Ensuring Greater Inclusivity and Representation at PUSH

Notes on our new Governance Structure from ICM Chief Executive, Dr. Sally Pairman

May 3, 2023

It’s challenging to get people to care about midwifery and midwives — this is a reality that I’ve consistently faced throughout my 40-year career as a midwife, and most notably in my role as Chief Executive of the International Confederation of Midwives (ICM). From this global vantage point, I’ve witnessed and supported the relentless efforts of our midwives’ associations to socialise the fact that midwives can meet about 90 per cent of the need for essential sexual, reproductive, maternal, newborn and adolescent health interventions (SoWMy 2021). The Lancet estimates that expanding midwifery care by 25 per cent over 5 years would result in 41% reduction in maternal deaths, and a 39 per cent reduction in infant mortality. This equates to 170,000 women’s lives saved and 1.2 million infants per year, by 2035 — yet often, this message falls on deaf ears. Why is this? Many reasons contribute to the marginalisation of the profession, but chief among them are the misconceptions and misinformation that plague midwifery, resulting from patriarchal, racist health systems that have ignored and silenced women’s and reproductive health for millenia. This misinformation campaign means that midwives often stand alone, or with limited support, in their efforts to advance the profession, and promote their potential and worth. 

So, how do we get more people, especially more women and gender diverse people, to understand midwifery as a pathway to reproductive autonomy and gender equality? 

This question has been a motivating factor in my career since the 1980s when New Zealand midwives and women partnered to successfully advocate for the reinstatement of midwifery autonomy and the implementation of a woman-centred and midwife-led maternity service, but in 2019, with just over ten years to go until the SDG deadline, we at ICM began to think seriously about how to dramatically widen the net of support for midwives. We knew from a growing body of evidence that increased investment in midwives educated to ICM standards and working to their full scope of practice as defined by ICM would be a direct pathway to ending preventable maternal and neonatal mortality and improving the status of women in their communities. But the challenge was convincing our colleagues in the gender equality and social justice sectors to champion midwives and midwifery in pursuit of their own advocacy objectives. 

Together with our members, partners, and funders, we hosted workshops to determine how to approach the challenge of getting voices outside of midwifery to care about our life-enhancing, life-promoting profession and the potential of its practitioners. From these workshops, we conceptualised the PUSH Campaign — at its core was the notion that success would be contingent on cross-sector participation and representation in order to foster true inclusivity and relevance. 

On this International Day of Midwives, I am proud to announce that PUSH is implementing a new governance structure critical to ensuring our campaign achieves its ambitious objectives and continues to resonate with the women and women’s groups it was designed to engage. This new structure will consist of 12 members representing every region of the world and possessing the skills and experiences that we, as midwives, don't have on our own. From media relations to philanthropy to policy advocacy, we’ve put together a team of global and regional leaders with the knowledge, dedication, and capacity to make more people care about, advocate for, and invest in midwives. ICM will maintain two seats on the steering committee, being a voice for the evidence and potential of a well-resourced midwifery profession in terms of lives saved and improved. We’ve also prioritised representation from marginalised groups within midwifery, including trans and Indigenous midwives, as well as early-career midwives. 

By transferring the governance of PUSH to a steering committee, we are allowing for greater participation and leadership from diverse groups and individuals who are passionate about advancing women’s rights and achieving gender equality. This new structure will ensure sustainability and continuity and enable PUSH to remain relevant and responsive to the evolving needs and priorities of women and midwives around the world, even as leadership and focus shifts over time. Importantly, this decision is in line with ICM’s commitment to promoting and strengthening midwifery globally. By sharing the leadership of the PUSH Campaign, we are creating opportunities for midwives and midwifery organisations to work more closely with partners from other sectors and gain more exposure to new approaches and ideas. This will ultimately benefit the profession and enhance the impact that midwives have in promoting maternal and newborn health.

We look forward to announcing the members of our esteemed PUSH steering committee in the next few weeks. In the meantime, happy International Day of the Midwife to midwives and all those who champion the rights and health of women — let’s PUSH forward together. 


Sally is a New Zealander who arrived in the Netherlands in January 2017 to take up the role of Chief Executive at ICM. Before that, she had a 35-year career spanning all aspects of midwifery – practice, education, regulation, professionalism and politics including roles as President of the New Zealand College of Midwives, inaugural Chair of the Midwifery Council of New Zealand, and Head of Midwifery, Professor of Midwifery, and Director of Learning and Teaching at Otago Polytechnic. Sally holds various academic qualifications including a Doctorate in Midwifery and has authored numerous papers and books including co-editing an Australasian Midwifery Textbook (now in its 5th edition). Sally is passionate about midwives and midwifery and believes strong midwives’ associations can incite changes in their countries to ensure strong midwifery professions and midwife-led continuity of care services for women and their families. In 2008 she was made a Member of the New Zealand Order of Merit for services to midwifery and women’s health. She is married to Michael Lucas, and the couple have two adult sons, Oscar and Felix.