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This article describes the program components, program outcomes and challenges of two iterations of a leadership development program that was intended to contribute not only to individual capacity building but also to succession planning within midwifery professional associations. The young midwifery leaders programs were similarly designed, using self-study modules that focused on essential leadership knowledge and skills, and a mentor–mentee relationship to provide guidance and support to selected midwives early in their professional careers. The International Confederation of Midwives (ICM) implemented a 3-year leadership program conducted from 2004 to 2007 for five mentee participants. A collaborative United Nations Population Fund (UNFPA)/ICM team in Latin America designed and implemented an 18-month program with 12 mentees that began in 2013. Examples of leadership outcomes in policy and education include assumption of elected offices in midwifery associations, integration of evidence-based topical content into an established midwifery education program, and development of a new preservice education program in a rural zone of a large country. The vision for the future is to expand this program globally while simultaneously adapting the program content and strategies to reflect the leadership needs of the regional context in which it is implemented.

The 2014 State of the World's Midwifery report included a new framework for the provision of woman-centred sexual, reproductive, maternal, newborn and adolescent health care, known as the Midwifery2030 Pathway. The Pathway was designed to apply in all settings (high-, middle- and low-income countries, and in any type of health system). In this paper, we describe the process of developing the Midwifery2030 Pathway and explain the meaning of its different components, with a view to assisting countries with its implementation. The Pathway was developed by a process of consultation with an international group of midwifery experts. It considers four stages of a woman's reproductive life: (1) pre-pregnancy, (2) pregnancy, (3) labour and birth, and (4) postnatal, and describes the care that women and adolescents need at each stage. Underpinning these four stages are ten foundations, which describe the systems, services, workforce and information that need to be in place in order to turn the Pathway from a vision into a reality. These foundations include: the policy and working environment in which the midwifery workforce operates, the effective coverage of sexual, reproductive, maternal, newborn and adolescent services (i.e. going beyond availability and ensuring accessibility, acceptability and high quality), financing mechanisms, collaboration between different sectors and different levels of the health system, a focus on primary care nested within a functional referral system when needed, pre- and in-service education for the workforce, effective regulation of midwifery and strengthened leadership from professional associations. Strengthening of all of these foundations will enable countries to turn the Pathway from a vision into reality.

In 2015, the International Confederation of Midwives (ICM) launched the Midwifery Services Framework (MSF): an evidence-based tool to guide countries through the process of improving their sexual, reproductive, maternal and newborn health services through strengthening and developing the midwifery workforce. The MSF is aligned with key global architecture for sexual, reproductive, maternal and newborn health and human resources for health. This third in a series of three papers describes the experience of starting to implement the MSF in the first six countries that requested ICM support to adopt the tool, and the lessons learned during these early stages of implementation. The early adopting countries selected a variety of priority work areas, but nearly all highlighted the importance of improving the attractiveness of midwifery as a career so as to improve attraction and retention, and several saw the need for improvements to midwifery regulation, pre-service education, availability and/or accessibility of midwives. Key lessons from the early stages of implementation include the need to ensure a broad range of stakeholder involvement from the outset and the need for an in-country lead organisation to maintain the momentum of implementation even when there are changes in political leadership, security concerns or other barriers to progress.

© 2018, © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Background: Many countries are responding to the global shortage of midwives by increasing the student intake to their midwifery schools. At the same time, attention must be paid to the quality of education being provided, so that quality of midwifery care can be assured. Methods of assuring quality of education include accreditation schemes, but capacity to implement such schemes is weak in many countries. Objective: This paper describes the process of developing and pilot testing the International Confederation of Midwives’ Midwifery Education Accreditation Programme (ICM MEAP), based on global standards for midwifery education, and discusses the potential contribution it can make to building capacity and improving quality of care for mothers and their newborns. Methods: A review of relevant global, regional and national standards and tools informed the development of a set of assessment criteria (which was validated during an international consultation exercise) and a process for applying these criteria to midwifery schools. The process was pilot tested in two countries: Comoros and Trinidad and Tobago. Results: The assessment criteria and accreditation process were found to be appropriate in both country contexts, but both were refined after the pilot to make them more user-friendly. Conclusion: The ICM MEAP has the potential to contribute to improving health outcomes for women and newborns by building institutional capacity for the provision of high-quality midwifery education and thus improved quality of midwifery care, via improved accountability for the quality of midwifery education.

