In 2018, the International MotherBaby Childbirth Organization (IMBCO) and the International Federation of Gynecology and Obstetrics (FIGO) collaborated to create guidance for safe and respectful maternity care, in close partnership with the International Confederation of Midwives, the International Pediatric Association, and the White Ribbon Alliance. This led to the launch of International Childbirth Initiative (ICI): 12 Steps to Safe and Respectful MotherBaby-Family Maternity Care. These steps for implementation of evidence-based respectful maternity care worldwide have been adopted by seventy health facilities across thirty countries. Implementation is guided by a multidisciplinary committee within each facility that is required to include meaningful community participation and progress is monitored using tools for feedback from women and their companions in local languages.
Each committee prioritizes steps according to the individual needs of their health center and community, and there are opportunities for the health facilities to convene virtually to present their progress and discuss the challenges they encounter. The facilities submit an action plan to ICI and set concrete goals to strengthen their capacity to provide respectful care that supports physiological birth. Many facilities have chosen to focus on the provision of continuous support during labor and birth, training health care personnel on nonpharmacological comfort measures, and updating their facility to support upright birth positions or offer water births. Early reports have shown that some participating facilities have lowered caesarean section and episiotomy rates, and have better maternal and neonatal survival rates when compared to the standard in their region. In 2023, all ICI facilities will follow a new protocol for to allow for standardized assessment of the impact of the Initiative on clinical outcomes.