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Last chance saloon or a ray of hope? COP26 climate change and midwifery practice

In this important blog, Lorna Davies RM, PHD. PGCE(A), Principal Lecturer, School of Midwifery, Otago Polytechnic, New Zealand, discusses the COP 26 climate summit. She calls  for midwives, as public health professionals, to be aware and responsive to the current climate emergency.


On 31st October 2021, the 26th UN Climate Summit (COP 26) opened in Glasgow and is planned to run until 12th November. During this significant summit, leaders and delegates from governments around the world, business leaders, scientists, faith groups, and those representing indigenous peoples and NGO’s are gathering to make decisions around the current climate emergency which will have ramifications for humanity and the future of the planet.  COP26, the latest in a series of summits that have been convened since 1995, is considered to be the most important meeting since COP21 in Paris six years ago. During the 2015 event, the delegates pledged to take measures to hold “the increase in the global average temperature to well below 2°C above pre-industrial levels and pursuing efforts to limit the temperature increase to 1·5°C.” (UNFCCC 2021). They also agreed  to find more ways of providing  financial and technological support to low resource countries.

The blueprints of what the extensive cuts in the carbon emissions might look like for their individual countries were to be presented at COP26 in 2020, until the advent of a global pandemic put this on hold for a year. Tangible strategies from all of the participating nations are essential if the promises that have been made over the last three decades are to have any real impact. The call on those attending, in a nut shell, is to stop all new fossil fuel projects immediately and to begin to phase out all coal, gas and oil extraction and processing.

COP26 carries the weight of forging an existential defining moment and as Prince Charles recently stated at a pre-COP meeting in Rome  this is “quite literally our last chance saloon” and that we must “now translate fine words into action” (Walker 2021). This  may sound melodramatic but the current  decade is viewed by many scientists and others as the last opportunity to take  serious action if we want to mitigate the very worst  effects of  climate change and extreme weather events that will affect all our lives forever. We need only consider the language used to describe this current predicament to sense an increasing sense of urgency as we have moved from ‘global warming’ and ‘climate change’ to ‘climate crisis’ and ‘climate emergency’.

Clearly, at a macro level the ball lies firmly in the court of politicians and big business, but we also have a responsibility on a less grandiose scale to raise both our consciousness and awareness of the issues.  We need to look seriously at the things that we can do to mitigate the damage occurring and influence governments and businesses  to make the necessary changes. Most of us are aware of the things that we can do in our personal lives that may help on a small scale at least to reduce  the carbon emissions that are causing so much destruction to our planet. However, perhaps the question of how  the ominous crisis of climate change relates to us  as midwives at a professional level is perhaps less obvious.

By affecting our environment,  climate change impacts on the social determinants of health such as our food supply, the air that we breathe, our drinking water and our homes and livelihoods. Clearly this has a significant link with health and wellbeing  and this means that health care and health care professionals become important elements in the climate change debates. It is predicted by the WHO  (2021) that climate change will increase morbidity and mortality considerably particularly in parts of the world with poor health infrastructure who will not be able to prepare and respond the problems created by extreme weather events. These effects will be caused by a number of different causes including physical injury from weather events, heat stroke, increasing pollution, food scarcities and poverty, waterborne disease, respiratory problems, changes in the location of vector such as mosquitos in Northern Europe bringing, mental health issues and the consequences of tension and conflict.

Many of these causes and effects will affect women and their families and  will therefore have a direct influence on maternity services, midwifery practice and the care that we give.  All healthcare workers including those in maternity care,  need knowledge and understanding in order  to be prepared to take action to negate or at least ameliorate climate threats. This means that health education and health promotion strategies are key factors in any strategy (Femia & Werrell, 2015). We  need to be lobbying for action on the effects of climate change.  It currently feels as though there is a very minimal focus on climate activism  within the sphere of midwifery practice even though there has been a burgeoning of sustainable health organisations within many countries and health care systems in recent years, where members are militating to varying degrees. Additionally, serious academic exploration of the broad subject area of sustainability in relation to midwifery is acutely limited and midwives do not appear to be exceptionally visible in the health and climate change organisations  surfacing around the world (Davies 2017).  All of this makes the need for education within midwifery curricula both at under and post-graduate levels and within the field of research an imperative.

Collaborating and co-operating with other health care professional groups is a further tactic. The field of inter-professional education is developing, but perhaps as well as clinical simulations, time could be given to sharing sustainability literacy in this context which would open the door for climate change awareness and action. From an interdisciplinary perspective, the Lancet Report on Climate Change, (Watts et al. 2019) suggests  that climate change could be a “global health opportunity” to reframe healthcare structures and practices and that this will require the  involvement of  all of those groups involved in the health services globally.

