Ensuring respectful maternity Care
International Childbirth Initiative (ICI)

12 Steps to Safe and Respectful MotherBaby-Family Maternity Care

Advocating rights and access to care
Protecting the MotherBaby-Family triad
Promoting wellness, preventing illness and complications
Supporting women’s autonomy and choices to facilitate a positive birthing experience
Providing a healthy and positive birthing environment
Using an evidence-based approach to maternal health services

Join us for a webinar on the 12 steps and the experience of Hôpital Brome-Missisquoi, Quebec (in French only)

Watch the 12 Step Webinar Series

Download as an MP3

The White Ribbon Alliance’s Elena Ateva describes the implementation of Step 1:
Provide Respect, Dignity and Informed Choice

Treat every woman and newborn with respect and dignity, fully informing and communicating with the woman and her family in decision making about care for herself and her baby in a culturally safe and sensitive manner ensuring her the right to informed consent and refusal. Incorporate a rights-based approach, preventing exclusion and maltreatment of the marginalized and socioeconomically disadvantaged, and including protection of HIV-positive women and women who experience perinatal loss. Under no circumstances is physical, verbal or emotional abuse of women, their newborns and their families ever allowed.

Download the presentation

Elena Ateva is an attorney and human rights advocacy who is the Advocacy Manager for the White Ribbon Alliance.
Access WRA’s Respectful Maternity Care Charter: The Universal Rights of Women and Newborns here: https://www.whiteribbonalliance.org/r…
Resources here:

Mercy in Action’s Vicki Penwell talks about the experience of following Step 2 at birth centers in the United States and in the Philippines.

Provide Free or Affordable Care with Cost Transparency.

Respect every woman’s right to access and receive non-discriminatory and free or affordable care throughout the continuum of childbearing. Inform families about what charges can be anticipated, if any, and how they might plan to pay for services. Make costs for prenatal education and antenatal, intrapartum and postpartum care visible, transparent and in line with national guidelines. Include risk pooling for complications (no additional charge for caesarean delivery or other complications). Forbid under-the-table payments and routinely enforce this rule. Under no circumstances should a woman or baby be refused care or detained after birth for lack of payment.

View WHO’s 2020 statement on hospital detention and policy solutions: statement on hospital detention and policy solutions.

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Professor Soo Downe, Ann Yates (International Confederation of Midwives, Evita Fernandez and India Kaur (Fernandez Foundation) present Step 3:

Routinely Provide MotherBaby-Family Maternity Care.

Incorporate value- and partnership-based care grounded in evidence-based practice and driven by health needs and expectations as well as by health outcomes and cost effectiveness. Base care provision on what women want for their newborns and families during the childbirth continuum. Optimize the normal bio-psycho-social processes of childbirth by promoting the midwifery philosophy and scope of practice for most women, within a system that ensures multi-disciplinary collaboration, communication and care for women and newborns, including those with obstetric-neonatal risk and/or complications. Ensure that this MotherBaby-Family care model is available at all levels of care and in any setting and is provided by individual skilled health workers with the full scope of competencies, or within a team with combined competencies.

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Join the International Childbirth Initiative


The International Childbirth Initiative (ICI): 12 Steps to Safe and Respectful MotherBaby-Family Maternity Care provides clear steps for implementing evidence-based maternity care worldwide, acknowledging the interaction between the MotherBaby dyad, family and environment as well as their interactions with health providers and health systems. The ICI supports the implementation of the 12 steps with quality improvement mechanisms that can be used to monitor the process, effect and engagement in safe and respectful maternity services.

ICI is open to new health facilities who wish to participate and receive recognition through the Initiative. Please contact the Executive Committee if you are a health care provider or represent a facility interested in engaging with ICI.

ICI also remains open to partner organizations who are willing to endorse and promote ICI in their region.  Organizations who would like to discuss partnership can write to the Committee for next steps.

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ICI Partners

The ICI values its partner organizations, from the foundational organizations who created the original Initiative document in 2018 to those who implement ICI on the ground and steer its committee today. We welcome all organizations with a heart for the health and well-being of mothers, babies, and families to join us.

