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Most low- and middle-income countries failed to meet the Millennium Development Goal targets for maternal, newborn and child health, and even more ambitious targets have been set under the Sustainable Development Goals and the Ending Preventable Maternal Mortality initiative. This means that many countries will need to accelerate progress on sexual, reproductive, maternal and newborn health over the next few years. Recent years have seen the publication of a large and convincing body of evidence about the potential of midwifery to make a significant contribution to this acceleration, but little practical guidance has emerged to help countries invest in midwifery services so that their health systems can meet the increasing need for sexual, reproductive, maternal and newborn health care. To help fill this gap, the International Confederation of Midwives designed and launched the Midwifery Services Framework, a new tool to guide countries through the process of strengthening and developing their midwifery services. This first of a series of three papers introduces the MSF, explains why it is needed, how it was developed, its guiding principles and its anticipated outcomes and impact. The other two papers explain the process of implementing the Midwifery Services Framework, and lessons learned in the first countries to start implementation., Highlights • Acceleration is needed in progress on sexual, reproductive, maternal&newborn health. • Investing in the midwifery workforce is an effective strategy for improving outcomes. • The Midwifery Services Framework (MSF) provides guidance on how to do this. • This paper introduces the MSF, explains why it is needed and how it was developed. • It is a modular tool, applicable in all contexts.

[Introduction] In Africa over 24 million pregnancies every year are affected by malaria, with less than 5% of pregnant women able to access treatment or effective interventions (USAID). The Malawi National Malaria Control Programme established by the Ministry of Health and Population (MOHP) implemented a policy that all pregnant women should receive two doses of sulphadoxine-pyrimethamine (SP). This has become known as the intermittent presumptive treatment with SP (IPT-SP) policy. According to the guidelines, the first dose should be given “during the first antenatal visit occurring after the first trimester of pregnancy is complete”, and the second dose “at the beginning of the third trimester (between 28 and 34 weeks)” (MOHP, 1997). [Malawi Med J. Vol.14(1) 2002: 8-11]