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New York, United States – The year 2023, midpoint of the United Nations Sustainable Development Goals, marks a critical turning point in the global conversation around adolescent wellbeing and maternal healthcare. The Wellbeing Foundation Africa was proud to join the Clinton Global Initiative (CGI) meeting this September, bringing together influential global players to address the pressing needs of adolescents and to shine a light on a critical, often-overlooked phase of maternal health: the fourth trimester.

More than ten global organisations, including the Wellbeing Foundation Africa in partnership with Reckitt joined forces with Fondation Botnar to commit to action aimed at tackling the challenges faced by the world’s 1.8 billion adolescents, including water, sanitation and hygiene, focused on our programming, Dettol Nigeria Hygiene Quest. 

Alongside this, at CGI, I was honoured to contribute to ‘The Fourth Trimester: How to Provide Postpartum Support  and Reduce Post-Birth Mortality’, addressing the critical issue that demands our immediate attention: the fourth trimester, that often-overlooked period from birth to 12 weeks. This is a time when the delicate dance of mother-baby bonding unfolds, and mothers embark on the journey of physical recovery from childbirth. 

This phase represents a time of profound vulnerability for mothers as they navigate physical and emotional changes, including sleep deprivation, hormonal fluctuations, and the responsibility of nurturing a newborn. Unfortunately, inadequate support during the fourth trimester can lead to long-term health issues, including postpartum depression, anxiety, and increased risk of chronic illnesses.

Nigeria, like the United States, faces similar challenges in maternal healthcare. Maternal mortality rates remain a pressing concern, particularly for black, asian and minority ethnic rural and underserved communities in the USA. In this pivotal moment in history, it is imperative that we recognize the urgency of these matters and take global action to ensure that mothers and babies not only survive but thrive during the critical phases of healthcare. 

As we unite in our efforts to protect the wellbeing of mothers, their newborns and adolescents worldwide, let us forge a path toward a brighter, healthier future.

 

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It has been a huge honour and an incredibly valued privilege to serve the International Confederation of Midwives as its Inaugural Goodwill Ambassador since the first of June 2014.

On that day in Prague, as I addressed world midwives on the theme, ‘Education: the bridge to midwifery and women’s autonomy’, I looked at the faces of the midwives, and I pledged to walk focused, fearlessly and fervently with you all. My commitment was to actualise a rightful yearning for recognition, remuneration and much-deserved respect in a line of duty that so palpably personified care, continuity and courage. I was all too aware that it would be a daunting task, but I knew also, that it would be a fulfilling one.

The journey had actually begun in May 2011 when I attended the launch of Monique and the Mango Rains – a multi-layered tale of midwives’ realities which amplified the heroic voices of a Malian midwife and a Peace Corps volunteer. This midwife had so tenaciously mobilised resources while vividly demonstrating the numerous responsibilities that are so often synonymous with midwives and echoing their primary charge too; standing with women right up until the point of their life’s most anticipated introduction. That particular story immediately caused me to recall the names of the midwives who had laboured with me as I welcomed my own children into the world. As a result, I instantly became a convert-interlocutor, on a mission determined to amplify the ethos of recognition, rights and a much-needed redemption of respect for the ancient and modern profession that was, and still is Midwifery.

I embraced the global call to action in 2014, to increase respect for midwifery education, in order to join the ICM as it stands with hundreds of millions of women who had and would labour and deliver new life – and as I walked with the world midwives of the ICM, so did my Wellbeing Foundation Africa, by intentionally and immediately placing midwives at the heart of our unique institutional actions.

It is of utmost importance to me that all healthcare professionals are given opportunities to upskill, progress and demonstrate the highest level of competency, repeatedly.

Midwifery in particular, is a daily-charge, an exercise of accountability and a lifelong commitment directed towards holistically practicing what I as an advocate, and midwives as front-line professionals, work so intentionally hard to preach. So together with the ICM Midwives, and armed with the goals of the Midwifery Services Framework, I have travelled far and wide proudly bearing the responsibility of being the first Global Goodwill Ambassador.

