Global Health's Missed Voices: Why Key African Midwives Were Silenced in Lisbon

The pursuit of solutions for global health crises often clashes with cold bureaucratic logic, a stark reality laid bare by the recent International Confederation of Midwives (ICM) congress in Lisbon, Portugal. While politicians, donors, and UN agencies convened to address the millions of avoidable mother and baby deaths occurring annually, a crucial contingent of frontline experts from Africa and Asia—regions bearing the highest mortality burden—found themselves barred by last-minute visa rejections.

This exclusion of eminent midwives from countries including Nigeria, Ghana, Rwanda, Burundi, Uganda, Tunisia, Ethiopia, and Sierra Leone, among others, has drawn sharp condemnation. ICM advisor Kate Stringer articulated the profound irony: “A mother dies every two minutes due to pregnancy or birth. How are we going to intervene if the researchers and professors at the heart of it are banned?” This sentiment underscores a disconnect between the stated urgency of global health initiatives and the practical barriers erected against those best positioned to contribute.

The case of Harriet Akello from Uganda exemplifies this systemic flaw. Akello runs a WHO-recognized, life-saving initiative focused on reorienting fragmented maternity systems towards a “midwifery model of care” in a remote, post-conflict region near South Sudan, 95km from a referral hospital. Despite having recently travelled to Sweden within the Schengen zone, her visa application for Lisbon was denied. Her frustration is palpable: “The world’s policymakers are in Lisbon, yet here I am in Uganda, trying to explain to an embassy why I should have the right to travel. I am gutted and insulted.” Her unique, proven model, critical for global learning, was effectively silenced, undermining the very dialogue the congress sought to foster.

This phenomenon extends beyond individual cases. Two Bangladeshi midwifery union leaders, pivotal in representing local practitioners, were denied visas even as a male government official from their country flew to Lisbon to pledge 25,000 additional midwives. Similarly, Dr. Arthur Munkana from the Democratic Republic of the Congo expressed profound disappointment for four midwives from his country, devastated by maternal deaths, who were unable to attend. Such instances highlight a significant disparity in participation, leading Alison Perry, a researcher at Imperial College London, to label it “overt discrimination against equitable participation in international conferences.”

Portugal’s Ministry of Foreign Affairs maintained that visa assessments were conducted “rigorously, objectively and factually” in line with Schengen rules. However, the outcome signals a deeper problem: when visa policies inadvertently or otherwise exclude the most relevant voices from critical discussions, the effectiveness and legitimacy of international collaboration are severely compromised. It perpetuates a top-down paradigm where solutions are theorized *for* affected populations rather than co-created *with* their frontline experts. The economic and social cost of hindering such vital knowledge transfer — delaying the adoption of proven models that save lives — is immeasurable, and ultimately, self-defeating for global health progress.