Founding Organizations


Endorsing Organizations



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Implementing partners

Countries with participating ICI facilities

Global map indicating ICI participation

ICI is recruiting new facilities for its 2021 cohort, with 19 countries engaged at various stages of the recognition process.  If your health facility or organization would like to apply or engage with ICI, please contact us for more information on the first steps. 


The initiative is steered by a small voluntary Executive Board representing partner organizations.

Geraldine Nyaku, Executive Committee
Soo Downe, Executive Committee
Carlos Fuchtner, FIGO President
Dr. André Lalonde, Executive Committee Co-Chair
Debra Pascali-Bonaro, Executive Committee Co-Chair
Claudia Hanson, Executive Committee Member
Suellen Miller, Executive Committee Member
Geraldine Nyaku, Executive Committee

Geraldine Nyaku, Executive Committee

Geraldine Nyaku is an ardent women’s rights advocate who has worked in civil society for over seven years. She is currently the National Coordinator for White Ribbon Alliance Zimbabwe. Geraldine brings extensive experience in advocacy for children and women’s rights, gender-based violence, and national legislation to the Alliance. She holds a BA Law degree from the University of Johannesburg and professional trainings on advanced human rights from the Centre for Human Rights, University of Pretoria; comprehensive sexuality education from ActionAid Zimbabwe; and is an alumna from the Young African Leaders Initiative from USAID and the University of South Africa.  She has worked with diverse communities at grassroots level and with different government structures from local authorities to ministries and policy makers to advocate for the rights of women and children. She brings her multifaceted leadership style and innovative solutions to improve and promote maternal and newborn health and rights both in the national and global alliance.

Soo Downe, Executive Committee

Soo Downe, Executive Committee

Soo is a member of the International Mother Baby Childbirth Organization, and of the ICI Board. She spent 15 years working as a clinical and research midwife. In 2001 she joined the University of Central Lancashire where she is now the Professor of Midwifery Studies. Her main research focus is the nature of, and cultures around, normal birth. She has been a member of the Technical Working Group of the World Health Organization antenatal, intrapartum, postpartum, and optimising caesarean section guidelines. She has published over 160 peer reviewed papers, and has undertaken research using a wide range of qualitative and quantitative methods. She is a member of the NHS England Better Births national Stakeholder group. She was the founder of the International Normal Birth Research Conference Series.

Carlos Fuchtner, FIGO President

Carlos Fuchtner, FIGO President

Dr. Carlos Fuchtner was Extraordinary Professor of Obstetrics and Gynecology at Hospital Municipal de la Mujer from 2009 to 2015 in Bolivia, President of the Bolivian Obstetrics and Gynecology Society from 2000 to 2002, President of the FLASOG from 2005 to 2008. In 2010 he was awarded Honorary Fellowship Society SOGC and in 2014 MAESTRO of Latin American Obstetrics and Gynecology in Ecuador.

Dr Fuchtner has been actively involved in numerous aspects of FIGO’s work for many years, including being a member of FIGO’s Executive Board from 2002 to 2005 when he represented FLASOG, and from 2012 to 2018 representing SBOG. Dr Fuchtner became President FIGO on 19 October 2018. Dr. Fuchtner selected ICI as the Presidential Initiative for his term.

Dr. André Lalonde, Executive Committee Co-Chair

Dr. André Lalonde, Executive Committee Co-Chair

Dr. André Lalonde has developed extensive knowledge and expertise in several areas of women’s health such as: risk management; assessment and development of collaborative care models; health programs to meet the unique health needs of aboriginal population; development and implementation of clinical practice and consensus guidelines; consumer health education programs; capacity building of health delivery systems in Canada and in low resource countries.

His expertise includes the implementation of safe motherhood programs, reduction of maternal mortality and morbidity programs and audits, management of clinical services in hospitals, risk management, sexual reproductive health, and partnership programs with low resource countries.

