An International Approach to Mainstreaming Midwifery in America

by Peter Johnson, CNM, PhD, FACNM

As we celebrate Midwifery Week—a time to recognize our profession and celebrate our achievements—I am struck by the good work midwives are accomplishing globally. National Public Radio aired a story last week that highlighted the work of my organization, Jhpiego, that is taking place in the far northern region of Afghanistan. While listening to Renee Montagne’s interview with a young Jhpiego-trained midwife, I felt proud, but it also reminded me of the work left to be accomplished both around the world and here in the United States.

Jhpiego, which serves to “innovate to save lives of women and their families,” has been doing creative work for nearly 37 years and has always maintained close ties to ACNM. Our nearly 800 midwives, nurses, physicians, and public health professionals strengthen midwifery education in war-ravaged countries like Afghanistan and Liberia, support care to women and families living in urban slums of Kenya, and prepare midwives to reduce the mother-to-child transmission of HIV in Southern African countries. The great majority of these professionals are native residents in the countries where we work.

My travel building cherished relationships with new colleagues from around the world has convinced me that we have more in common than one may think. For example, we all seek to build a stronger health care system that respects the autonomous role of the midwife. We all want midwives and other health care professionals to have the best possible work environment and access to the equipment and supplies needed to do their jobs. We want midwives to have a quality education that forms the foundation for life-long learning and growth.

Even our challenges, while apparent on a different scale in low resource countries like Afghanistan, are largely the same. We all struggle to find the resources to educate our midwives and offer them a living wage for their services. We work to develop autonomous regulatory structures that provide midwives with a framework for optimal practice. We strive to optimize midwives’ work environment so that they can maximize their effectiveness in practice. Even in America, where midwives often serve the most vulnerable of society’s women, these struggles are apparent. There are far too few of us because of our inability to overcome these challenges, and women suffer because of it. Let us use this week to celebrate midwifery globally while mobilizing our midwives here at home to overcome our shared challenges. Let us reflect on the lessons learned by midwives around the world that can “mainstream” midwifery practice in America.