2014 saw us address American Midwives in Washington DC, and the following year included my humble donation to midwives in Lesotho and the launch of EmONc in my native Nigeria. During this time, WBFA Mamacare classes were birthed, and brought forth the ability to teach advanced clinical and maternal skills using Laerdal anatomical models. The UNFPA are also a great partner in co-signing our SRH efforts. Through it all, the desire to position midwives at the heart of global health policy actions began to grow. In 2016, we worked together to host Nigeria’s First Global Midwifery Conference  – an incredibly proud and full-circle moment for me.

As we marched for more midwives in Toronto in 2017, the Canadian Government announced plans for the reparations of indigenous midwives – a conversation and a figure which sees a deserved increase, right up until today. This served as encouragement that both change, and recognition were on the horizon. Windhoek, Abuja and Suriname were also among the communities we frequented, and every step of the way, we engaged with midwives, policy makers and parliaments reiterating the commission to this great call.

In 2017, we advocated the importance of midwives being qualified to administer safe single-use injectable contraceptives at the FP2020 Family Planning Summit. Within this very same year, the WBFA Alive and Thrive Initiative was in full effect, and midwives were proudly educating women and their families about the importance of MNIYF Care and Nutrition. Through your eyes, I have witnessed the extension of midwifery practices and capacities in Brazil, Mexico, South Africa, India, Japan, and the United Kingdom – all while encapsulating the heart, passion and desires of the ICM Midwives. In doing so, we have successfully and strategically urged governments to invest in midwifery education and mandatory training in a bid to encourage the promotion and facilitation of safer approaches to practice worldwide.

No journey is without regret, and my inability to attend our ICM Congress in Jamaica still weighs heavily on my heart, as I looked forward to frontline observation of midwifery-led birthing centres as a goal to be realised globally.

However, in these inaugural six years together, we’ve beckoned the world to take another long and intentional look, which has in turn, caused me to hone in on the core causes and constructs I so passionately started with – mobilising resources to empower independent midwives, and harnessing the competencies of midwives as the backbone, and heart, of primary and community health.

We have signposted and amplified promising examples of research and policies which will shape the future of midwifery and have proudly recognised and championed some of the most hardworking hands in the realms of global health diplomacy. We have addressed and welcomed alliances with global organisations, the United Nations, African Union, ECOWAS and the WHO World Health Assembly, as well as celebrating remote village-level ward development committees as they continue to challenge stigma, and harmful cultural practices on behalf of the women and families in their care.

Many of us are aware by way of research that women from the black and minority ethnic classification are five times more likely to die from pregnancy and childbirth related complications. Indeed, in a world where racism has become a crisis, I appreciate, respect and applaud the courage of the ICM in choosing me, in 2014, a black African woman, as your first ever Global Ambassador – an organic action that speaks to the egalitarian inclusiveness of the International Confederation of Midwives, and the values of the midwifery profession, globally.

The introduction of the WBFA- JNJ- Liverpool School of Tropical Medicine and Hygiene’s highly specialised BEmONC and EmONC training gaining acceptance across Africa was an incredibly pertinent and refreshing moment for me, as a welcomed and proactive contribution directed at helping mothers to survive, babies to breathe and families around the world to continue celebrating a million more birthdays. WBFA’s new partnership with the Chelsea and Westminster Trust will cascade this innovative learning.

Excitingly, the London School of Hygiene and Tropical Medicine’s WOMAN Trial of tranexamic acid as an early intervention for post-partum haemorrhage was recorded in 2017, and the game changing Ferrings’ heat-stable Carbetocin arrived in this year – both reassuring signs of progress and impact that our ambassadorial advocacy for research-based support and intentional curriculae reaps and delivers results.

Each construct pertaining to health and wellbeing from birth to age and beyond – be it pregnancy and delivery, neonatal and infant feeding or boldly reinforcing the need for adolescents to understand sexual and gender-based violence – all contribute to building a more positive socio-economic road to maintaining our wellbeing. That being said, the entire spectrum of reproductive health has been and must continually remain a primary consideration.

By representing the significant and globally resounding voice of the ICM Midwives, we have recalibrated previously held misconceptions and re-assigned unattributed affiliations. The profession must continue to move forward in order to maintain the recognition it deserves for its contributions in improving sexual and reproductive health beyond just the physiological joining of mother and child. At different points along this momentous journey, midwifery has taken pride of place in reigniting and exemplifying a plethora of best practices for essential frontline Health workers, and has likewise birthed a series of incredibly poignant and monumental experiences within a space I am so truly proud to be advocating for.

