The Aachen Declaration
On
Midwifery for All
1st European Congress for Out-of-Hospital Births,
Aachen, Aken, Aix-la-Chapelle, Germany
28 September – 01 October 2000
The 1st
European Congress for Out-of-Hospital Births ('The Congress'), meeting on 01
October, 2000, in Aachen, Aken, Aix-la-Chapelle, Germany, unanimously adopt the
following Declaration set out hereunder,
1. Having
regard to
(i) the recognition
by the United Nations (UN) and the World Health Organisation (WHO) that the
attainment of the highest possible standard of health is a basic human rIght
(ii) the adoption of
gender equity as a key principle by UN, WHO, the European Union (EU) and other
agencies
(iii)
the adoption of
the new public health approach by EU Member States recognising the right of
citizens to assume responsibility for their own health, and the need to
re-orient health care from centralised, tertiary curative services to disease
prevention and health promotion at primary health care level
(iv) the UN Beijing
Declaration of 15 September 1995 stating that women's rights are human
rights, reiterating women's right to control all aspects of their health,
advocating sustainable primary health care for women, demanding gender equity in
health care, recognising that women's life events are often treated as medical
problems leading to unnecessary surgical intervention and inappropriate
medication, affirming the social
significance of motherhood and maternity; and women's right of access to
appropriate and safe maternity services
(v)
the EU Council
Resolution of 8 June 1999 stating that improvements in public health can only be
achieved by responding to the concerns of citizens (1999/C 200/01)
(vi)
the EU Council Resolution of 4 December 1997
highlighting the lack of reliable and comparative data on women's health
(vii)
the WHO Safe
Motherhood Initiative
(viii)
the WHO Making
Pregnancy Safe Programme
(ix)
the WHO Health21
health for all policy for the European Region
(x)
the WHO Care
in Normal Birth concluding that a midwife is the
most qualified professional to take responsibility for normal pregnancy
and birth, that this responsibility includes risk assessment and diagnosis of
complications, and that midwifery for all
is the most cost-effective form of maternity care
(xi)
the EU Directive of 21 January 1980 on the
mutual recognition of midwifery qualifications, the effective exercise of the
right of establishment, and the freedom to provide midwifery services
(80/154/EEC)
(xii)
the EU Directive of 21 January 1980,
defining minimum standards in midwifery education, and specifying the scope of
midwifery practice, including the power and responsibility to diagnose
pregnancies at risk, and to recognise signs of abnormality in the mother, and in
the infant, which necessitate referral to a doctor (80/155/EEC)
(xiii)
the EU Directive of 11 December 1986 on the
application of the principle of gender equity to the area of self-employment
(86/613/EEC)
(xiv)
the EU Directive of 22 June 2000 reducing
the working time of doctors in training, which, it is generally believed, will
result in the widespread closure of obstetric units throughout EU Member States
(2000/34/EC amending 93/104/EC)
2. Considering
(i) the commitment
of the European Union to maximise both health and social gain for women
(ii)
that the provision of maternity care to the
435 million women in the European Region of
WHO is a major public health issue,
given that four out of five women become mothers,
(iii)
the high maternal and infant mortality and
morbidity rates in many EU Member States
(iv)
the spiralling Caesarean section and
instrumental delivery rates in most of the EU Member States
(v) that maternity
care services are in crisis in many EU Member States, due, in part, to the
high
numbers of midwives leaving the profession, and to an ever-increasing scarcity
of resources within the tertiary care sector which is compromising maternal and
child health
(vi)
the low breast-feeding rates in many EU
Member States
(vii)
the significant variation in women's access
to primary midwifery care throughout the
European Region of WHO
(viii)
that midwifery has been significantly under-utilised
as a force for health and social gain
in the vast majority of EU Member States
(ix)
the potential of midwifery, which is based
on a social, holistic and physiological approach
to childbirth, to provide safe,
high-quality, and sustainable
services for women in childbirth
at primary health care level
(x)
that the
provision of social support by midwives in high-risk pregnancies is an essential
measure for improving the physical and emotional health of mothers and babies
both during and after birth, for the promotion of good parenting, and for
increasing the breast-feeding rates
(xi)
the need for sustainability in health care
systems
(xii)
that the dominant model of maternity care in
almost all EU Member States is medical, and
that this results in the wasteful
provision of costly tertiary care services, leads to unnecessary medical intervention, and causes
iatrogenic damage in childbirth
(xiii)
that at least 80 per cent of women have
normal pregnancies and births, which require solely midwifery services at
primary health care level
3.
THE CONGRESS HEREBY DECLARES AS FOLLOWS:
1.
Maternity care policies should henceforth
form an integral part of all public health policies,
at local, national and
European levels.
2.
Such policies should recognise midwifery as
a distinct and separate profession
from nursing, and from obstetrics.
3.
EU Member States should introduce
legislation strengthening the separate and
autonomous nature of midwifery as a
profession.
4.
Continuity of care from a domiciliary
midwife at primary health care level from conception
through to six weeks after
the birth should be recognised as the single most important strategy in the
promotion of maternal and child health in the European Region of WHO.
5.
EU Member States should introduce changes in
national health and insurance systems
privileging midwifery care.
6.
EU Member States should introduce
legislation giving midwives powers and responsibilities in the provision of
maternity care services at community level equal to those currently held by general medical practitioners.
7.
EU Member States should introduce
legislation giving midwives
prescribing rights in the
matter of drugs and other requisites necessary for the
practise of their profession; referral
rights; hospital admission, practising
and discharge rights; and certification rights in the matter of unfitness to
work in pregnancy, and in relation to birth, and perinatal death.
8.
EU Member States should ensure that national
health and insurance systems give midwives equal remuneration with general
medical practitioners and with obstetrician/ gynaecologists for the provision of
services to women for normal birth.
9.
EU Member States should introduce
legislation mandating the collection and publication of
statistics in maternity
care, measuring perinatal and maternal outcomes by care provider, and
obliging
maternity hospitals to collect and publish annual statistics on medical
interventions,
such as Caesarean section.
10.
A charter of rights for women in childbirth, which
recognises the right of all women to
continuous, one-to-one care from the
midwife of their choice, should be drawn up.
11.
Equality of midwifery representation with nursing and
medical representation should be
recognised as a gender mainstreaming measure in
maternity care and related services,
and in maternity care policy-making
structures at local, national and international levels.
12.
The European Union should fund the establishment of a
European Institute of Midwifery,
to provide for the educational, research and
training needs of midwives.
