Overview of the MANA Core Competencies Revisions

In 2008 the International Confederation of Midwives took a serious global look at the health of mothers and babies and developed a series of core documents to support the growth and utilization of midwives throughout the world. In June 2011 the ICM Council endorsed new global midwifery standards for education, regulation, and association – the “3 pillars” for the profession. The World Health Organization uses the ICM Core Competencies to inform midwifery organizations and government agencies to improve the health of mothers and babies world-wide.

In March 2013 the MANA Document Committee prepared a side-by-side comparison document of the ICM and MANA Core Competencies to identify where these two documents were aligned and where they differed. At this time both ACNM and MEAC were engaged in similar work.

The goals for the MANA Core Competencies revision were:

• to bring them in line with the ICM Core Competencies as they apply to US midwifery, and
• to make our language inclusive and welcoming to all who seek midwifery care.

Bringing the Core Competencies In Line With ICM Core Competencies

Examples of changes made to the Core Competencies:

• Inclusion of environmental concerns such as access to clean water. Although this is often a concern in developing countries, there are areas in the US where pollution makes a community water supply unsafe.
• Including the ICM Core Competencies concerning abortion that apply to US midwifery, with sensitivity to the politically controversial nature of this topic, and that relate to providing information and support for decision making regarding timing of pregnancies and resources for counseling and referral.
• Expanding cultural awareness and sensitivity to the needs of communities of color and the LGBTQ community: Human rights and their effects on the health of individuals, including issues such as domestic violence, genital circumcision, gender equity, gender identity and expression, and how their expression affects health outcomes.

Making Our Language Inclusive and Welcoming To All Who Seek Midwifery Care

The MANA Core Competencies is a policy-level document and should address the full scope of any midwife’s potential practice. With that in mind, MANA opted to revise the Core Competencies to reflect all of the clients MANA midwives serve. The group that worked on these Core Competencies, like all our documents, included members of the Document Committee and the Board. After moving through the various steps and being reviewed by many MANA members as well as the entire MANA board, input on the final draft was solicited from Indra Lusero, JD, genderqueer parent and former Director of the Transgender Military Initiative; from Shafia M. Monroe, MPH, DEM, CDT, Founder and President of the International Center for Traditional Childbearing; and from the other Allied Midwifery Organizations including MEAC, NARM, NACPM, AME and CfM. We received suggestions and additions which we incorporated. The revised Core Competencies were approved via consensus decision of the full MANA board.

MANA is the national midwifery organization that represents the “Big Tent” where all midwives can feel valued and find support for their work. MANA is keenly aware of the social determinants of health. There are many issues of disparities to marginalized communities, such as the disparities in pregnancy outcomes among communities of color, and culturally inclusive issues and language reflect our goal of creating a document that can speak to all the diverse communities across the nation who can benefit from midwifery care.

Whereas pregnancy, birth and breastfeeding are unique to the female sex, there are those who seek midwifery care who do not gender identify as women. Increasingly, health care providers are needing to develop a basic level competency to understand the difference between sex and gender reality and an awareness that there is not a simple binary regarding both sex and gender, that there are more than two manifestations in human reproduction and in the psychology of gender identification.

Considering the national initiatives challenging health care professionals to provide gender neutral services and gender inclusive health care materials, we committed to a document reflective of these national trends and consistent with our values. In the process of crafting these revisions to our Core Competencies, many of the midwives involved found ourselves undergoing a paradigm shift and realized that many of these issues and practices apply more broadly to include other family members. Changing to gender neutral language reaffirms the midwives’ goal with relationship to the whole family system.

Inclusion is about membership and belonging. It is a process that acknowledges and supports the meaning of equal worth and equal rights. Inclusion promotes the growth of self-esteem. Inclusive language helps us all learn to be more aware, sensitive and humble to the needs of each family system and the devastating effects of marginalization. No individual wants to be singled out or identified as “different” or less worthy. As long as a single client is excluded from the midwifery community, all clients are potentially vulnerable to discriminatory treatment.