In a coordinated effort to modernize maternal healthcare across the continent, more than 200 midwifery leaders, senior educators, and civil society organizations have called on the European Commission to implement more rigorous EU midwifery standards. The collective action, submitted on May 7, 2026, seeks a more ambitious revision of the legal framework governing the profession to ensure that the quality of care for women and newborns remains consistent across borders.
The effort was coordinated by the International Confederation of Midwives (ICM) and took the form of an open letter addressed to European Commission President Ursula von der Leyen and Executive Vice-President Roxana Mînzatu, who oversees social rights, skills, and quality jobs. The signatories argue that the current trajectory of policy updates is insufficient and fails to reflect the complexities of modern clinical practice.
At the heart of the dispute is the revision of Directive 2005/36/EC, the European Union’s primary mechanism for establishing minimum professional qualifications for midwives. This directive is not merely a bureaucratic requirement; it is the engine that enables the automatic recognition of qualifications across Member States and the European Economic Area (EEA), directly impacting workforce mobility and the standard of care provided to millions of patients.
According to the signatories, the Commission’s proposed changes to the directive are too limited. They contend that the current proposals ignore critical input from more than 96 stakeholders across 24 countries and fail to integrate the latest scientific evidence and international benchmarks.
The Gap Between Policy and Clinical Reality
The primary concern cited by the professional collective is the misalignment between EU law and global health benchmarks. Midwifery leaders argue that the updated directive must fully align with the ICM Global Standards and the World Health Organization (WHO) guidance on Midwifery Models of Care. These frameworks provide the essential competencies required for safe, evidence-based practice in the 21st century.
The practical implications of this policy gap are significant. In several Member States, the outdated directive is being treated as a maximum standard rather than a minimum. This creates a ceiling for midwifery education and practice, effectively preventing the profession from evolving and restricting the ability of highly trained midwives to move between countries to address staffing shortages.
This stagnation creates a fragmented landscape of care. While some European nations have advanced their midwifery protocols, others remain tethered to an obsolete legal minimum, resulting in systemic inequalities in the quality of maternal and neonatal healthcare available to women depending on their geography.
| Framework | Primary Purpose | Current Status in EU Revision |
|---|---|---|
| Directive 2005/36/EC | Sets minimum qualifications for automatic recognition | Undergoing limited revision; criticized as insufficient |
| ICM Global Standards | Defines essential competencies for safe practice | Requested for full integration into EU law |
| WHO Midwifery Models | Provides evidence-based care frameworks | Currently not fully reflected in Commission proposals |
Linking Midwifery to Global Health Strategy
The open letter emphasizes that the revision of midwifery standards is not an isolated labor issue but a strategic necessity for health system resilience. The signatories argue that strong midwifery is a cornerstone of gender equality and demographic sustainability, particularly as Europe faces fluctuating birth rates and an aging healthcare workforce.
the profession is urging the Commission to explicitly link the directive update to the EU Global Health Strategy. Because European midwives frequently operate in humanitarian settings and international partnerships, the standards set within the EU have a ripple effect on global health programs.
The call for action highlights three specific demands:
- Full Alignment: Adopting a text that mirrors the latest scientific evidence and ICM Global Standards.
- System Resilience: Ensuring the update supports health system stability during crises and promotes gender equality.
- Global Integration: Connecting internal qualifications to the EU’s broader international health commitments.
A United Professional Front
The scale of the submission—spanning 27 countries—marks a rare moment of broad consensus among a diverse group of stakeholders. The list of signatories includes presidents of national midwives’ associations, heads of academic education programs, and civil society organizations specializing in sexual and reproductive health and rights (SRHR).
By uniting clinical leads with policy advocates, the profession is signaling that the current “limited” approach to the directive is no longer acceptable. The consensus is that without a strategic overhaul, the EU risks missing a critical opportunity to safeguard the future of maternal health across the bloc.
Disclaimer: This report discusses healthcare policy and professional qualifications; it does not provide medical advice. For clinical guidance, please consult a licensed healthcare professional.
The European Commission is expected to review the submissions as part of the ongoing legislative process for the directive’s revision. The next critical checkpoint will be the publication of the Commission’s revised proposal, which will determine whether the input from the 200+ leaders is integrated into the final legal text.
We invite readers to share their perspectives on healthcare standards in the comments below.
