcome to everyone of us on on the screen you will see the picture of the first national stakeholders meeting that was held in Pakistan so we're going to start from Pakistan in September 2021 the WHO supported the federal ministry of national health services regulations and coordination to convene the first national stakeholders meeting on midwifery it was a very well attended meeting by midwifery stakeholders midwifery leaders and midwifery supporters not only from the national level but from the provinces as well as our partners and including the private sector it was an hybrid meeting which was very well attended both in person and online and it was at this meeting that the ministry requested that the world health organization as well as other partners working with the government of Pakistan to come together to develop the first national strategy for midwifery for the country and that brings me to my question to Dr Sabil now that the government of Pakistan has decided to transition to a distinct care of professional midwife what actions are needed to ensure that this happen and to make sure that we have significant changes and impact over to you Dr Sabil thank you. Bismillahirrahmanirrahim thank you Editoro for giving this opportunity to government of Pakistan to share our situation of midwifery sector in Pakistan as you won't know midwifery is our oldest profession one of the oldest profession and in Pakistan there are many different cater and nomenclature used for midwives we have lady health visitor program the pupil midwife the nurse midwife and having various qualification and length of diplomas in this field in addition in mid 2000 government of Pakistan also introduced the cater of community midwife especially to address high maternal motility in the rural areas also there are two universities which also offer post-RN registered nurse bachelor's program for midwifery in addition these have resulted in degrees in an improvement in the maternal motility dates in Pakistan and degrees in the and the degrees have been seen from 286 to almost 140 per thousand life birth many efforts have been taken in this regard to strengthen and improve the midwifery sector in Pakistan but still this sector faces many challenges one of them being expect acceptance by the society especially if the girls are young and not married and in a rural setting delivering degree by young girls is not taking is not very much acceptable another challenge is this is the faculty availability of faculty skill development jobs opportunities and career structure to address these being a divorce sector different process that they can different step we and insane there are briefly midwifery led units has been piloted with a private sector and CSOs which has produced very good result in in addressing maternal and child care same government itself has created posts for them senting posts have been created and around 3000 community midwife have been inducted with a career structure in place Punjab has reviewed its character and it's trying to bring in collaboration with the nursing council to at par with the international standard however as although the midwifery sector has evolved over the time in Pakistan where there is need to develop a strategic framework for which we will request our all UN partners and held development partner to support in this endeavor and they have already been there for us. Thank you very much Dr Sabin I can highlight three key issues that you have raised there thank you so much for your response you mentioned the fact that there are multiple providers in Pakistan and also not enough or required number of midwives you mentioned that Pakistan is moving in the right direction to ensure that you have the right number and the right quality of midwives so it's very exciting to hear that and it's also important that we that Pakistan as a country moves faster on these you've talked about our partners coming together to support the government of Pakistan in the development of the national strategy for midwifery the very first national strategy for midwifery and we are excited to hear that and we look forward to seeing that thank you so much once again I'm Dr Sabin I want us to hear what is happening in Syria alone. Madame Merifula will be telling us a bit more about the transition to quality midwifery education in Syria alone through effective midwifery leadership which is what this project in five countries supported the government of Syria alone to do over to you Madame Merifula. In the 90s what happened this we started because there was no decrease in the maternal death we now said they were to train maternal and child health assistants this we are now graduate people perhaps with just one or two all levels at that time and they were trained for two years in just maternal and child care they are with us up to this day working in the most remote areas in the districts the main the directorate of nursing and midwifery is the leadership program in the ministry of health and sanitation for midwifery practice and education and it is responsible to govern direct and regulate the midwifery trainings institutions and the service delivery facilities. Since midwifery is a lifelong and hands-on skills profession a good leadership is needed to direct and strengthen midwifery the pre-service trainings and the in-service trainings mentoring of the nurses and coaching of the midwives is needed by a good leadership the midwifery framework the WHO midwifery framework has prompted the directorate of nursing and midwifery in Sierra Leone to look at the midwifery education and practice holistically so that it will benefit both the midwife and the beneficiaries who are the women and the children in the country um it has also opened the eyes of the directorate to reactivate the quadrat meetings which normally deals with midwifery strategic plan we will have out things that will improve the education and the and the practice of midwifery in the country this quadrat consists of partners consists of UN