Table 1 Potential midwifery roles across the emergency disaster management cycle according to key guidelines and statements

SRH in crisis multi-agency guidelines

Integrate SRH into disaster risk reduction/ mitigation, emergency preparedness and response plans

Make sure SRH is included in disaster risk reduction/ mitigation, emergency preparedness and response plans: allocate human and financial resources to see this happen.

Address laws, policies and practices that affect whether people in crises can access SRH services:

a. Address laws, policies and practices for SRH for stable settings:

Build resilience by addressing SRH in laws, policies and practices for stable settings.

(WHO [3]; UNISDR [25])

b. Assess laws, policies and practices for SRH in crises:

Review and develop national and local frameworks of laws, regulations and policies, ensuring the coherent integration of SRH and DRR.

(UNISDR [25])

c. Include vulnerable populations:

Develop and adopt specific policies and practices for the inclusion of women, adolescents, newborn, displaced, disabled and other vulnerable groups in humanitarian settings.

(WHO [3]).

d. Clarify and implement coordination policies and procedures:

Ensure clear policies are in place at all levels for the coordination of SRH services and supplies (WHO [3]).

Involve the community, particularly vulnerable groups in monitoring:

Develop and implement early warning systems by establishing community networks to monitor hazards, vulnerabilities and capacities at a local level.

(WHO [3])

Identify and reduce risks for vulnerable communities and SRH services by reducing underlying risk factors…“by ensuring strong primary health care and preventive health measure with key provisions for SRH (and advance gender equality)” (WHO [3]:3).

Identify and prepare human resources, infrastructure, funding, & supply, information and logistics systems.

a. Identify and estimate capacity:

Locate and assess existing human resources for SRH (WHO [24])

b. Engage existing resources:

“Prepare existing SRH services to absorb impact, adapt, respond to and recover from emergencies” (WHO [3]:3) by integrating disaster risk management into primary, secondary and tertiary health care (UNISDR [25]:4/6).

c. Develop relevant curricula/ training courses:

Systematically include health emergency risk management, emergency response planning and the MISP in the curricula for SRH workers, and health and emergency management workers more broadly. (WHO [3]:3).

Enhance training capacities in disaster medicine and encourage the implementation of disaster risk reduction approaches in health work.

(UNISDR [25])

d. Ready supplies:

Pre-position SRH supplies, including reproductive health kits in support of MISP implementation

“Undertake population-based health education around the needs of women and babies before, during and after birth with a particular emphasis on danger signs and when and where to seek care” (WHO [24]:2). “Integrated SRH messages into health sector and non-health sector-driven public awareness campaigns and educational materials about disaster risk management” (WHO [24]:2).

Midwifery scope of practice

WHO/ ICM

Midwives included in strategic disaster planning and midwifery integrated into disaster risk reduction/ mitigation, emergency preparedness and response plans:

a. Advocacy:

ICM urges Member Associations to advocate to institutions and government for the inclusion in disaster preparedness and response plans for midwifery services and the equity and social justice elements needed to deliver these services. (ICM [21])

b. Strategic Planning:

ICM and WHO encourage the active participation of midwives in strategic disaster preparedness and response planning activities with institutions and government.

(ICM [21]: Position statement 2014_003).

(WHO [20]: 8).

Address laws, policies and practices that affect whether people in crises can access midwifery services:

a. Assess and develop laws, policies and practices:

ICM and its Member Associations will work in leadership and partnership with involved organisations to address legal, policy and practice support for access to midwifery services in crises.

(ICM [21]); (ICM [65]:

b. Ensure equity and access:

ICM will amplify the voice of women and children affected by disasters by advocating to ensure equity and equality in access to health services during and directly after a disaster.

(ICM [21]: Position statement 2014_003)

Identify and prepare midwives to be effective in disaster/ emergency situations

a. Provide information and facilitate training:

ICM will “[p]romote the dissemination and facilitate access to knowledge, information, and training on disaster/emergency preparedness for midwives” (ICM [21]: Position statement 2014_003 p2).

b. Understand local disaster typologies:

ICM encourages Member Associations to familiarise themselves with local disaster/ emergency realities and associated health needs, and to disseminate this understanding to members.

c. Systematically train midwives to be effective in emergency situations:

Midwives should be prepared to plan for and respond to disasters by incorporating disaster/ emergency preparedness and response into current curricula, and providing continuing education opportunities on disaster midwifery.

(ICM [21]: Position statement 2014_003)

The MISP

Ensure an organisation is identified to lead the implementation of the MISP;

-RH Officer in place

-Meetings to discuss RH implementation held

-RH Officer reports back to health cluster/ sector

-RH kits and supplies available and used

Prevent and manage the consequences of sexual violence;

-Protection system in place especially for women and girls

-Medical services and psychosocial support available for survivors

-Community aware of services

Reduce HIV transmission;

-Safe and rational blood transfusion in place

-Standards precautions practiced

-Free condoms available

Prevent excess maternal and newborn death and illness;

-EmONC services available

− 24/7 referral system established

-Clean delivery kits provided to birth attendants and visibly pregnant women

-Community aware of services

Plan for comprehensive sexual and reproductive health care, integrated into primary health care, as the situation permits.

