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

The Initiative

The International MotherBaby Childbirth Organization (IMBCO) and the International Federation of Gynecology and Obstetrics (FIGO) have joined forces developing a single global initiative to provide guidance and support for safe and respectful maternity care, building upon their previous work and incorporating the most recent evidence and insights into what constitutes optimal maternal and newborn health.

Launched in 2018, this 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 also supports the implementation of the 12 steps and self-initiated quality improvement mechanisms that can be used to monitor the process, effect and engagement in safe and respectful maternity services.

​We believe that implementation of the 12 steps will lead to better health and wellness for mothers and their babies, with more positive birth experiences and a better start to life within an environment of strong emotional attachment. It has been endorsed by health professionals’ organizations, advocacy groups, and childbirth education organizations and support is growing.

The 12 steps include promoting compassion and dignity in care provision, ensuring access to affordable care and adopting midwifery and family-centered care guidelines. Other steps include the provision of continuous companion support in labour and birth, appropriate use of non-pharmacologic and pharmacologic pain relief and evidence-based practice including avoidance of unnecessary routine procedures. The steps address measures to enhance health and wellness and appropriate emergency care with collaboration and communication between levels of care. ICI also promotes a supportive human resource policy and fully incorporates the Baby-Friendly Hospital Initiative (BFHI).

ICI also supports the implementation of the 12 steps and self-initiated quality improvement mechanisms that can be used to monitor the process, effect and engagement in safe and respectful maternity services.



An Introduction to ICI

Joining the International Childbirth Initiative

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Stay informed. Sign up for News Updates on the Initiative

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



Commonsense Childbirth

Bixby Center for Global Reproductive Health UCSF

Harvard T.H. Chan School of Public Health

American College of Nurse Midwives

Midwifery Today

Midwives Alliance of North America

The Sanctum Natural Birth Center

International Council of Nurses

Bumi Sehat Foundation

International Childbirth Education Association (ICEA)

Lamaze International

International Pediatrics Association (IPA)

International Confederation of Midwives (ICM)

International MotherBaby Childbirth Organization (IMBCO)


International Federation of Gynaecology and Obstetrics (FIGO)

DONA International

White Ribbon Alliance for Safe Motherhood (WRA)

Mercy in Action

Every Mother Counts

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.

Carlos Fuchtner, FIGO President
Dr. André Lalonde, Executive Committee Co-Chair
Debra Pascali-Bonaro, Executive Committee Co-Chair
Kathy Herschderfer, Executive Committee Director
Claudia Hanson, Executive Committee Member
Suellen Miller, Executive Committee Member
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.

Kathy Herschderfer, Executive Committee Director

Kathy Herschderfer, Executive Committee Director

Midwife and Researcher with more than 20 years of experience in community midwifery practice in the Netherlands. She later combined midwifery practice with a position as midwife-researcher working in national and international coalitions. Between 2003 and 2008 she was the Secretary General of the International Confederation of Midwives, representing the midwifery profession in the international arena and advocating for the improvement of the quality of maternal and newborn health. Between 2008 and 2012, she worked as senior advisor Reproductive Health and Rights for the Royal Tropical Institute in the Netherlands, working primarily in post-conflict situations and in fragile states. Since then, she has worked as a freelance consultant- advisor in Reproductive Health for UN agencies, NGO’s and research institutes.

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.