In June 2026, more than 100 midwife leaders signed a public letter demanding help for colleagues who had been denied entry visas. The colleagues were trying to attend the International Confederation of Midwives' 34th Triennial Congress in Lisbon, Portugal, held June 14–18, 2026. The letter came just two days before the congress began — too late for anyone to fix the problem.

Why does this matter? This congress is the midwifery world's biggest gathering. It happens every three years. Doctors, nurses, policymakers, and midwives from more than 140 countries come together to decide what the profession should focus on next. When midwives from Africa and Asia — the regions with the most mothers dying in childbirth and the fewest trained midwives — cannot attend, those voices get left out of the room where decisions are made.

The problem was not money. The organizers had already set up a fund to pay visa costs (between €10 and €150) to help midwives from poorer countries afford the application fee. But paying for a visa does not help if your visa application gets rejected.

What is a Schengen visa? Portugal is part of a European zone called the Schengen Area, where 27 countries share simplified border rules. To enter, people from most African and Asian countries need a short-stay visa. These visas are approved or denied by Portuguese consulates — offices that handle immigration — or sometimes by consulates from other European countries acting for Portugal.

Here is what went wrong: visa decisions are made in different places, and the rules and timelines are not consistent. One consulate might approve 70 percent of applications. Another might approve 15 percent. There is no fast-track appeal process if you are denied. The decision is final. The letter asked for "urgent reconsideration," but there is no standard way to do that.

Why do visa applications get rejected? The most common reasons are: the applicant cannot prove they have strong ties to their home country, they don't have enough money in their bank account, or they are flagged as a risk by security screening. These reasons affect applicants from sub-Saharan Africa more than others.

So what does this reveal? A fund that pays the visa application fee is useless if the government denies your application for other reasons. The midwives' letter was a protest to their governments and to the Schengen system — a way of saying: this is not an accident, this is a pattern, and it needs to change.

What comes next? The next big midwives congress will be in Abu Dhabi, in the United Arab Emirates, in 2029. The UAE has its own visa system, which will bring different challenges. The midwives' organizations learned something from Lisbon: when choosing where to hold future conferences, they need to think hard about whether delegates from around the world can actually get there.

One thing we still don't know: how many midwives actually missed the congress because they could not get a visa. The organization has not released that number.