Every victory counts, and I have rejoiced as nation-states begin appointing Chief Midwifery Officers. This call to action further reiterates the level of excellence and accountability implored by so many within this incredible profession. Regarding our original goal of Midwifery Education, I was particularly pleased to see the WHO AFRO launch a comprehensive curriculum setting a new standard for the training of midwives back in 2018.

To be crowning six years of ambassadorial achievements with the ICM in this 2020 Year of the Midwife and Nurse, is truly an unprecedented achievement. I remain hopeful that these years have been a catalytic culmination of intentional, educational and strategic efforts that offer a glimpse at centuries of quality advocacy, advancements and assistance. The call to midwifery is patience and perseverance personified. To safely nurture, be the first set of clean hands to touch and guide new life and initiate the first nourishing embrace between a celebratory woman and child is priceless. To do this on rotation, routinely, day in day out is heroic.

We have walked together and achieved the amplification of a vibrant and much-needed platform to celebrate, demonstrate and mobilise the heroic and admirable profession worldwide. The ICM’s leadership in representing, reconfiguring and increasing awareness of Midwifery globally is remarkable and unmatched.

This new decade started with the unique challenge of the Sars-Cov2 virus pandemic that has affected us all, yet pregnancy and childbirth wait for no-one, and front-liners continue to remain ever-ready for battle. The days ahead will require the intensification of resources, courage and commitment. Midwives have proven their mettle in the most daunting of circumstances, and it is time for the world, and the global health community to redeem the centuries of contributions that midwives have made to all our lives, and to community health.

In the vein of supporting the ICM as its midwives continue to stand with women, on the International Day of the Midwife, I joined the WHO, the Global Handwashing Partnership and Hygiene In Health Care Facilities Stakeholders in a resounding new commitment to “Applaud With WASH”.

We will, over this decade, mobilise and reinforce the key resources of water, sanitation and hygiene in health care facilities, to ensure that midwives and nurses clean hands can save more lives. We are confident that an internal approach to education will influence a more widely societal one.

As I bid farewell to the honorary role of Inaugural Global Goodwill Ambassador, I recall that we started our journey to claim the respect, recognition and resources for midwives with an African proverb, of ‘walking together, far and fast’ – in a succession of constant elevations; working authentically to strategize, take action and liberate women and girls from the constraints of family planning, child birth, and the other gender specific limitations they very often face. Our concepts of preparation and delivery have been very much centred around understanding, championing and reiterating the indelible bravery, resilience and selflessness of the millions of midwives who answer the ‘great call’ around the world each day. These particular efforts have been all the more powerful and pertinent because they have been achieved, with honourable dedication, repeatedly, and together.

Together, we have made great strides in authentically hailing a profession which charges each of us to wholeheartedly and strategically contribute to ensuring many more meaningful tomorrows. Our monumental six-year term of collaborative efforts and support for midwives alongside the ICM team has been invaluable. To work in close proximity with likeminded and driven people with an assurance of ‘togetherness’ in this profession as the word is defined, leaves me parting on an empowered, encouraged and excited note.

To all the incredible ICM Leaders, Council, Board and Teams; thank you for facilitating so many memories, key breakthroughs and positive affirmations along the way. Advocacy in itself is an unending journey. I am incredibly proud to be able to say that being the Inaugural Global Goodwill Ambassador for the ICM, will remain an unforgettable part of mine, and I am excited by the thought of new plans, possibilities and partnerships for healthy futures for women, girls and families – all with the midwives’ hands at my heart.

In this most wonderful Year of the Midwife and Nurse, as I appreciate the singular honour of serving the ICM for the last six years as its Inaugural Global Goodwill Ambassador, may I crown our collaborative advocacy efforts with one final African proverb, ‘a friend today is a friend for life.’

I assure the ICM, and every world midwife, that throughout this decade of action and delivery, I have pledged to mobilise resources in parallel to all your goals. At the ICM, you will always have a friend, supporter and partner in me, and in the Wellbeing Foundation Africa. Thank you ICM, and thank you world midwives, again and again, and again.