bodies the BHO UNFPA seed global the the midwife association and the higher education the TEC in Sierra Leone so we all come together on quarterly basis to ensure that we track we align what we have been doing for midwifery doing the quarter and we give results and then we our challenges and we come together and see how we forward the way forward thank you very much Mary and thank you for those critical points that you have raised the one on realistic approach to midwifery education and practice as well as the effective leadership not only at individual level but having a core group that speaks to the needs of midwifery at the national level thank you very much um in I want to uh quickly uh say that for uh what we are seeing now is um like a a theme that is running through uh this um discussion uh and it's uh the theme is talking about leadership is talking about coordination is talking about people coming together and that brings me to the question that I have for um Leni uh Leni we uh how as a partnership as it been critical to our quality midwifery education in Malawi thank you over to you Leni Malawi is well on the road to successful completion of the WHO five country project which is focusing on strengthening midwifery education knowing that collaboration and partnerships are key to the success of this project WHO has reached out to various partners starting with policy makers at the ministry of health to service provision sector they have also reached out to advocates such as the white ribbon alliance for safe matterhood the professional association of midwives the regulatory body which is the necessary midwifery council and the training institutions themselves the WHO has also reached out to development partners such as USAID and UNFPA WHO has made the purpose of this um project very clear to improve the wishes to improve health outcomes for mothers and newborns WHO has ensured that the partnerships are built on a shared and common vision that is investing in midwives means investing in women and newborns they have promoted the value of building synergies in order to avoid wastage and duplication of effort and resources this can only lead to one thing better outcomes for mothers and newborns success of one partner is success for everyone just as failure of one partner is failure for everyone no single organization has answers to all the maternal and newborn health challenges as well as the daunting challenges that midwifery service providers are experiencing in Malawi but together we can succeed thank you thank you so much Lenny together we will succeed I agree with all the points I'm raised by Lenny we need to come together we need to work together we need to take a multi-sector approach including policymakers including service providers advocates regulatory bodies training institutions themselves as well as our partners and having a shared and common vision in order for us to to in order for us to avoid wastage to ensure synergy and avoid duplication of efforts and resources because just like what Lenny said that is only when we'll be able to have better outcomes for mothers and newborns and I'm talking about mothers and newborns I want to show us a video of a woman from Bolivia thank you so that is to remind us about the importance of having accessible midwifery care midwifery care at the very point of need to the remotest part of the country or the world uh I'll be asking our professor Binfa about um the situation in um Bolivia how this project will support the government of Bolivia to strengthen midwifery in the country having a clear understanding of the gaps that currently exist over to you Lenny Bolivia is a plurinational state which makes it a very heterogeneous and diverse country therefore different strategies are needed to ensure maternal and neonatal center safe and respectful care within the framework of the family intercultural community health policy in terms of midwifery education today there are three universities that are training nurse midwives from which 385 professionals have been graduated the development and subsequent labor insertion of this career have been greatly favored by the support of various international organizations un fba pow and inter-american development bank which have worked in close collaboration with the ministry of health and sports the project has recently started but we have already taken the first step to come together among all stakeholders to guide and plan sustainable and strategic work towards achieving our goal that women from the most remote rural areas of Bolivia may have the right to quality services therefore this project will contribute with and to other ongoing programs developed by these organizations in a close relationship with the ministry of health to highlight and put on the public health agenda the importance of this professional so that she is valued and recognized we wanted to put a human face to our presentation because we believe that the best way to celebrate the international day of the midwife is with this testimony on behalf of all the women who can be cared by nurse midwives thank you very much um Lorena and uh i want to say very important term statement some you have made there uh valued recognized distinct professional midwife is key to enhancing quality uh quality care and improving health alcohol and with that uh i want to bring this panel discussion to a close thank you so much to all our panelists for their time and for their very useful insights i want to thank you all for attending the panel session and i will now hand over back to Fran thank you so much everyone happy international day of the midwife thank you at the tour that was super and that is so good to hear from the country that i actually love the woman in Bolivia i thought that was great so thank you thank you very very much now i'm really pleased because we do focus on africa and um southeast asia and and the americas and so forth but we have with us a really special midwife from romania um arena popescu and she is