Good morning. I am delighted to extend a very warm welcome to all of you to this International Day of the Midwife event, hosted jointly by the Wellbeing Foundation Africa and ACT Foundation.

• I pay tribute to our partners here today, all of whom are tremendous champions, advocates and representatives for midwives. The ACT Foundation of course, which supports our MamaCare programme in twenty healthcare facilities in Lagos. Thank you, as ever, to the National Association of Nigerian Nurses and Midwives; to the Ministry of Health, FHI360, and the Luth School of Midwifery. We are joined here today with a common vision and passion, and I am sincerely heartened by your presence and ongoing enterprise. 
• I stand before you today as the Global Goodwill Ambassador for the International Confederation of Midwives, commonly known as ‘ICM’, which represents 500,000 midwives, in 132 associations across 113 countries. Within that huge scope there are of course significant differences in the environments and conditions in which midwives operate. Wherever they work, however, midwives are the community leaders and interlocutors who are best placed to foster safe environments including, but also beyond, pregnancy, birth and breastfeeding. 

• As allies of midwives, it is incumbent upon us to advocate for the whole-system support to enable and elevate midwives as the key defenders of women’s rights – in Nigeria and around the world. Today I would like to alight on the critical elements of that whole-system support, with a particular focus on the role of women’s rights in light of the theme of this year’s International Day of the Midwife. I will also explain why I do not believe it is a coincidence that it is a day shared with ‘World Hand Hygiene Day,’ as water, sanitation and hygiene, or ‘WASH,’ is a critical factor in systemic progress for and with midwives. 

• Midwives are champions of women’s rights; but can only be effective if their rights are also secure. This includes the right for every midwife—and all health workers—to decent work and a safe and dignified workplace. Saving lives does not mean a midwife should risk her own. Sadly, as we all know, in the past year we have lost selfless Nigerian midwives. Too often midwives also suffer ‘burnout’ – from long hours carrying out a complex role, combined with the lack of basic infrastructure or professional support to deliver high-quality care. Many rural midwives represent the sole point of access to health care in remote and under-served areas. It is our first duty to keep the care-givers safe.  

• Whole-system support means providing midwives with the adequate tools, equipment, and medicine to provide the full scope of timely, high-quality care, and the capacity to carry out the WHO-recommended 8 antenatal visits. That can only be achieved through effective supply chain management and procurement, overcoming challenges related to drug selection, registration, quantification, procurement, storage and distribution, quality assurance, and information systems.  

• If 13 essential reproductive and maternal health-related commodities were more widely available, it is estimated that the lives of over 6 million women and children could be saved. Those commodities are as follows:

• Oxytocin – for post-partum haemorrhage (PPH) 
• Misoprostol – also for postpartum haemorrhage 
• Magnesium sulfate – for eclampsia and severe preeclampsia 
• Injectable antibiotics – to combat newborn sepsis 
• Antenatal corticosteroids (ANCs) – for preterm respiratory distress syndrome 
• Chlorhexidine – for newborn cord care 
• Resuscitation devices 
• Amoxicillin – for 
• Oral rehydration salts (ORS) – to treat diarrhoea 
• Zinc – also for diarrhoea 
• Female condoms 
• Contraceptive implants 
• Emergency contraception – family planning/ contraception 

• Each of these commodities form part of the toolkit with which we need to equip midwives. But they also need to be equipped with a career trajectory and security to benefit them and the communities that they serve. Health system managers, supervisors and policymakers need to better support midwives throughout their careers: from planning, for example for a midwife’s recruitment and deployment to a post, to providing supportive supervision and clinical mentoring and amplifying midwives’ leadership roles.

• Where midwives’ human resources metrics are not tracked, they cannot be managed. Thus, more data on midwives is needed: from midwifery schools on graduate profiles; from professional associations or councils on licensure, registration, and continuing professional development; and routine, robust, and up-to-date human resource information systems.  In addition, midwife-generated data streams can provide valuable feedback on how services are delivered and promote service improvements.  A comprehensive civil registration and vital statistics system must form the basis of health services and personnel decision making. That will, I have no doubt, provide the evidence needed to understand how midwives’ enhanced leadership roles can optimize health systems.

• I recently chaired a technical working group at SwitchPoint Conference in North Carolina, organised by IntraHealth International. Our focus was on gender equality and the workforce. Despite my many years of working with frontline health workers, I was shocked by some of the accounts of gender violence. As an absolute essential element of a functioning, decent and dignified health system, a midwife’s workplace must be free from sexual harassment and gender discrimination. According to a global survey conducted by the International Confederation of Midwives and the WHO,  37% of midwives reported that they have experienced harassment at work, whether from colleagues or patients. Effective interprofessional collaboration is important to keeping midwives’ workplaces safe.