In a practical sense midwives need to consider the resources that they are using and whether they could scale back at all or use alternative products.  The use of technology, communication media, transportation and equipment create a significant carbon load in practice.  Martis (2020) advises that we have professional duty and accountability to critically reflect on what we use in practice in terms of resources that we take for granted.  One way to address this is by adopting the concept of a carbon handprint rather than footprint. This is when the positive environmental impact of using a product or service throughout its life cycle is considered (Hayward 2012).  Sustainability literacy in education would provide the knowledge of how to audit the life cycle of a product (Davies, Harre and Kara 2020)

Healthcare has an important part to play in addressing climate change at every level at which it operates and it needs hard evidence that the voices of authority are listening. Consequently, the voice of healthcare is being heard at COP26. Over 45 million health workers represented by more than 450 health organizations from 102 countries have written and signed an open letter to the delegates of COP26 calling for urgent climate action to protect health and wellbeing globally.  Our own International Confederation of Midwives (ICM) is one of those organizations. The statement on the ICM website claims that a midwife-led model of care is essentially environmentally sustainable that should have little call for medical intervention or excessive resources. The call for action states that

“investing in midwives and their status and autonomy is investing in solutions to the impacts of climate change” (ICM 2021). 

The ICM Board unanimously  accepted a proposed  position statement on midwifery and climate change in 2014 at the ICM Congress in Prague. The Position Statement offers the following  recommendations for the profession.

  • Be aware of the scientific consensus that global climate change is occurring and that human behaviours are making significant contributions.
  • Incorporate the health implications of climate change for childbearing communities into midwifery education and professional development.
  • Recognise the importance of midwifery input in climate change policymaking at national, regional, and global levels and aim to achieve representation wherever possible.
  • Encourage government agencies to strengthen public health infrastructure to ensure that the global health effects of climate change can be anticipated and responded to more efficiently within childbearing communities.
  • Encourage midwives to serve as role models for promoting environmental sustainability and play an active role in educating women and their families on sustainable practices.
  • Conduct research to further inform the climate change agenda in relation to both midwifery practice and the impact of climate change on the childbearing community.

(ICM 2014)

I would suggest that every midwifery organisation in the world needs to take up the clarion call and keep these principles at the forefront of any policy development of decision making.

The idea that COP26 will end on a note of disappointment with further unresolved promises and rhetoric that is never eventuated, is a hard thought to bear. However, as I have outlined in this short article, there are things that we can do at a professional level to help to promote the climate change agenda in health care and promote understanding of what is at stake amongst colleagues and the women and families that we work with.  Midwifery is in so many ways  the archetypal sustainable healthcare profession that predates medicine and other healthcare fields. Midwives are the most enduring healthcare professionals.  We have shown strength and resilience over millennia when faced with yet another body of opposition.  Once again, we will have to learn additional ways of doing and being in order to meet the challenges from climate change that we will be facing in the decades to come.  In so doing we will be protecting the interests of a new generation who deserve to be born into a world that is worth inheriting.





Davies, L. (2017) Midwifery: A Sustainable Healthcare Practice? Unpublished thesis. Accessed 3rd November 2021

Davies, L,.Harre, N., and Kara, K. (2020) A values-based approach to sustainability literacy in a Bachelor of Midwifery programme in Sustainability, Midwifery and Birth. London. Routledge.

Femia, F., and Werrell, C. (2015)“Tag Archives: Rear Admiral Neil Morisetti «.” Exploring the Security Risks of Climate Change. Accessed March 24.

Hayward, B. (2012)  Children, Citizenship and Environment: Nurturing a Democratic Imagination in a Changing World, London, Routledge

ICM (2021) COP26- Midwives and the impact of climate change. accessed 2nd November 2021

Martis, R. (2020) Good housekeeping in sustainable midwifery practice in Sustainability, Midwifery and Birth. London. Routledge.

UNFCCC (2021)  What is the Paris agreement? Accessed 4th November 2021

Walker, P. (20221) Cop26 ‘literally the last chance saloon’ to save planet – Prince Charles. The Guardian.

Watts, N. Amann, M., Arnell, N. et al  (2019) The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. The Lancet.  394, 10211:1836 – 1878

World Health Organisation WHO (2021) Climate change and health. Accessed 3rd November 2021


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