the deputy president of the romanian independent midwives association so arena is a mover and a shaker trying to make a difference in romania and she's told us also she is the coordinator for the refugee reproductive health program and this is for the women now coming in from ukraine into romania into romania um and their needs will be absolutely huge so i'm really pleased to hand over to arena to tell us about a few things that they've been doing and why it matters in europe where we don't often concentrate on actually the really huge midwifery needs that there are thank you so much for joining us arena over to you hi happy international midwife day i'm happy to be here so the story for today it's about the mate the assessment tool that was presented to us by billy hunter and grace thomas uh within some sessions that took place last summer and um i wonder if we're having some connection problems with arena thanks so should i just continue and let arena pick up i hope she can come back in on the on the next slides thank you all right so shame to miss her so so so what she was saying was the university card if the wha collaborating center with billy hunter grace thomas came to romania to help a very initial discussion on how they can move forward on midwifery with this midwifery education tool sorry midwifery assessment tool for education and it's just a set it's very simple and it's a set of 33 questions and arena can you hear now please do pick up if you can hear yes sorry for this it's my connection it's not always great in romania okay so um i wanted to let you know about how we worked with mate we gathered around obstetricians neonatologist pediatricians and also a lot of the decisional factors from ministry of health i was also working at ministry of health when we did this and also colleagues that are in hospital management and decisional factors from the insurance company and this this was great because for romania since i'm active like 12 years ago as a midwife it was the first time when this was happening and also women and journalists i forgot to say this but they were they were the most important actually because we we also wanted to speak with mothers women who could benefit of midwifery and for us the autonomy of our profession is still even we if we have legislation we have faculties now they are getting close a lot of them are already closed and we we try to to see the exact point of pressure that we need to start our our change because yeah we need to change things to have better care for women and babies so yeah we we go through all these questions what is it now and how it could be and also we had students at midwifery that weren't aware about full scope of practice for midwifery because we don't have midwives that teach midwives but doctors that teach midwives so we don't have even if we have doctors in in midwifery we still we are they're not allowed to work at universities unfortunately so this is this proportionate things there and about the curriculum curriculum it's it's very good it's the same mostly the same from from europe but it's also about who is teaching this curriculum to students and the practical part because i did the practical part in a hospital that was 80 percent caesarean section i never saw antenatal care in my practice for me it was good because another midwife from switzerland took me in her private practice to teach to teach me but this was i was very lucky not everybody's so so lucky unfortunately and also we are not looking at neonatal care for midwives it's just the neonatologist and it's not about bad intention of course it's just about how things are in in rumania midwife can can work near the doctor but the children then the new net it's for neonatological care always unfortunately and this is what we are trying to explain to our colleague that we can do home visit we need postnatal care because of course our colleagues are overwhelmed with physiological care for for mothers for women and for babies and for breastfeeding and they're really overwhelmed and women are going to hospital and primary care it's like very close to a low level a very a too low level that needs to be to be changed and and for for us it was very very helpful to see that with with this tool we can separate the problems we can see the exact points that that needs needs to be changed the representation from the order of midwifery they we need to improve how they represent us because it's not it's not perfect the point of pressure for the insurance company that don't sign contract with midwives but we are getting close because we discussed and we explained and they weren't aware of what a midwife is it was just like this the their legal part their protocol part they weren't aware about midwives and why to sign a contract direct with a midwife and when we we use all this argument you know the care it's it's done in team to identify the risk not not to hide the risk because they are sort of okay but you will treat everything no just our part and you will do our your part and everything work better and also in this team we have to put the women always put the women in the team don't take decision without her don't push the decision on her and and take take good care of them in in team and this was a little feedback from from our participants on on made I told you also about the midwife student now I know what a midwife could do and and they they also never heard about about an obstetrician and an ontologist to say okay so now we need to work in in a team because this is how we provide better care and everybody's more efficient at his job not not overwhelmed and yeah also the doctor's college okay everybody everybody really everybody was was at this round table it was also online but it it was very well organized because we were mixed together in in rooms and even now after several months we are still connected even if not every every time the answer is yes or yes we will we will collaborate sometimes it's now but still they we are not ignored anymore