-Background data collected

-Sites identified for future delivery of comprehensive RH

-Staff capacity assessed and trainings planned

-RH equipment and supplies ordered

Additional priorities:

a. Continue family planning

b. Manage symptoms of STIs

c. Continue HIV care and treatment

d. Distribute hygiene kits and menstrual protection materials

Disaster Midwifery Scope of Practice:

ICM &WHO

Leadership:

“Regardless of command structure it is often the person on the scene who takes initial leadership” (WHO [20]:8).

Sexual Violence:

“…assist in efforts to mobilise the necessary resources for midwifery care in disaster/emergency situations, giving special attention to vulnerable groups” (ICM [21]: Position Statement 2014_003 p3).

WHO list of core competencies for nurses and midwives in emergencies includes: “Practical competencies to treat people with special needs, i.e. vulnerable groups and addressing gender-based violence” (WHO [20]:10).

Reducing HIV transmission

a. Standard precautions in care during pregnancy, labour and post-partum period:

“…the principles of infection control often need to be emphasised” (WHO [20]: 6)

“ICM…believes that Personal Protective Equipment (PPE)- latex gloves etc.- should be available to midwives at an affordable cost” (ICM [66]).

“Midwives are urged to accept their responsibility [by]…Following universal precautions when handling body fluids and at other times of handling infected or potentially infected blood or blood stained products” (ICM [66]: Position Statement PS2008_006).

b. Minimising transmission of HIV during birth:

“Working in partnership with medical staff and women agreeing the optimum method of birth to minimise mother-to-foetus transmission” (ICM [66]: Position Statement PS2008_006).

c. PMTCT: “Midwives are in a unique position to support breastfeeding and safe infant feeding during times of natural disaster or emergency, thereby protecting the health of infants in these circumstances” (ICM [21]: Position Statement 2014_003 p3).

“Working in partnership with women to determine the optimum method of feeding the newborn to prevent vertical transmission, and providing support for the implementation of the woman’s choice of feeding method” (ICM [66]: Position Statement PS2008_006).

d. Free condoms for post-partum health and general sexual and reproductive health: “ICM…urges midwives, in their capacity as professionals and members of communities to be educators as well as practitioners in working to prevent the spread of HIV and provide care and treatment as it becomes available” (ICM [66]: Position Statement PS2008_006).

Prevent excess maternal and neonatal mortality and morbidity:

“ICM urges Member Associations with regard to disaster/ emergency response to:”

-Encourage midwives to continue to provide ongoing care and support to women during childbirth [which encompasses pregnancy, birth and the postnatal period], and to lactating women.

-Work with existing capacities, skills, resources, and organisational structures.

-“Care for midwives and others who provide direct services” (ICM [21]: Position Statement 2014_003 p3).

“A key gap is responding to the psychosocial needs of nurses and midwives affected by emergencies…” (WHO [20]: 15).

Planning and collecting background data:

“ICM will:

…-Contribute to assessments and reports on MNCH during and after disasters/emergencies through partnerships with other relevant organisations and international networks” (ICM [21]: Position Statement 2014_003 p2).

WHO list of core competencies for nursing and midwifery in emergencies includes: “competencies for needs assessment and planning, providing and managing care: situation and needs assessment” (WHO [20]: 10).

Additional priorities:

a. Midwives involved in family planning:

“ICM supports the right of women to control their pregnancies, and takes every opportunity at regulatory, educational, and political level to enhance this right by…”

-participating in the strategic planning, provision and evaluation of services which enable women to plan their pregnancies and prevent unwanted;

-ensuring all women have available to them family planning services which are appropriate, accessible, cost-effective (or free of charge), and women-friendly;

-providing quality advice and support to women in a way and at a level which is relevant to their needs;

-“…strengthening midwives role in pre-conceptual health education for adolescent and school age groups to prevent unplanned and adolescent pregnancies” (ICM [67].

b. Clinical care during pregnancy, labour and post-partum include managing symptoms of STIs and/or ARVs (ICM [66], 2008: Position Statement PS2008_006: “ICM…underlines that all HIV positive pregnant women have a right to access anti-retroviral drugs for themselves and their newborns”).

SRH in Crisis Granada Consensus

Mainstream SRH in all health policies:

Integrate and mainstream SRH in all health policies and strategies to revitalise and strengthen the health system during recovery.

Develop partnerships and synergy between humanitarian and development actors:

Prevent gaps and loss of SRH services as the crisis moves from acute to post-acute phases through partnerships between development and humanitarian actors. This should include ensuring funds and a commitment to sound health recovery plans, policies and strategies.

Disaster Midwifery Scope of Practice:

ICM &WHO

Advocacy and strategic planning