19/06/2026
🇨🇾The project at the ICM Congress: From Dialogue to Action on Respectful Maternity Care
At the International Confederation of Midwives (ICM) Congress, Nicos Middleton presented the Cyprus project and its journey towards promoting Respectful Maternity Care (RMC) through research, stakeholder engagement, and collaborative action.
🎯 The focus of the presentation
The presentation gave an overview of the project and highlighted the participatory and inclusive process used to initiate a national dialogue on maternity care in Cyprus, bringing together a diverse set of stakeholders to identify challenges, co-produce solutions, and take action.
🧩 From barriers to solutions
Among the RESPECT resources presented were:
📍 The stakeholder-generated socio-ecological map of barriers to Respectful Maternity Care
📍 The National Strategy for Respectful Maternity Care, structured around four pillars
📍 Key research findings and the recommendation to institutionalise routine monitoring of women's experiences of maternity care
📍 Professional development programmes focusing on communication skills and shared decision-making
📍 Women's empowerment workshops and online training on rights, informed choice, informed consent, and assertive communication
📍 The WHO-based Respectful Maternity Care checklist for maternity services
📍 The RESPECT public awareness campaign and related educational materials, including the research-informed RMC lexicon, and the animated video "When Standard Practice is not Practicing Standards"
💬 A lively discussion
The presentation generated considerable interest and many questions from the international audience.
❓️ One topic that attracted particular attention was Cyprus' very high section rate. Many participants were surprised by the figures and asked what measures are being taken to address the issue.
❗️The discussion highlighted that Cyprus now has a National Strategy for the promotion of physiological birth but it is too soon to see impact; and perhaps, too optimistic too, since caesarean section rates are not simply a clinical problem to be solved in isolation.
They are closely connected to wider issues including:
🔹 Models of care and the absence of midwifery-led care options
🔹 Medicalisation of birth within a decentralised and fragmented maternity care system
🔹 Weak interprofessional collaboration
🔹 Loss of skills related to physiological birth and VBAC
🔹 Liability concerns and defensive medical practices
Many of these factors were identified directly by stakeholders through the RESPECT project.
🤝 The question we enjoyed most
❓️One participant asked: "How did you manage to bring so many stakeholders together?"
❗️The answer was that bringing people together was only the first step.
The real challenge was keeping them in the room 🤣 and engaged throughout a project that required talking not only about respectful maternity care, but also about experiences of disrespectful maternity care.
It was not easy! Of course, there was resistance. There was pushback. There were difficult conversations. At times there was even confrontation and backlash.
The session chair (from the USA) wondered whether this was partly due to the social capital and personal connections that exist in a small country like Cyprus.
Certainly, being a small country helped. But trust, persistence, transparency, and a willingness to continue the conversation, especially when it became uncomfortable were equally important.
🏡 Home birth, freebirth, and trust
❓️The questions also touched on home birth and freebirth (as there was a presentation in the same session on the topic from the UK on a study undertaken by the Midwifery Council)
❗️Home birth remains extremely rare in Cyprus and in the margins as it is not currently supported or integrated into the maternity care system, like in orher countries.
Participants from other countries (UK, US, Australia) described growing rates of freebirth as one possible symptom of declining trust in maternity services.
Cyprus is not facing this phenomenon. Yet the discussion served as an important reminder that Respectful Maternity Care is ultimately about trust.
Trust between women and professionals.
Trust in services and institutions.
And trust that every woman will be heard, respected, informed, and supported throughout her maternity journey.
🔗 All RESPECT project resources, reports, training materials, videos, and tools are freely available at:
https://birthforward.com/our-work/projects/respect/