because for for this made tool we we really spoke together we we really thought okay but how is more efficient how how is care at home after birth because also we don't have this in Romania implemented and the results are not so good of course and I think we are aware now every every institution that needs to take decisions that we have to implement midwifery at full scope of practice as soon as possible also in Romania thank you Irina thank you so much from that and you've just touched on so many of the points actually in that seven step action plan it was really really interesting from quite a small intervention from a quite simple tool so it's been really really interesting to see you know how that goes so it's so good to hear from Europe as well and we need to hear more from you and good luck with all the work you do with those refugees and in midwifery thank you so much for for joining us so now we're moving we're moving on and I want to introduce Matthew and Matthew you can say more about you but we know that you're at the Witwaters Rand University in South Africa and you're really working on climate change and the impact particularly heat on women and babies and I want to add that you're just such a great guy to work with because you totally get midwifery you know what we can do and you talk to us a lot and so please say anything else about yourself before just taking us through some main points we really want midwives to understand about climate change the impact on mothers and babies and what they can do so over to you Matthew thank you thank you friend it's always a great pleasure to work with you and your team um and that I used to work in in obstetrics and with midwives for for some years I'm very well aware of the vital work that um so um what I want to start off by by giving it quite an overview if you look at it at the left of this of this figure it shows the different manifestations of climate change and here raised temperature and heat waves but also increased precipitation with typhoons or cyclones for example wildfires, rising sea levels and also droughts obviously so those and all of that occurs within a particular social economic and cultural context so in other words the climate change may be the same of the same nature but its impact will depend on where um where that is occurring and what that context is so within with those changes in climate that can result in the disruption of health services these direct impacts on pregnant women and newborns and of course climate change has a large mental health conditions and I think this will become increasingly apparent as as climate change worsens as a stress anxiety depression and of course there's indirect impacts through failed crops and malnutrition and all of these that in turn can affect maternal and and newborn health the area as as Fran mentioned the area that that that I think is um is really important to to think through as um as a health system and in obstetric or or maternal health services is around heat and you know high ambient temperatures or heat waves and I think for those who've been following Pakistan and India heat wave recently if you have a sense of of many of the maternity wards in those in those settings are really poorly resistant to heat they were built at at a time when temperatures were a few degrees lower than than are now and where heat waves were very very rare so in these kind of buildings the material is poorly reflective so they actually absorb heat in this case the black roof so the temperatures indoors inside this facility will be um three or four degrees warmer than outdoors often as poor ventilation and women um then in these four in terms of health health workforce at these higher temperatures it's really discomfort and you have a lot of heat related symptoms not getting to headaches and um really a sense of unease that one gets at these very high temperatures and that in turn affects your your work performance um and the patient interactions at those high temperatures so with with some minor modifications to to the built environment and the natural environment as well as some additional um clinical interventions many of the problems in the previous slide can can be addressed so starting from the the arts a part of this figure the um the greening is a is a very one of our key cooling strategies trees trees and other forms of shade and trans transpiration have a can really lower temperatures by by um many degrees a white reflective paint um again um will will ensure that the inside of a building is cooler than outside which which should really be um the the basic minimum that would aim for with the with the building envelope and then ventilation through windows rational use of air conditioning a fan a simple fan with um water spray is also very effective and and care for the midwife and health care workers is is um is really a key part of responding to um increased temperatures within health facilities and that we can't we need to focus not only on the the effects of heat on on women doing uh lame and childbirth but also the effects um on the well-being and on the work performance of midwives and other stuff to take a broader approach so i think heat during childbirth or labor is really probably an area we need to focus most on but i think a whole pregnancy approach um is is important to consider so even preconception and here are some people in hot areas of the world um to promote uh conception or beginning a pregnancy during hot season so then in the cooler part of the year um when you in third trimester um you know that's kind of the winter or autumn seasons um and of course within climate change there are there are these ongoing debates around the importance of population growth or family planning and planned pregnancies etc but in terms of midwife and obstetric care so in the first trimester i think it's important to identify high risk women in terms of heat so that's there's women who are obese or got diabetes or um above the age of 35 or twins for example