Thank you very much for your kind comment and question. I am delighted to be here alongside such brilliant champions for midwives and all frontline health workers, and as the proud Global Goodwill Ambassador for ICM. 

I must begin by commending ICM, in particular Franka and Sally, on their outstanding work and advocacy representing over 600,000 midwives through their 132 midwifery associations in 113 countries. As we discuss making the case for midwifery and promoting midwives as integral to a successful, caring and nurturing health system, ICM is leading the way with smart and powerful initiatives. I was particularly touched by the recent launch of the ‘Midwifery Leaders Showcase’ which tells the stories of midwives all over the world in a series of featured interviews. In doing so, ICM demonstrates the dynamic and diverse roles that midwives play in shaping policy, leading civil society organisations, influencing professional practice and creating a better and brighter future for women, newborns and their families. It also features the Wellbeing Foundation’s own much-missed and dearly departed Felicity Ukoko.

It was in fact ICM’s 50,000 Happy Birthdays campaign that was the key evidence which led the Wellbeing Foundation to partner with Johnson & Johnson and the Liverpool School of Tropical Medicine to bring anatomical skills models-based teaching to midwives and doctors alike. We are now trying to take those same skills to preservice level. 

I feel that the heart of midwifery competencies is directly relevant to your question – although I do advocate for midwives all over the world, I am aware that it is their stories and experiences which are the most powerful. Four years ago WBFA put midwives at the core of our programs to reach women and children across Nigeria and ensure they deliver safely and happily. Even when looking at new programs, I give our WBFA MamaCare midwives the platform to advocate themselves. For instance, alongside the WHO, Global Water 2020 and other partners, we recently launched a global WASH campaign, to improve water, sanitation and hygiene conditions in healthcare facilities, schools and communities. Whilst I am proud to lead the campaign, our best traction came from videos and accounts from our WBFA midwives, who took the materials to their communities and taught in their own inimitable style. In doing so, they make their own case for midwifery very successfully. They come across as they are – as Joy can attest, having visited MamaCare classes herself, WBFA midwives, like their colleagues all over the world, are motivated by a strong sense of duty and compassion. Their good humour and treasure trove of stories are the most persuasive qualities I know. 

So whilst we lead the way for midwives, it is midwives themselves who lead the way so brilliantly. Our role must be to give them the platforms to do so. 

Thank you again for the invitation to join you here today – and thank you most of all ICM for championing midwifery so effectively. 

As Founder-President of the Wellbeing Foundation Africa and Special Adviser to the Independent Advisory Group to the World Health Organization Regional Office for Africa, I commend today our partners,  philanthropies, NGOs, faith-based organizations, financial institutions, corporations, and universities as we join together at this historic convening to announce new and wide-ranging commitments to improve water, sanitation and hygiene (WASH) conditions in healthcare facilities. 

Amongst the many commitments made today, the Wellbeing Foundation has outlined its programmatic and advocacy promises to the world:

To disseminate information and advocacy regarding WASH standards through its influential MamaCare midwives and our partnership with Unilever Lifebuoy

To teach about WASH in healthcare facilities and schools

To continue its #WASHWednesday advocacy campaign

To develop our WASH for Healthcare Facilities Proper Cleaning programme.

Having successfully introduced and intensified our WASH for Wellbeing hygiene in health care facilities techniques to health workers and patients in over 570 medical facilities in 5 states of Nigeria, our challenge remains taking those standards to a national scale in Nigeria’s 36 states of the federation – to that end I was encouraged by the speech in November last year given by His Excellency President Muhammadu Buhari declaring a state of emergency in water, sanitation and hygiene in Nigeria and launching the National Plan of Action.

We know that this is a global challenge. 45% of healthcare facilities in ‘Least Developed Countries’ lack basic water services, and 1.5 billion people around the world have to use healthcare facilities without basic sanitation. The impact on infant and maternal mortality, pandemic and infection prevention and control, and antibiotic resistance, is devastating and well-documented.

The commitments made today, however, are truly unprecedented and reflect the impact of advocacy at local, regional and global levels.