Dr. Lalonde has been responsible for the development and implementation of several maternal and newborn care risk management programs which are currently implemented across Canada (MOREOB, ALARM).  In recent year, he was instrumental in integrating the ALARM International program in over twenty low resource countries as a method to address maternal mortality and morbidity and strengthen obstetric and gynecological societies. He has been active in partnerships with family physicians, nurses, midwives, and other stakeholders involved in reproductive health at the national and international level.


Debra Pascali-Bonaro, Executive Committee Co-Chair

Debra Pascali-Bonaro, Executive Committee Co-Chair

Debra Pascali-Bonaro is a dynamic leader and inspirational speaker who has utilized her extensive experience, training, and acquired skills in perinatal care to develop community-based programs as well as consulting and trainings to create optimal models of maternity care.  Recognized internationally for her expertise, she has become a sought after speaker and recognized authority in MotherBaby models of care, perinatal doula care, comfort techniques in labor and birth as well as creating her acclaimed online childbirth birth class Pain to Power Childbirth. She directed an award-winning documentary focusing on physiologic birth and co-authored a related book.

Since 2007, Debra has been the Chair of the International MotherBaby Childbirth Organization (IMBCO), an ongoing international initiative promoted by working with global Leaders, grassroots organizations and Ministries of Health to promote optimal MotherBaby care through a human rights approach with the International MotherBaby Childbirth Initiative (IMBCI).  Debra has also been a part of a number of National Boards and Initiatives. including Childbirth Connection, CIMS with the Mother-Friendly Childbirth Initiative, Lamaze, DONA, and Advisor to ICEA and the Birth Sanctum.

Debra has numerous published works, has authored two books, directed a film, and has been featured on ABC’s 20/20, Good Morning Russia, The NBC Today Show, Discovery Health, in The New York Times, The LA Times, The UK Times as well as numerous Parenting and Health Magazines around the world. Debra has spoken in 40 countries reminding parents and practitioners that birth can be full of respect, pleasure, and love.

Claudia Hanson, Executive Committee Member

Claudia Hanson, Executive Committee Member

Claudia Hanson is an Associate Professor (Obs & Gyn, PhD) working in Maternal Newborn health research at Karolinska Institutet, Sweden, and London School of Hygiene and Tropical Medicine (LSHTM), UK. She is working on global maternal and newborn health since the early 1990s. She leads several research projects in Africa and Asia focusing on quality improvement, capacity building, and health system strengthening and is passionate to make delivery a safe and joyful event everywhere in the world.

Suellen Miller, Executive Committee Member

Suellen Miller, Executive Committee Member

Professor Suellen Miller is Director of the Safe Motherhood Program and Professor, UCSF Dept. of Obstetrics and Gynecology. Professor Miller has been practicing as a certified nurse-midwife since l977, in private and public practices, and is the author of the Hesperian Foundations’ “A Book for Midwives,” which has been translated into French, Spanish, Nepali, and Urdu. She conducts both qualitative and quantitative research, mainly in lower resourced settings, primarily focused on maternal survival and maternal health.  Her studies include the clinical trials of the Non-pneumatic Anti-Shock Garment (NASG) and the continuum of maternal care in Peru, Dominican Republic, Bangladesh, Nigeria, Egypt, Ethiopia, Zambia, Zimbabwe, Timor Leste, and Tanzania. She is currently Principal Investigator on an NIH-funded study on community reintegration for women having had fistula repair surgery in Uganda and the integration of NASGs in 300 primary health care centers and ambulances in rural Tanzania. The author of over 100 peer-reviewed journal articles, Professor Miller is co-author of “Beyond Too Little Too Late, Too Much Too Soon,” in the Lancet 2016 Maternal Health Series as well as author of one on the seminal works on Respectful Care, Quality of care in institutionalized deliveries:

The Paradox of Maternal Mortality in Dominican Republic, 2003 . She is currently co-editing special sections of the BMC Reproductive Health Journal: one on Female Genital Cutting/Mutilation and one on Respectful Maternity Care.