those are women with higher risk of heat related conditions during pregnancy and i think to advise women to avoid extreme heat especially occupational settings and and sports etc but and and in particularly for women in many areas needed to fetch wood or to fetch um a water um you know traveling often over long distances in the heat is a major problem and in the second trimester again here i think to reemphasize to that high and extreme heat need to be avoided um and and to begin to prepare for complication um complications if there's a heat wave how to if there's if it's if the temperature is about 40 degrees for example and you're going to into labor then how does one um get what what transport for example do you use to get to your health facility and heat the mental health as i mentioned um there's a major impact on on your stress or your level of aggression or anxiety when it's hot so we also need to bear that in mind during the second trimester i think um and then during the third trimester here we really are trying to avoid um heat exposure you need one to be in a mild um temperature zone during the third trimester early warning systems and then tiered interventions i think in third trimester really important um and something that's really it is beginning to be to to be um advanced as a as a key strategy as a cooling center so this would be um it's analogous to a maternal waiting home in some ways where you would have a an area that's dedicated just for women in the third trimester or those with very high risk pregnancies where they are able to stay in a room that has air conditioning or good ventilation or cold water available um and painted in white reflective paint for example so and i think that's that's something that would really um become more and more important over time really a dedicated cool area for for women um at high risk during heat waves and then during childbirth as as i said this is a time when there's a lot of heat being generated um in a labor over eight or ten hours or um there's a whole lot of heat generated by utribe contractions at the amount of exertion that's required and often accompanied by dehydration or bleeding etc hemorrhage etc so this is important that hydration water supplementation again cooling and infections we know that during warmer parts you know as temperature increases so does food waterborne um and a reproductive tract infections increase so here group we strap the caucus is really important in childbirth and postpartum there's um breastfeeding is much less discomfort there's more discomfort with breastfeeding during extreme periods of extreme heat the neonatal sepsis and postpartum sepsis in women these are those are the the kinds of conditions we should we should be aware of uh lastly um none no midwife or or public health or solely solely provide clinical care we we move way beyond that and a very a figo and others have and many organizations have begun to really focus on on climate change from uh advocacy and and from a um a sense that we really need to respond to the need of women and and and children so the lovely phrase the health impacts of the global climate crisis on maternal and childbirth can no longer be ignored and they set out in this in this um poster they set out the problem very clearly but they also move on to note that um what we can do and they center this around advocacy I think and from the health perspective and um maternal and newborn health there's really a lot of we have a lot of um a leverage or a lot of credibility or we have a very um a voice that people listen to that we can really advance advocacy and um figo and this and heal and others we're really among the first two to really push the investment from fossil fuels from a health perspective so there's a lot that the health sector can do as this problem really begins to expand and and um it's a major crisis in the world but there is a lot that we can do thanks friend still on mute friend talking to myself again sorry I just want to say Matthew thank you so much it's a really brief but important uh piece of work here and I think as midwives we have no choice but now to get much uh more involved in this and move forward so we really rely on you for this information and and to keep us up to date as well so thanks a million now I'm going to hand over to Annie Portella um from the maternal newborn child adolescent health and aging department in WHO which is where I sit as well and hot off the press I'm really really excited um because post-natal care as Matthew's um Matthew mentioned it is a really big issue and um we haven't previously had such a brilliant recommendations on maternal newborn care for positive post-natal experience and Annie's joined by Mercedes Bonnet who is from the sexual reproductive health department uh at WHO too so over to you too for some really exciting updates on this thank you so much friend and thanks to all of you we're really happy to share in the celebration with you uh congratulations on this day uh and special thanks to the organizer for allotting us um time to share information with you about the newly released WHO recommendation on maternal and newborn care for a positive post-natal experience and I'm Annie and and my colleague Mercedes and what we'll do is just take you through a few um a few snippets uh to lure you into then finding the guideline on the web and and reading it and using it in your practice uh you'll see the link here so when you have the slides hopefully you can access it a friend said it well post-natal care of the maternity care continuum uh is the most neglected coverage and quality lag um lag behind global targets um as uh facility births have gone up in in births with skilled professionals have gone up length of stay in health facilities after birth very widely across countries and in many places women do not stay long enough to receive adequate care and support to transition to home uh while anti-natal care has gone up over the last years post-natal care remains one of the lowest