• Safe workplaces also mean safe conditions of water, sanitation and hygiene: WASH. I am delighted that Dr Tedros, Director-General of the World Health Organization, has matched World Hand Hygiene Day with International Day of the Midwife. Midwives of course need clean water to facilitate a safe and healthy delivery and support families’ sanitation and hygiene needs across their lives. Everyone here today knows of healthcare facilities where midwives must pull buckets of water up from wells themselves; purchase their own examination gloves; chase livestock out of the health centre compound for lack of a proper fence; or dig makeshift pits to dispose of medical waste. 

• At the Wellbeing Foundation Africa, we launched a water, sanitation and hygiene campaign in May 2018, at the World Health Organization offices, in Abuja. We did so precisely because of the overwhelming evidence coming back to us from our frontline healthcare programmes that we had to retrace our steps – that WASH indices in Nigeria were not only poor; but were worsening in many instances. Poor WASH conditions endanger Infection Prevention and Control systems and put health workers and service users at risk. The fact that outbreaks of diseases have been so severe in Nigeria recently – with the WHO commenting that the Lassa Fever outbreak last year was unprecedented – is no coincidence. 

• Our MamaCare midwives began to advocate in healthcare facilities for better standards and taught proper handwashing techniques to staff. Their experiences informed our updated Personal, Social, Health and Economic (PSHE) education programme which takes place in schools, teaching staff and students alike the importance of good WASH standards. We already had the framework in place – and the trust of communities – to adapt our programmes to address a significant health risk, thanks to midwives. 

• But in a country of almost 200 million people we knew that we had to reach far beyond that. This is where the key relationship between frontline experience and the ability to improve capacity by achieving effective advocacy comes in. 

• As we launched the campaign last May, we announced that the Foundation would work with partners including Global Water 2020, an initiative based in Washington D.C. which is designed to accelerate progress toward water access and security for all people in developing countries, with a particular focus on increasing the availability of WASH in healthcare facilities.  A key element of that partnership is advocacy for improved WASH standards, both in Nigeria and around the world. As Special Adviser to the WHO Africa Regional Office, I strongly advocate for the WHO Sepsis Resolution to be adopted and implemented by all governments. In October 2018 the WHO introduced new and pioneering guidelines for WASH in conjunction with neglected tropical diseases. 

• In September 2018 the WBFA partnered with Unilever Lifebuoy Nigeria and Sightsavers to improve hygiene practices to impact more than 2 million children over the following 12 months. The partnership works on programmes which promote hygiene messages and prevent disease, advancing critical hygiene interventions such as handwashing with soap, addressing the issue of child illnesses and mortality due to preventable diseases.

• In many West African countries, data provided by UNICEF indicates that between 15 to 20% of newborn deaths in their first month of life are due to sepsis. According to the World Health Organization, improved access to WASH and improved handwashing for all health workers could help prevent infections, and the risk of sepsis in health facilities. We know what works for WASH standards: we must provide those standards and training for midwives. 

• As we are joined by our partners here today, I must also mention and commend them for our joint work on the Alive and Thrive programme.  I am delighted by the nucleus of critical host community support from the Lagos State Government and thank our Alive & Thrive programme partners, FHI360 for their technical support and oversight, the Association of General and Private Medical Practitioners of Nigeria, the Wellbeing Foundation Africa Team and all those involved in the organization of this conference. Thank you for your efforts as Nigeria unites to ‘Start Strong!’ for infant and child nutrition as part of a global movement.

• Alive & Thrive is an initiative to save lives, prevent illness, and ensure healthy growth and development through the promotion and support of optimal maternal nutrition, breastfeeding and complementary feeding practices in rural and urban Lagos as well as Kaduna.  Good nutrition in the first 1,000 days from conception to two years of age is critical to enable all children to lead healthier and more productive lives. Alive & Thrive works through a four-pronged approach:  policy and advocacy; interpersonal communication and community mobilization; mass communication; and the strategic use of data. Our midwives are crucial to each part of that approach and I cannot conclude my remarks here today without paying tribute to them for their work on this programme. 

• I must also pay a special tribute to our MamaCare midwives. They deliver classes in primary healthcare centres, hospitals, and at IDP camps, which are a frontline for women and their infants. Despite dire mortality rates in Nigeria – where women face around a one in thirteen risk of maternal mortality in their lifetime – we have not lost even one of our over 250,000 MamaCare mothers during childbirth. 

• Our MamaCare midwives have achieved this not only by providing classes to a global standard – and achieving the WHO benchmark recommendation of at least 8 antenatal visits – but also because they act as even more than lifesavers. They provide safe spaces and safe conversations: no subject is taboo or off-limits. They can only do this because they are part of the community that they serve. Too often, global institutions have faced push-back when trying to deliver services – examples that stand out to me include vaccinations and family planning provisions – because they attempt to do so as outsiders, without the trust of a community. 

• Placing midwives at the centre of our work gave us an army of community counsellors which has helped to drive the behavioural change to make women an empowered and informed partner. Midwives are the interlocutors between our Foundation, its aims, and women. 

• They should however become the interlocutors between every government and global institution and the communities that they serve.
  To achieve this, we must enabling and elevate midwives with whole-system support – as ‘Defenders of Women’s Rights.’ Thank you.