In 2015, the International Confederation of Midwives launched the Midwifery Services Framework: a new evidence-based tool to guide countries through the process of improving their sexual, reproductive, maternal and newborn health services through strengthening and developing the midwifery workforce. The Midwifery Services Framework is aligned with key global architecture for sexual, reproductive, maternal and newborn health and human resources for health, and with the recommendations of the 2014 Lancet Series on Midwifery. This second in a series of three papers describes the process of implementing the Midwifery Services Framework: the preparatory work, what happens at each stage of implementation and who should be involved at each stage. It gives an idea of the scale of the task, and the resources that will be required to implement the Midwifery Services Framework in a given country context. The paper will be of interest to health policy-makers, development partners and professional associations in countries considering different approaches to strengthening their sexual, reproductive, maternal and newborn health services, and it will help them to decide whether and when either full or partial/staged implementation of the Midwifery Services Framework will be an appropriate initiative to address identified deficits in their specific context, given the current and projected availability of resources., Highlights • Investing in the midwifery workforce is an effective strategy for improving outcomes. • The Midwifery Services Framework (MSF) provides guidance on how to do this in a systematic way. • This paper explains how the MSF is implemented. • It is a multi-stakeholder, country-led process with several stages. • Commitment and resources from a range of stakeholders is necessary.

Changes in the river flood regime may be due to atmospheric processes (e.g., increasing precipitation), catchment processes (e.g., soil compaction associated with land use change), and river system processes (e.g., loss of retention volume in the floodplains). This paper proposes a new framework for attributing flood changes to these drivers based on a regional analysis. We exploit the scaling characteristics (i.e., fingerprints) with catchment area of the effects of the drivers on flood changes. The estimation of their relative contributions is framed in Bayesian terms. Analysis of a synthetic, controlled case suggests that the accuracy of the regional attribution increases with increasing number of sites and record lengths, decreases with increasing regional heterogeneity, increases with increasing difference of the scaling fingerprints, and decreases with an increase of their prior uncertainty. The applicability of the framework is illustrated for a case study set in Austria, where positive flood trends have been observed at many sites in the past decades. The individual scaling fingerprints related to the atmospheric, catchment, and river system processes are estimated from rainfall data and simple hydrological modeling. Although the distributions of the contributions are rather wide, the attribution identifies precipitation change as the main driver of flood change in the study region. Overall, it is suggested that the extension from local attribution to a regional framework, including multiple drivers and explicit estimation of uncertainty, could constitute a similar shift in flood change attribution as the extension from local to regional flood frequency analysis., Key Points A new framework for consistently attributing flood changes in a regionSpatial scaling of flood changes allows attribution of multiple driversBayesian framing allows estimation of the attribution uncertainties

In this paper, I explore the place of research in the theme ‘Midwives and women: together for the family of the world'. I begin by examining each of the concepts involved. What is the family of the world? Midwives: what do they contribute to the family of the world? Women: what do they contribute to the family of the world? Putting midwives and women together what is the impact on the family of the world. What is the place of research and what is its impact? I build an argument to show that midwifery research covers social, cultural and political spheres. It breaks the barriers between midwives and women and helps create a true partnership where there is interactivity rather than just one-way information giving from midwife to woman. Once midwives interact with women, they are more likely to persuade them and the world around the women to change their way of doing things. By evaluating what they do using research, midwives are able to capture the safe motherhood success stories and effect replication where needed. With research, midwives become unified, assertive, and mutually supportive in order to reinforce professional identity, accountability and autonomy in the delivery of quality care for women and their families. The family of the world therefore has a ready source of care and support, leadership, knowledge and policies that have been tried and tested to be effective in contributing to the health of women and their families.