Reflections from the ICM Triennial Congress, Lisbon, June 2026
Benash Nazmeen, Non-Executive Director, Birthrate Plus
In June I went to my first International Confederation of Midwives Congress, in Lisbon.
Five days of midwives from all over the world in one room. Gathering. Challenging each other. Celebrating, mourning, and reflecting on everything that presses on us as individuals and on all of us together as one profession.
I had the pleasure of joining Birthrate Plus on their stand while I was there, and of talking to a great many of those people. We handed out a small wellbeing package, a bit of love for people a long way from home, and we asked them for their feedback.
Three hundred and forty eight people filled in a form for us, from more than seventy countries, over five days.
The first thing they told us is the thing we already knew. There are not enough midwives in the world.
The State of the World’s Midwifery put a number to this in 2021, it states that the world is short of around 900,000 midwives. If nothing changes, it will still be short of around 750,000 in 2030 (UNFPA, WHO and ICM, 2021).
Midwives educated to international standards, and able to work to their full scope, can meet about 90% of the need for essential sexual, reproductive, maternal, newborn and adolescent health care. Fully resourced midwifery care could avert 67% of maternal deaths, 64% of newborn deaths, and 65% of stillbirths. That is 4.3 million lives a year by 2035 (Nove et al., 2021; UNFPA, WHO and ICM, 2021).
So, the message is bigger than midwives. We need enough midwives, with the right skills, in the right place, with the capacity to give women, people accessing maternity services, newborns and families the care they require.
That is a workforce planning question. It is what Birthrate Plus does.
What we have had the privilege of doing is helping to make that case. Our methodology, our rigour, our independence. Putting facts to something that should be about feeling, because facts are what the people holding the money will follow.
And then we asked everybody about it in tick boxes.
That was my first mistake. More than seventy countries came to that stand, and every one of them had a conversation with us. Then we handed them four boxes and asked them to make themselves fit inside one of them.
Minimising people into tick boxes is not okay. I know that better than most, and I did it anyway.
There were barriers, and some of them were funny. We got things wrong. We mispronounced each other’s names and then tried again. We learned how many different ways there are to say midwife, how differently the job is drawn from one country to the next, and what those roles are actually allowed to do.
Every conversation, in every language, arrived at the same place. Is there somebody with the right skills in the room at the moment a woman or person accessing maternity services needs them.
From a tertiary unit in Australia to a district hospital in Zambia, it was the same fear. It was about being one midwife on a ward that needed three.
We are far more alike than we are different. I knew that.
What I was not ready for was how wrong we would be, at that scale, about what people actually wanted from us.
Forty-eight per cent asked for advice, knowledge sharing and capability building. Thirty two per cent asked for the tools.
Split it by where people came from and it stops being a preference. Of the fifty three responses from African countries, sixty eight per cent asked for capability and twenty three per cent asked for the tools. From high income countries it is close to even.
The less resource a system has, the less it wants the product and the more it wants the knowledge.
I don’t think most of us would have known that was what would come up.
I teach cultural safety, a framework pioneered by Māori nurse and scholar Irihapeti Ramsden (1993). So let me ask the question I ask in every session. What does it actually mean, and do we have the resources to be culturally safe, here and everywhere else?
Safety is not judged by the person who gave the care. It is judged by how the person receiving it received it.
You can be well intentioned, well trained and well resourced, and still get it wrong, because you were the one who decided what help looked like.
That is what power is, isn’t it. The privilege of not having to see the lens somebody else is experiencing life through.
I’ve spent years telling clinicians they cannot become competent in another human being. That culture changes village to village and person to person, that you’ll never learn it all, and that something always falls on the other side.
Then I went to Lisbon with a form we had already filled in for seventy countries.
That’s the same test, pointed at an organisation instead of a person. I don’t think we pass it.
I don’t think anyone did anything wrong either. There’s a mechanism underneath it.
A tool is procurable. Somebody can sign for it, budget for it and take it to a board. Capability is not procurable. It is a relationship, it runs for years, it has no unit cost, and there is no line for it in anybody’s finance report.
So what travels is what can be bought, and what is actually being asked for is the thing nobody can raise a purchase order against.
That is not anyone’s fault. It is what happens when the only route into a health system is a procurement route.
The workforce is the largest expense in any health system and the one most often planned by instinct. In any other business you would call it human resources and you would protect it. Everybody who stopped at that stand already knew that. What they wanted from us wasn’t our software. It was the method, and the evidence, that would let them go to their own ministry and ask for staff.
Half of them couldn’t do that either.
Half of the people who came to us were clinical midwives rather than budget holders. They give direct care to women, people accessing maternity services and their families, every day, all over the world.
At the bedside, we trust midwives with enormous clinical responsibility. Yet they have almost no authority over whether the system invests in enough midwives to deliver that care safely.
Several told us so on the form. Will speak with manager. Happy to share info with decision makers. I am not the one in charge.
They came anyway, on their own time, at a congress, and asked us themselves.
So what do we owe them.
We owe them the tools, the mechanism and the support to go and get what they need. Not what we decided they needed.
Being independent means being willing to say when our own tool isn’t the answer yet. For many of the systems that approached us, the honest first step isn’t implementation. It’s finding out what data exists, what the methodology needs, and what would have to be collected before any of it means anything.
That’s a smaller and slower conversation than the one we had set up to have. It’s also the more honest one.
A third of the people who came to us teach. They are training the midwives who are not there yet, in universities and in practice, and they came to ask us the same question everybody else did. We have more to offer them than we currently do.
85% told us they wanted to keep talking. Nobody fills in a form on a congress floor to be sold to.
They didn’t ask us for a product. They asked us for the knowledge and expertise behind it.
You’ve read that now, too.
So, what are we going to do differently?
Reference list
Nove, A., Friberg, I.K., de Bernis, L., McConville, F., Moran, A.C., Najjemba, M., ten Hoope-Bender, P., Tracy, S. and Homer, C.S.E. (2021) ‘Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study’, The Lancet Global Health, 9(1), pp. e24-e32. Available at: https://doi.org/10.1016/S2214-109X(20)30397-1 (Accessed: 14 September 2026).
Ramsden, I. (1993) ‘Kawa Whakaruruhau: Cultural Safety in Nursing Education Aotearoa (NZ)’, Nursing Praxis in New Zealand, 8(3), pp. 4–10. doi: 10.36951/NgPxNZ.1993.009. Available at: Nursing Praxis in Aotearoa New Zealand (Accessed: 4 September 2026).
UNFPA, WHO and ICM (2021) The State of the World’s Midwifery 2021. New York: United Nations Population Fund. Available at: https://www.unfpa.org/sowmy (Accessed: 14 September 2026).