levels of coverage across the can continue on both for the women and for the newborn the guideline has 63 recommendations there are 31 new and updated recommendations and 32 integrated recommendations so integrated from existing guidelines so hopefully you can find uh all the information you need in one publication we've divided the recommendations or their group according to maternal care newborn care and health systems and health promotion interventions and i'm going to pass over to Mercedes who's just going to take you through some of uh some of the key recommendations thanks Annie so um what i will be presenting is just a quick snapshot on what is in the guideline so as um Annie just mentioned it we have three main areas so on maternal care we have recommendations around maternal assessments also interventions for common physical signs and symptoms as well as preventive measures for common problems such as mastitis or constipation we is the first time that WHO issues recommendations around maternal mental health and we have two um recommendations on screening for um and prevention of depression and anxiety and there's also recommendations around use of um my um iron supplementation and physical activity very important we also have integrated recommendations around postpartum contraception moving to the newborn care we have structured the recommendations in a similar way so recommendations for newborn assessment preventive measures nutritional interventions as well as recommendations to promote infant growth and development you can go to the next slide the third section in this guideline is around health systems and health promotion interventions so we have updated recommendations around the schedules for postnatal care contacts length of staying facilities after birth for the first time also recommendations around what are the criteria that should be assessed before discharge from health facilities after birth as well as um updated recommendations on home visits for postnatal care contacts and then on the right side of the slide there's recommendations that have been integrated from other guidelines and that but they are very much relevant to postnatal care including midwifery continuity of care from pregnancy through intrapartum up to the postnatal period that's sharing components of postnatal care recruitment and retention of staff in rural and remote areas involvement of men in postnatal care home use of home base record and also use of digital target client communication and digital birth notifications next slide please so all these recommendations come together in the W2 postnatal care model and is the figure that you can see on the right hand side of this slide and as you can see the woman and the baby are at the center of the care that is provided through a facility based care after birth up to discharge and then continuous care in the community or at home for the first weeks after birth this model aims to achieve a positive postnatal experience that is defined in the guideline and one in which women newborns the partners parents caregivers and families receive information and reassuring from health providers and this most certainly includes midwife and that both the woman and the baby's health social and developmental needs are recognized with a resource and flexible health system that respect their culture context and all this is of course included in this postnatal care model I think that that's the last slide that we have and I will be passing over to Fran the huge thanks Annie and Mercedes that was really super again just a snapshot but speaking as a midwife myself and knowing others online postnatal care is just the most wonderful part of midwifery the woman's got through the birth she's there the baby's there the family's there the partner's there is just full of love and affection and excitement so these recommendations couldn't be more timely and more important and we all want them and we all want to start implementing them and I spoke to midwives in the Norjit region today from other parts of the world they apply to everybody so your work has been fantastic and it's great to have you both uh with us and supporting us midwives take this forward thanks a lot to both now in the interest of time I'm just going to just do a couple more slides um as to where we're moving forward and I just wanted to know that we have all been working for some time on an interprofessional midwifery education toolkit and this is for people who have qualified so it's continual professional development but bringing all the materials together based on the WHR recommendations and making learning fun and interesting and self-directed and challenging we have power walks and we have videos and we have um treasure hunts to get the recommendations and all kinds of activities so it's just to say they're a facilitator and learner guides coming it's blended you can do quite a lot online before you even start um but you do need to come in and work with each other as a team interprofessionally as we've been discussing to see how you can improve that quality of care as well as what you do it's based on a continuity of care midwifery model so it's bye bye to simulation labs that are just about looking at a placenta and then a woman's vagina and then resuscitating a baby this is following the woman her partner the baby all the way through the process um and there's antenatal coming childbirth is just launched we're just getting all those information up on the website now the post little care guidelines are out we can really get working on that sexual reproductive have very good comprehensive abortion care module coming out there's a wonderful cross-cutting module on essential respectful care take you through why it's happening what's happening how we can stop it how do we recognize what can we do about it and what are our human rights as midwifery care providers as well as what are the rights of women newborn and her family newborn included and her family so hugely informative and