1. ICM/WHO Global Standards for Midwifery Regulation Dr Sally Pairman Co-chair ICM/WHO Global Taskforce on Midwifery Regulation Washington DC 2010

2. Why does ICM want global standards for midwifery regulation? Regulatory mechanisms enable protection of the public (women and families) by ensuring that: – midwives are educated to meet the ICM Competencies for Practice – midwives are able to work autonomously within their full scope of practice according to the ICM definition and scope of practice of a midwife – Midwives continue to practise competently after registration and provide high standards of midwifery care to every woman and baby. Regulation is a mechanism to raise the status of midwives and ensure that they have authority to act on their own professional judgements within their scope of practice. An educated, competent and regulated midwifery workforce will raise the standard of maternity care and the health of mothers and babies will be improved.

3. How does regulation affect standards of midwifery practice? Regulatory legislation empowers a midwifery regulatory authority to: – set the competencies for entry to registration (ICM competencies for practice) – set the standards for pre-registration education (approval and accreditation processes; ICM education standards) – set the requirements for ongoing competence for registered midwives – take responsibility for the profession in a consistent way

4. A framework for a skilled and professional midwifery workforce Together, the ICM definition and scope of practice of a midwife, the ICM competencies for practice, the ICM global standards for midwifery education and the ICM global standards for midwifery regulation provide a framework through which midwives can fulfil their role and contribute fully to the delivery of maternal and newborn care in their country.

5. Is regulated by Midwifery Regulatory Authority Continues to practise competently through approved programme. Is educated through approved midwifery programme Meets ICM competencies for practice before registration Midwife – educated, competent, professional Mother & baby

6. Process of development Taskforce established – ICM & WHO membership – ICM Asia-Pacific region meeting in Hyderabad, India November 2009 – ICM/UNFPA South Asia midwifery meeting, Bangladesh, March 2010 – Literature review Taskforce meeting, Hong Kong, April 2010 First draft document circulated for feedback to member associations and other stakeholder groups June 2010 Focus group discussions at upcoming midwifery regulation meetings (ICM/ICN regulation mtg, European regulators, WPSEAR, Canadian regulators, others…) Review of feedback & amendments Final standards to ICM Board then ICM Council meeting for adoption in Durban 2011

7. Purpose of standards Determine who may use the title of midwife; Describe the scope of practice of a midwife consistent with the ICM definition of a midwife; Ensure that midwives enter the register following education consistent with the ICM Standards for Midwifery Education; Ensure that midwives enter the register able to demonstrate the ICM basic/core midwifery competencies; Ensure that midwives are authorised and able to practise autonomously within their prescribed scope of practice; In partnership with midwifery associations ensure that midwives demonstrate continuing competence to practise; Ensure that midwives and women (as users of midwifery services) are part of the governance of midwifery regulatory bodies; and. Ensure public safety through the provision of a competent and autonomous midwifery workforce.

8. Intended use of standards Deliberately generic and take a principle rather than a detailed approach to midwifery regulation. Provide a benchmark for global standardisation of midwifery regulation. Provide the basis for review of existing regulatory frameworks Provide guidance and direction to countries seeking to establish regulatory frameworks for midwifery where none currently exist. High level standards that set a regulatory direction to underpin and enable autonomous midwifery practice.

9. Draft standards - categories Model of regulation – Midwifery-specific (self-regulation) & National Separate legislation or Umbrella legislation with specific regulatory authority Protection of title Governance – Transparent; consultative; collaborative Functions: – Scope of practice Other legislation – Education leading to registration & entry to profession Approval & accreditation – Registration Range of registration status overseas – Continuing Competence Relicensing; return to practice – Complaints & discipline – Code of conduct & ethics

10. Principles of good regulation NECESSITY – is the regulation necessary? Are current rules and structures that govern this area still valid? Is the legislation purposeful? EFFECTIVENESS – is the regulation properly targeted? Can it be properly enforced and complied with? Is it flexible and enabling? FLEXIBILITY – is the legalisation sufficiently flexible to be enabling rather than too prescriptive? PROPORTIONALITY – do the advantages outweigh the disadvantages? Can the same goal be achieved better in another way? TRANSPARENCY – is the regulation clear and accessible to all? Have stakeholders been involved in development? ACCOUNTABILITY – is it clear who is responsible to whom and for what? Is there an effective appeals process? CONSISTENCY – will the regulation give rise to anomalies and inconsistencies given the other regulations already in place for this area? Are best practice principles being applied?

11. Good midwifery regulation has the potential to: Raise the status of midwives (social mandate) Raise the status of women Raise standards of midwifery care Strengthen midwifery education Build partnerships with: – Women and families/women’s organisations (governance) – Midwifery associations – Government Improve maternity services for women, babies and their families