The world's policymakers are in Lisbon, yet here I am in Uganda
In Lisbon this week, the world convened to confront one of humanity's most preventable tragedies — the deaths of a quarter-million mothers and millions of newborns each year — yet the practitioners who understand this crisis most intimately were barred from entering the room. Visa denials in the final days before the International Confederation of Midwives congress turned away experienced midwives and researchers from Nigeria, Ghana, Rwanda, Uganda, Bangladesh, India, and beyond — the very nations where maternal death is most concentrated. It is an old and painful pattern: those with the least power to shape global decisions bear the greatest cost of the decisions made without them.
- A mother dies every two minutes from pregnancy or childbirth, and the summit meant to address this crisis opened in Lisbon missing the frontline practitioners who know how to stop it.
- Last-minute visa rejections by the Portuguese embassy swept out leaders from more than a dozen African and Asian nations, leaving organizers scrambling and scheduled speakers stranded at home.
- Uganda's Harriet Akello — whose WHO-recognized midwifery model operates 60 miles from the nearest hospital in a post-conflict region — was denied entry despite having recently traveled internationally without issue.
- In Bangladesh, two midwifery union leaders were turned away while a male government official flew to Lisbon to announce a national plan for 25,000 new midwives — a disparity one advisor called 'gender inequity laid bare.'
- Portugal's Foreign Ministry defended its visa process as rigorous and objective, offering no account of why experts from the world's highest maternal mortality countries were systematically excluded from a conference built around their crisis.
- The summit proceeded without them, widening the structural gap between where global health policy is debated and where women are actually dying.
This week in Lisbon, the International Confederation of Midwives congress brought together politicians, donors, and UN agencies to confront one of global health's most enduring crises. But the conference was hollowed out before it began: visa denials in the final days barred experienced midwives and researchers from Nigeria, Ghana, Rwanda, Uganda, Bangladesh, India, and several other nations — the very countries where maternal death is most acute.
Harriet Akello, a Ugandan midwife running a WHO-recognized program in a remote post-conflict region, had been scheduled to present her work on transforming fragmented maternity systems into evidence-based models of continuous care. She had traveled internationally without difficulty just months before. The Portuguese embassy rejected her application anyway. 'The world's policymakers are in Lisbon, yet here I am in Uganda,' she said. 'I am gutted and insulted.'
The absurdities multiplied. In Bangladesh, two midwifery union leaders were denied visas while a male government official attended to announce a national expansion of 25,000 midwives. In the Democratic Republic of the Congo, four midwives remained home while one official was approved. Kate Stringer of the International Confederation of Midwives called it 'colonial bias' made visible — a life-and-death situation compounded by structural exclusion.
The stakes are not abstract. Globally, 260,000 women die in childbirth each year; 70 percent of those deaths occur in sub-Saharan Africa. Nearly 1.9 million babies are stillborn annually, and 2.3 million newborns die — losses that evidence-based midwifery models are proven to reduce. Portugal's Foreign Ministry defended its visa process as objective and compliant with Schengen rules, but offered no explanation for the pattern. The conference proceeded without its most essential voices, and the distance between where policy is made and where mothers die remained as wide as ever.
This week in Lisbon, Portugal, the world's leading midwifery experts gathered to discuss how to prevent the deaths of a quarter-million women and millions of babies each year. The International Confederation of Midwives congress brought together politicians, donors, and UN agencies to tackle one of global health's most persistent crises. But the conference was missing its most essential voices: the midwives actually working in the places where mothers die.
Visa rejections in the final days before the summit barred experienced practitioners from Africa and Asia—the regions bearing the heaviest toll. Leaders from Nigeria, Ghana, Rwanda, Burundi, Uganda, Tunisia, Ethiopia, Sierra Leone, Bangladesh, India, and Indonesia were turned away at embassy gates. The exclusions were not accidental oversights but last-minute denials that left organizers scrambling and speakers unable to attend.
