Portugal's visa system has blocked at least 20 senior midwifery experts from Africa and Asia from attending a major global health conference in Lisbon this week, drawing sharp criticism from organizers and raising questions about how Schengen rules affect international cooperation on maternal health—a sector where Portugal itself faces staffing shortages.
Why This Matters
• Professional exclusion: Delegates from Nigeria, Ghana, Rwanda, Burundi, Ethiopia, Sierra Leone, DRC, Uganda, Bangladesh, and India—countries with the highest maternal death rates—were denied entry despite submitting applications up to 3 months in advance.
• No remote option: The 34th Triennial Congress of the International Confederation of Midwives (ICM), running through June 18 in Lisbon, is entirely in-person, meaning rejected delegates lose both their registration fees and the chance to contribute to policy debates.
• Local impact: Portugal faces its own midwife shortage, making knowledge exchange with high-burden regions particularly valuable for domestic health system planning.
Conference Organizers Call Rejections "Heartbreaking"
Isabel Ferreira, vice-president of the Portuguese Association of Obstetric Nurses (APEO), described the visa refusals as "truly sad" given that her organization competed to host the event—the first time the triennial gathering has come to Portugal. The congress convenes roughly 4,000 midwifery professionals from around the world to tackle a global shortfall of 1 million midwives, a deficit linked to approximately 260,000 maternal deaths during pregnancy or childbirth each year and 4.2 million infant deaths in the first month of life.
Ferreira emphasized that networking opportunities at such events are "fundamental" for delegates from regions with acute training needs, enabling them to learn from peers and import best practices. "These meetings allow them to evolve," she told Portuguese media, noting that rejected attendees had pre-paid flights and accommodation and submitted full documentation from the ICM certifying their speaker roles.
The International Confederation of Midwives confirmed to AFP that a minimum of 20 keynote speakers had been turned away "at the last minute," though the actual figure may run into the hundreds when accounting for association representatives and researchers. Over 100 midwifery leaders have since signed an open letter demanding an "urgent review" of the denials, arguing that the exclusions silence voices from frontline health systems in countries where maternal mortality remains stubbornly high.
What the Foreign Ministry Says
When pressed by the Lusa news agency for a breakdown of how many applications were received, how many were rejected, and on what grounds, the Portuguese Ministry of Foreign Affairs (MNE) issued a procedural defense. All short-stay visa requests, the ministry stated, "are analyzed and processed in a rigorous, objective, and factual manner, in full compliance with the rules and criteria set out in the Schengen Visa Code."
The MNE added that the same procedure applies when other Schengen member states process applications on Portugal's behalf in regions where Portuguese consular representation does not exist. The ministry reiterated its "firm commitment to ensuring swift, uniform, and transparent treatment of applications" but did not release refusal statistics or country-specific denial rates.
In at least one documented case, an Ethiopian professor was turned down due to an "inadequate financial bank statement and unreliable purpose of travel"—a standard Schengen justification that organizers argue makes little sense when applicants hold formal invitations, paid registrations, and confirmed hotel bookings.
A Recurring Pattern in EU Conference Hosting
The Lisbon episode mirrors similar controversies in recent years. Midwifery and public-health groups point to a 2024 conference in Germany and a 2022 gathering in Canada where delegates from the Global South faced disproportionately high rejection rates. Advocacy organizations note that an African applicant is roughly eight times more likely to be refused a Schengen visa than an Asian counterpart, a disparity that persists even when applicants present identical documentation.
Conference invitation letters—while helpful—carry no binding weight in the visa adjudication process. Organizers typically disclaim any authority to intervene once an application enters the consular pipeline, leaving delegates to navigate opaque refusal notices with minimal recourse. Some events now offer conditional refunds of registration fees if a visa is denied, but that does little to offset lost travel costs or the career setback of missing a keynote slot.
What This Means for Residents
For those living in Portugal, the fallout extends beyond reputational damage. The country is actively marketing itself as a hub for international associations and business events—Lisbon regularly ranks among Europe's top congress destinations—yet restrictive visa enforcement threatens that positioning. Major events such as co-hosting the FIFA 2030 World Cup will hinge on smooth cross-border movement, and any perception that Portugal applies Schengen rules more stringently than neighbors could deter future bids.
From a public-health perspective, Portugal's own chronic midwife shortage makes it a net beneficiary of global knowledge exchange. Blocking professionals from regions that have developed low-cost, high-impact maternal care models limits domestic practitioners' exposure to innovations that could be adapted for under-resourced rural areas or migrant communities. APEO members who hoped to establish training partnerships with African and Asian counterparts now face an event diminished by the absence of precisely the expertise they sought.
The Bigger Picture on Maternal Mortality
The congress theme centers on closing the 1 million midwife gap identified in international workforce studies. Maternal and neonatal mortality remain concentrated in sub-Saharan Africa and South Asia, the very regions now excluded from the Lisbon discussions. Delegates from Nigeria, for instance, would have brought firsthand data on community-based delivery models that have reduced hemorrhage deaths; Bangladeshi representatives were slated to present on integrating traditional birth attendants into formal health systems.
Without those voices, policy recommendations risk skewing toward high-income country priorities—antenatal apps, hospital consolidation, advanced imaging—rather than the low-tech, high-touch interventions that save lives in resource-constrained settings. Conference outcomes typically feed into World Health Organization guidelines and bilateral aid strategies, meaning the exclusions have downstream effects on funding allocations and program design.
Schengen System Upgrades Add Complexity
The 2026 visa landscape includes two major digital overhauls. The Entry/Exit System (EES), fully operational since April 10, replaces passport stamps with biometric scans (fingerprints and facial recognition) for all non-EU travelers, automatically tracking overstay risks. Later this year, the European Travel Information and Authorization System (ETIAS)—a €7 pre-travel clearance for visa-exempt nationals—will launch, adding another layer of screening.
While these systems aim to tighten border security, critics warn they also amplify existing biases. Algorithmic risk scoring may flag applicants from countries with high irregular-migration rates, even when those individuals hold professional credentials and return tickets. For Portugal, which lacks direct consular posts in much of West Africa and South Asia, outsourcing visa decisions to third-party processors or other Schengen states compounds the problem, as applicants have no direct line to Portuguese officials who understand the context of a specific event.
Accountability and Next Steps
The open letter from midwifery leaders calls for an immediate reassessment of denied applications and a longer-term review of how Schengen states handle conference-related visas. Signatories propose a fast-track mechanism for vetted delegates attending accredited international gatherings, similar to protocols already in place for athletes and cultural performers during major tournaments or festivals.
The APEO has not announced whether it will seek compensation from the government for reputational harm or push for policy reforms ahead of future congresses. The ICM, meanwhile, is exploring hybrid formats for its next triennial event to ensure that visa barriers do not again prevent participation from the countries most affected by the issues under discussion.