exciting a perinatal mental health course coming which will link him well to those post little care guidelines and very interestingly after the discussions on leadership from Sierra Leone for example we will be developing an essential midwifery leadership course for people to take not an academic course um but we're working with those five countries who are feeding into us what it is that they need we've learning from a course we ran in India and we're going to put out something for everyone to review that is this is what people want at countries now let's take it forward so that's really really interesting and exciting work and then of course there's lots of other courses in WHO this midwifery education talk is about healthy women and babies it's about what midwives do best and mostly but we link to all the emergency obstetric care courses we link to maternal perinatal death surveillance course very important that midwives are involved small and sick newborns violence against women and women health worker courses really good postpartum family planning HIV malaria tv etc so all coming into one place very soon and just to say um all based the childbirth care course coming up first is based on all these recommendations um and when we come to postnatal care of course it will be based on the postnatal care recommendations but they dive into those recommendations they find out what they are they dive into the new labor care guide they start to use it for the three women that we care for right the way through labor childbirth and the newborn care so they get to know the evidence they get to feel confident empowered know where to find it know how to use it and apply it and and this is what it looks like this facilitators guides that start with an introductory module how to teach differently how to learn differently in the learner guide labor first stage second stage third stage and um immediate newborn care and then a really important new one altogether about appropriate respectful referral and that is a WHO quality of care standard that we've turned into a guide to make sure that if something does happen you stay with her you communicate you document you work as a team you care for her until she's referred so it's a really exciting course the online materials will come out first so you can all access it for free and use them and this will be the website so just keep your eyes open for that and so now just to finish off we want you all to join our global nursing and midwifery leadership community practice this evolves quickly i think i've just heard that this slide is already out to take but it really is set up by midwives and nurses for midwives and nurses many of us are extremely isolated and uh no matter where you are that's what i can tell you um and you know many are in such remote areas they don't have internet connection they're called a chief government nursing midwifery officer or something they have no budget no laptop they're not invited to meetings they don't have a work plan and this is where we can all get connected it involves icn icm nurses midwife the wto academy and many more there's a very strong steering committee they're already running webinars multilingual webinars so matthew's work on climate changes already been up there with even more depth and detail there's a lot going on on this website so what i want you to do please is to connect you can set up your own group you can join other groups that you can talk about what you want you can ask what you want so you just literally google nursing midwifery global.org you can make your comments and suggestions on it and Emily McWhorter's done an amazing job in setting this up from scratch and it's really moving forward fast it is the global platform where we'll put our education materials where everything else that you need to know whether it's postnatal care guidelines the latest in this climate change etc will be there so with that it's now time to end this and i'm here unfortunately elizabeth has had to go um for for personal reason um but i know what she had to say was an absolute massive thank you to all the participants um getting people in countries without internet to sit internet cafes to create videos it's really really hard to get these these videos from ministries of health who are incredibly busy so thank you to all the participants and and Annie and Mercedes and arena um and matthews and a huge thank you to vidm for organizing us and making us get all this together um and most importantly thank you to all midwives everywhere as you heard the dg say you matter to us you are hugely valued and you are just brilliant so thank you so much take care of everybody and bye from over to you jane thanks thanks fran so i think we can give a massive thank you big hearts to the world health organization i think i was seeing some comments there and there's a toro blessings here blessings and it's so good i think you know as the pandemic has brought us all together and we're talking a lot about bringing us back together that all the sections that we had presented today so relevant for all of us wherever we are midwives um you know i love the the film i think it's from bolivia it's incredible the information about climate change the importance of leadership having equitable resources for all of us and thank you to chris there's lots of um information there in the chat box and i don't know i know it's very late for some of you and very early for some of you in the world i don't know if anyone would be willing to take maybe a question or two if there's any specific questions or make sure you check out the links here and we'll certainly be posting them on vidm.org as well so that everyone will be able to have equitable access to all the wonderful links and information that you've shared so thank you i think we had it we had a great turnout and especially for those of you that are here in the middle of your night we appreciate you getting up early and late and uh happy happy international day as a midwife to you all