twin2twin an innovative & sustainable method for empowering midwives. Improving and protecting the health of mothers and babies in low- and middle-income countries (LMICs) requires well-educated and well-organized midwives. New evidence from the Lancet series on Midwifery and the State of the World Midwifery Report shows that quality maternal and new-born care is impossible without midwives . In order to realize the value of midwifery, midwives—and their organizations—must be empowered in a way that is sustainable, that allows them to speak in a unified voice, and that makes it possible for them to become change agents for their communities. The twin2twin (t2t) project is designed to provide a support network that empowers and strengthens midwives, individually and organizationally. It is a program that builds the foundation necessary for strong and effective midwife organizations, and hence for accessible and quality midwifery care. Furthermore, the sisterly or ‘twin’ relationship created by t2t generates leaders that will sustain the profession. The twinning concept was developed by the International Confederation of Midwives (ICM) as a way of promoting cooperation on the organizational level. The ICM defined twinning as “a two-way mutually beneficial exchange between two member Midwives Associations . Our project expands this definition by promoting cooperation on a personal level, between midwives. Our pilot t2t programme – already underway – spans 4 years and includes twelve workshops and two cross-cultural exchanges. Forty midwives from two cultures (20 pairs) are involved in the programme and they are supported by a bi-cultural team. The workshops use specific interventions that develop reciprocity, cultural tolerance and group cohesion. The focus on the individual, rather than organizational, level makes the project sustainable: twins have a personal responsibility to make their ‘twin relationship’ work and form a bond that is lifelong, extending beyond the terms of office in organizations. The value of the t2t concept in the areas of empowerment, sustainability, and cost effectiveness was already visible in our first, developmental version of the programme – between Dutch and Sierra Leone midwives: after that programme ended in 2012, the twins proactively intensified their contact in 2014 during the Ebola crisis and generated funds to provide gloves for their sister midwives. Up until now we have been running our projects with very limited funds, making it impossible to do systematic monitoring and evaluation. Further research is required to: 1) measure the effects of t2t, 2) to learn the features that promote success, and 3) to identify what must be done to scale up the concept for use in other settings. This award would contribute towards evaluation research. This will be done using data from the initial pilot project (2009-2012) between Sierra Leone and Dutch midwives and a project currently running (2014-2016) between Moroccan and Dutch midwives. Our work will result in an evidence based “tool kit”. This tool kit will be useful as a stand-alone method, or as an ‘add on’ to existing projects in order to enhance empowerment and sustainability.

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