About

Anna af Ugglas joined ICM in 2025. As Chief Executive, Anna is responsible for leading ICM and ensuring that the organization sets and achieves its strategic priorities. She works closely with the ICM President, Board and the Head Office Leadership Team. Prior to joining ICM, Anna brought over 33 years of professional experience as a midwife and educator.

What is the current status of progress towards SDG 3 related to reducing maternal and newborn mortality, and how does this relate to crisis preparedness?

Progress towards Sustainable Development Goal 3 is falling behind, especially on target 3.1, which aims to reduce the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030. From the UN Report on trends in maternal mortality, 260 000 women died in 2023 because of complications from pregnancy or childbirth – roughly equivalent to one maternal death every two minutes. These deaths are largely preventable — yet progress has stalled, particularly in countries affected by conflict, climate shocks, and fragile health systems.

Today’s world is facing more frequent and intense crises driven by climate change, war, natural disasters, and political instability. These emergencies have a devastating impact on health systems and hit women and girls the hardest. In humanitarian settings, 60% of preventable maternal deaths occur, and one in five women face sexual violence, increasing the risk of unwanted pregnancies and sexually transmitted infections. Yet sexual and reproductive health and rights (SRHR) are often overlooked in response planning.

To meet global health targets, we must recognize that crisis preparedness and maternal health are deeply connected. Midwives can provide up to 90% of essential sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) services, even in the most challenging settings. Excluding midwives and midwifery associations from preparedness and response efforts is effectively sidelining SRHR — which sets back progress toward SDG target 3.1 altogether. 

What role do midwives play in reducing maternal and newborn mortality, particularly in crisis situations? 

During a crisis, midwives play a critical role in reducing maternal and newborn mortality, especially during crises when health systems are under strain or have collapsed. Midwives are often the first and only point of care in emergencies. The role of the midwife is comprehensive: even during crisis, they offer women antenatal and postnatal care, ensure safe births, manage complications including pregnancy loss, support breastfeeding, provide contraception and comprehensive abortion care, and respond to gender-based violence. They are also trained to recognize and address the mental health and psycho-social needs of women and newborns — needs that are often heightened in crisis situations.

Midwives are uniquely positioned to respond rapidly. Based in the community and trusted by those they serve, they can distribute resources and accurate information, deliver care with minimal resources, and maintain continuity for those facing crisis-related complications. In many cases, aid takes time to arrive, but midwives are already there — with the knowledge, networks, and adaptability to act quickly and effectively.

How can competency-based education and simulation-based training enhance midwives' abilities to respond effectively in emergencies?

In the updated ICM Essential Competencies, there is now a competency specifically focused on the ability to provide midwifery care for women and newborns affected by humanitarian crises. This reflects the reality that midwives are increasingly expected to deliver care in complex, high-stress environments — and highlights the need for them to enter the workforce already equipped with the knowledge, skills, and behaviors to respond effectively.

Competency-based education and simulation-based training are essential for preparing midwives to meet these demands. These approaches move beyond theory, enabling midwives to build practical skills and confidence in managing emergencies. Simulation tools allow midwives to safely practice handling obstetric complications like postpartum hemorrhage, sepsis, and pregnancy loss, especially in low-resource settings.

There are several examples of effective tools that can be used:

• The ICM–Laerdal digital learning solution helps students develop and refine core clinical skills they will use throughout their careers — especially in high-stakes situations.
• The WHO’s Basic Emergency Care (BEC) program is another important resource. Designed for frontline health workers in low-resource settings, the BEC program trains nurses and midwives to recognize and manage life-threatening conditions using a systematic, practical approach to triage and emergency response. It focuses on core skills such as airway management, shock treatment, and trauma care — all of which are crucial during health emergencies when midwives may be the only providers available.

Together, these tools and approaches ensure that midwives are not only prepared for day-to-day care — but also ready to deliver lifesaving interventions when crises hit.

Since maternal mortality is on the rise in some high-income countries, what lessons can HICs learn from LMICs that have focused on reducing maternal mortality and morbidity, especially during humanitarian crises?

Maternal mortality is on the rise in some high-income countries, like the United States, largely due to inequities, fragmented health systems, and underinvestment in midwifery and community-based care. In contrast, several low- and middle-income countries (LMICs) have made progress by scaling up midwifery and prioritizing continuity of care at the community level — even in times of crisis. 

For example, Bangladesh has invested in midwifery education and deployed thousands of midwives in rural areas, contributing to a significant decline in maternal mortality over the past two decades. Sri Lanka achieved one of the world’s lowest maternal mortality ratios in the Global South by integrating midwives into its public health system and ensuring home-based care during emergencies. In Rwanda, midwives have played a central role in rebuilding the health system post-conflict, helping reduce maternal mortality by more than 70% since 2000. 