In response to the UN Secretary General António Guterres’ Call to Action on World Water Day in March 2018, I retraced the steps of each of the programmes undertaken by the Wellbeing Foundation Africa and launched a new WASH campaign with the World Health Organization in Nigeria.

I committed to work with my partners in the global health and development communities to stop mothers and newborns from dying from preventable and unnecessary complications, simply because the most basic of WASH services are not available, and to ensure that all countries implement the 2017 World Health Assembly Sepsis Resolution. Hand hygiene must be a quality indicator in every facility and a national marker of health care quality, with access to soap and water monitored and assessed.

To that end I conducted high-level meetings at the US State Department, with the World Bank, and with Congress to accelerate progress on WASH – and in many cases reverse worsening trends and indicators.

 At the World Health Assembly last month in Geneva, I spoke in favour of the historic WASH resolution, and was delighted when, for the first time, the 194 WHO Member States joined together to acknowledge this global health crisis and move toward concrete action.

That resolution, combined with the unprecedented commitments made today, represent a leap forward in improving WASH conditions in Nigeria and around the world and have the potential to save millions of lives. Thank you to the frontline healthcare workers who will make that possible, and all of those here today for your vision and endeavour. 

Thank you to the Dutch Government, Bernard van Leer Foundation, the International Confederation of Midwives, and the Dutch Taskforce for Healthcare for hosting us and facilitating this 23rd Board Meeting.

I know that as we sit here in the Hague, all of our discussions are focused upon our shared value and commitment to ensuring that women’s, children’s and adolescents’ health (WCAH) is at the top of national, regional and global agendas. I think it is right, therefore, that the Board Meeting seeks to evaluate and enhance its political engagement at all levels.

At the World Health Assembly this year, alongside Helga Fogstad, PMNCH Executive Director, Dr Tedros Adanhom Ghebreyesus, WHO Director General, and Her Excellency Mrs Emine Erdogan, First Lady of The Republic of Turkey. I commended PMNCH’s Call to Action on Aligning Women’s, Children’s and Adolescents’ Health and Wellbeing in Humanitarian and Fragile Settings.

Given that more than two billion people live under the threat of conflict and emergencies of diverse and complex natures, and that 69 million people have been displaced by humanitarian crises, we need bold steps to enhance coordination and bring together synchronized knowledge, policies and actions for a whole-system approach to achieving health for all, routinely across nations, in order to build the resilience for effective responses in protracted emergencies and in the humanitarian-development nexus. That is why I so strongly support PMNCH’s initiative and call to action, which is best placed to bring us all together – from every sector, region, country and background – to remove the inefficiencies, identify and address gaps of capacity and delivery in every sense.

PMNCH is uniquely positioned to mobilise broader political strategies, and partnerships of all kinds, as it can act as the standard-bearer and interlocutor between the WHO, global institutions, CSOs, governments, the private sector and frontline healthcare workers. This support is invaluable to Governments and healthcare providers, who we can consider to be the duty-bearers. 

At the Wellbeing Foundation Africa, of which I am the Founder-President, we have learned the value which emanates from engagement with PMNCH in Nigeria, as members who supported the ‘Saving One Million Lives’ campaign, the promotion of routine administration of the reinforced ORS-Zinc formula for management of diarrhoea, and the Midwives Service Scheme, a public sector collaborative initiative, designed to mobilize midwives, including newly qualified, unemployed and retired midwives, for deployment to selected primary health care facilities in rural communities.

I must report from Nigeria that whilst there has been an improved focus on surveillance – and a growing acceptance of the fact that suitable civil registration and vital statistics systems will be essential if we are to achieve universal health coverage – I hope that these milestones in accountability also able to catalyse improved services at the frontline. That can only be achieved with expanded investment in primary health.

I strongly support the PMNCH position that we must put women, children and adolescents at the heart of universal health coverage. The relationship between achieving health for all and WCAH must be at the core of our advocacy as the former is simply unachievable without significant improvements to the latter. 

It is of course no coincidence that women, children and adolescents – despite accounting for 60% of the global population – tend to constitute the groups with the least political influence and power, which is why United Nations, WHO and national policies must explicitly highlight and focus on WCAH as part of their UHC strategies. 

Only then can we claim to be truly working towards the principle of “leaving no one behind,” which is central to the Sustainable Development Goals and the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030).