Harriet Akello, a midwife in Uganda, was scheduled to present her work on transforming fragmented maternity systems into what the World Health Organization calls a "midwifery model of care"—a proven approach where mothers receive continuous support from a small team of skilled attendants. Akello runs an initiative that has caught WHO's attention, operating in a remote post-conflict region 60 miles from the nearest referral hospital. She had recently traveled to Sweden for work without incident. Yet when she applied to attend the Lisbon conference, the Portuguese embassy rejected her visa. "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," she said. "I am gutted and insulted."
Two midwifery union leaders from Bangladesh were denied visas despite a male government official from their country flying to Lisbon to announce plans for 25,000 additional midwives. In the Democratic Republic of the Congo, only one official received approval while four midwives stayed behind. Kate Stringer, an advisor to the International Confederation of Midwives, called the pattern "gender inequity laid bare." She pointed to the fundamental absurdity: "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 defies logic. It is a life and death situation, perpetuated by colonial bias."
The numbers underscore why their absence matters. Globally, 260,000 women die annually in childbirth. Nearly 1.9 million babies are stillborn each year, and 2.3 million newborns die. About 70 percent of maternal deaths occur in sub-Saharan Africa, with most of the remainder in Asia. The world faces a shortage of roughly one million midwives needed to meet safe staffing standards. Recent research published in the Lancet identified six critical factors for survival in childbirth bleeding—a condition affecting 27 million women annually and killing 43,000—including timely diagnosis and access to blood transfusions. These are interventions that midwives trained in evidence-based models can deliver.
Portugal's Ministry of Foreign Affairs stated that visa assessments were conducted "rigorously, objectively and factually" in accordance with Schengen regulations. The response offered no explanation for why experts from countries with the highest maternal mortality rates were systematically excluded from a conference designed to address that very crisis. Alison Perry, a researcher at Imperial College London who collaborates with a Ugandan midwife also denied entry, described the pattern as "overt discrimination against equitable participation in international conferences."
The exclusions reveal a structural problem in global health decision-making: those with power and resources gather to solve problems affecting those without access to either. The midwives who have developed working solutions in resource-limited settings, who understand the specific barriers their countries face, who could speak to what actually works—they were locked out of the room where solutions are debated. The conference proceeded without them, and the gap between where the world's policymakers meet and where mothers actually die grew wider.
Notable Quotes
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 defies logic. It is a life and death situation, perpetuated by colonial bias.— Kate Stringer, International Confederation of Midwives advisor
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.— Harriet Akello, Ugandan midwife
The Hearth Conversation Another angle on the story
Why does it matter that these specific midwives were excluded? Couldn't their expertise be shared another way?
Because presence at a conference like this isn't just about sharing information—it's about power and credibility. When you're in the room, you shape the conversation. You can push back on assumptions, offer real-world constraints, demand that solutions fit actual conditions. Akello wasn't just going to give a talk; she was going to help reshape how the world thinks about maternity care.
But Portugal has visa rules. Aren't those legitimate?
Technically, yes. But the timing and pattern matter. These weren't scattered rejections—they were systematic exclusions of people from high-burden countries. And the irony is brutal: a male government official from Bangladesh got in to announce midwife hiring, but the actual midwives didn't. That's not neutral administration. That's a choice.
What's the real consequence here?
Solutions get designed without the people who have to implement them. The conference will produce recommendations that sound good in Lisbon but won't account for what actually happens in a maternity ward 60 miles from a hospital. Progress slows. And the message sent is clear: your expertise doesn't matter enough to let you in.
Is this about money—can't these countries afford to send people?
Some can't, but that's not the issue here. Akello had funding. She had an invitation. She had a track record of international travel. She was blocked at the visa stage, not the funding stage. This is about who gets to be trusted to cross borders and participate in global conversations.
What happens now?
The conference continues without them. Policies get made. Resources get allocated. And the people doing the actual work in the places where mothers die most will read about decisions made without them.