These countries show that strong, community-rooted midwifery care is both effective and adaptable. High-income countries can learn from this by investing in midwives, expanding access to culturally safe, person-centred care, and ensuring that vulnerable populations are not left behind — especially in times of crisis.

What can be done to ensure midwives are included in crisis preparedness and response strategies?

To ensure midwives are fully included in crisis preparedness and response strategies, we need both policy change, commitment and action.

First, governments and humanitarian actors must formally recognize midwives as essential health workers in all emergency frameworks. That means including them and the national midwifery associations in national disaster and health emergency plans, ensuring they are consulted in decision-making processes, and giving them leadership roles where appropriate. Midwives should not be seen as optional — they are central to maintaining essential services, particularly for women, newborns, and adolescents.

Second, we must invest in midwives’ education, training, safety, and access to resources before a crisis occurs. This includes ensuring midwives are well educated and trained in emergency preparedness, equipped with emergency birth kits, and supported with mental health and psychosocial resources.

We can look to Japan as an example. There, midwives are not only involved in preparedness planning but are also fully integrated into the health system’s emergency response. They participate in regular emergency drills, have access to emergency kits, and follow established protocols to continue providing care during disasters such as earthquakes, floods, and typhoons. This level of integration ensures that midwives can act quickly, maintain continuity of care, and contribute effectively to coordinated health responses when emergencies strike.

Finally, there must be stronger collaboration between midwifery associations, emergency response agencies, and health systems at country level. Midwives are deeply embedded in their communities and bring vital insight into local needs. Their expertise must shape how we plan for and respond to emergencies.

How can national midwifery associations be strengthened to improve midwifery practices and support the profession, particularly in times of crisis?

National midwifery associations are key to strengthening the profession and supporting midwives. They can provide training, advocacy, and professional support, and serve as a vital link between midwives and health system leadership. To fulfill this role, associations need sustained investment — in leadership, funding, and integration into national health and emergency frameworks.

During our 2024 Regional Conferences in Europe, Africa, and the Eastern Mediterranean, ICM delivered a hands-on workshop titled “Midwives: Essential Humanitarian Responders” to all participants. These workshops focused on strengthening midwives’ preparedness, raising awareness of their role in emergencies, and building the capacity of midwifery associations to lead during crises. Strong associations mean stronger midwives — and stronger health systems that can face any crisis.

How do you envision partnerships developing in the years leading up to and beyond the end of the SDGs, especially regarding midwives' roles in crises?

As we approach the final stretch of the SDGs and face growing global crises, partnerships must become more targeted, inclusive, and sustainable. To truly protect the health and rights of women, newborns, and gender-diverse people, governments, donors, civil society, humanitarian actors, and professional associations must collaborate not just to respond to emergencies, but to prepare for them. Midwives must be recognized as essential to this work. This means investing in midwives before crises hit — through training, integration into emergency plans, and inclusion in decision-making. At ICM, we believe the partnerships of the future must focus on readiness, equity, and resilience, ensuring that when emergencies strike, midwives are equipped to respond, and no one is left behind.

If you had a wish related to the future of midwifery education that also includes crisis response, what would that be?

If I had one wish for the future of midwifery education, it would be that all midwives graduate fully prepared to respond to crises — not as an add-on, but as a core part of their training. This is now clearly reflected in the ICM Essential Competencies, which includes the ability to provide care during humanitarian emergencies. Every midwife should develop these skills before entering the workforce.

I'm a strong believer in simulation-based learning as a powerful tool to build competence and confidence. My wish is for midwifery and medical students to regularly practice crisis scenarios together — both during pre-service education and on-site in their health facilities, involving all relevant healthcare providers. The insights and teamwork developed through repeated simulations and debriefings are invaluable.

When a crisis hits, it’s too late to start learning or dividing roles. Simulation prepares teams to respond safely, effectively, and together — exactly what’s needed when the unexpected happens.

What is one question you wish would be asked more often, and what is your reply?

Too often, health systems are caught off guard when emergencies strike — and vital time and lives are lost because roles, responsibilities, and systems aren’t clearly defined in advance. Preparedness is rarely talked about enough, especially at the national level, and that needs to change.

I also wish there were more recognition of the critical role midwives can play in Maternal and Perinatal Death Surveillance and Response (MPDSR). When midwives are meaningfully involved in these reviews, they help turn every loss into actionable learning and accountable preparedness — something that’s urgently needed in both stable and crisis settings.

Finally, we need more data on the short- and long-term effects of crises on women and newborns. We’ve seen, through the work of institutions like Panzi Hospital in the DRC, the deep, lasting trauma faced by survivors of sexual violence. But we still know far too little about the broader impact (on their children, families, and societies) or the cost of rebuilding when women are left without access to midwives and SRH services.