On a final note, as the Global Goodwill Ambassador for the International Confederation of Midwives, one of our co-hosts this week, I must highlight the launch at the World Health Assembly this year, of the report ‘Strengthening quality midwifery education for Universal Health Coverage 2030: A transformative approach to improving quality of care’ produced by ICM, alongside WHO, UNFPA and UNICEF. Women and newborns are the most vulnerable in humanitarian and fragile settings where quality midwifery education saves lives by preparing all midwives to legislate for and respond to emergency health situations. As a critical element in achieving UHC and WCAH, I am sure that we all know that midwives can and do lead the way.

As Nigeria’s first and oldest country member of this esteemed and dedicated alliance, I am honoured by the Wellbeing Foundation Africa’s PMNCH Board Observer Privileges, and delighted to extend a warm welcome to Helen Clark, former Prime Minister of New Zealand, as Chair of PMNCH – who I know will ensure that women’s, children’s and adolescents’ health and wellbeing are reinforced as a global priority. Thank you.

World Intellectual Property Organization (WIPO), AB Building, Salle A, 34, Chemin des Colombettes, CH-1211 Geneva 20, Switzerland

Tuesday, 21 May 2019, 13:00-14:30

Thank you to PMNCH for your timely and powerful call to action. As a Nigerian who has long worked with frontline healthcare workers to empower women, their infants and their communities to stay healthy, safe and to thrive, I know that if we are to achieve universal health coverage, and truly leave no-one behind, we must better align our investments and efforts taking a life-course approach to safeguard women, children and adolescents in humanitarian and fragile settings and uphold their human right to the highest attainable standard of health.

Given that more than two billion people live under the threat of conflict and emergencies of diverse and complex natures, and that 69 million people have been displaced by humanitarian crises, we need bold steps to enhance coordination and bring together synchronized knowledge, policies and actions for a whole-system approach to achieving health for all, especially in protracted emergencies and in the humanitarian-development nexus. That is why I so strongly support this initiative and call to action from PMNCH, which is best placed to bring us all together – from every sector, region, country and background – to remove the inefficiencies, identify and address gaps of capacity and delivery in every sense. 

As the Global Goodwill Ambassador for the International Confederation of Midwives I welcome the launch yesterday of the report ‘Strengthening quality midwifery education for Universal Health Coverage 2030: A transformative approach to improving quality of care.’  produced by ICM, alongside WHO, UNFPA and UNICEF. Women and newborns are the most vulnerable in humanitarian and fragile settings where quality midwifery education saves lives by preparing all midwives to prepare for and respond to emergency health situations. 

It lends significant weight to PMNCH’s initiative, as we seek to provide comprehensive training and support necessary for midwives to provide the full scope of services in situations which are often dangerous and highly prone to change. 

In a year when we have lost midwives, nurses and doctors on the frontline of healthcare, we all know how critical this initiative is. 

PMNCH is best placed to mobilise partnerships of all kinds, and can act as the standard-bearer and interlocutor between the WHO, global institutions, CSOs, governments, the private sector and frontline healthcare workers. This support is invaluable to Governments and healthcare providers as the duty-bearers. At the Wellbeing Foundation Africa we have learned the value which emanates from engagement with PMNCH in Nigeria, as members who supported the ‘Saving One Million Lives’ campaign, the promotion of and ORS formula and zinc for management of diarrhoea, and the Midwives Service Scheme, a public sector collaborative initiative, designed to mobilize midwives, including newly qualified, unemployed and retired midwives, for deployment to selected primary health care facilities in rural communities.  

We know that the road to universal health coverage does not rest upon one single static action, but on the spectrum of interventions and initiatives; from water, sanitation and hygiene standards in healthcare facilities to breastfeeding education and training for healthcare workers. In a country as large as Nigeria, resilience throughout the whole nation’s system is necessary if we are going to be able to tackle critical health emergencies in fragile settings, for example in the north-east. That is why a strengthened primary health care system is imperative as the foundation and bedrock of achieving health for all and should be a focal point for investment. 

I call on all partners and stakeholders to rally behind PMNCH, to support this initiative and most importantly commit to action which will make health for all a reality. Together we can make sure that no-one is left behind. Thank you.