Dominique Licaud, Midwifery Coordinator at Centre Hospitalier (CH) Angoulême, France

Welcome to Pioneers of Safer Healthcare, an interview series celebrating the transformative efforts of Born Green Generation partners in advancing sustainability in healthcare.

Can you tell us a bit about your career as a midwife and what led you to your position at CH Angoulême?
I am a trained midwife, having graduated in 1981. This has allowed me to witness the evolution of practices surrounding perinatal care. In 2018, through a Public Health Physician at the CHU in Poitiers, I learned about endocrine disruptors and realised that throughout my career, I may have contributed to exposing patients to these substances. It was a shock, and to learn more, I undertook the Nesting training by WECF and the Interuniversity Diploma in Environmental Health at ISPED Bordeaux.

What personally motivates you to lead sustainability initiatives in the healthcare field?
I realised that since the beginning of my career, particularly from the early 1990s, I had observed an increase in the use of products potentially containing toxic chemicals, exacerbating children’s exposure to endocrine disruptors.

This worsening trend is evident in pediatric departments, where cases of diabetes in very young children are increasing. I myself was diagnosed with diabetes at 54, and knowing that children are now being diagnosed as early as age three was a catalyst for action.

By discussing with concerned colleagues, I quickly understood that we could take action within the hospital to minimise newborns’ and children’s exposure to endocrine disruptors.

How did CH Angoulême become involved in the Born Green Generation initiative, and how was the reaction within your team?
There was great enthusiasm among our teams to work on this issue. We quickly gained support and expertise from the hospital’s hygienist doctor and their team, as well as the Nouvelle-Aquitaine Regional Health Agency (ARS) and the Charente ARS.

We were supported by a Doctor in Genetics and Molecular Biology (from the Faculty of Medicine in Bordeaux) specialising in Environmental Health, who conducted a practice audit, and by an eco-nurse who led workshops to identify possible changes: from children’s toys to medications, medical devices, and even the food offered to patients and staff.

In the Women-Mother-Child unit, about fifty professionals out of a hundred were trained by an eco-nurse (lecturer, trainer, and expert in environmental health), helping to create a culture of environmental health within the unit’s teams.

To spread this culture throughout the hospital, the Sustainable Development Officer and the Sustainable Development and Environmental Health Commission initially established sustainability ambassadors, followed by health ambassadors, enabling more colleagues outside the Women-Mother-Child unit to get involved.

As a result of these initiatives, Health Care Without Harm Europe contacted us to join their European network and participate in their projects.

Can you provide an overview of the sustainable practices you’ve implemented, such as using reusable healthcare items, glass bottles, and sustainable meal options?
We started with very simple actions, such as using baby wash gels with a maximum of four ingredients, cleaning floors with microfiber cloths and water, or steam-cleaning cribs and incubators.

We then continued and expanded our actions by sharing experiences with colleagues from other maternity units in Nouvelle-Aquitaine, supported financially and technically by the regional agency and guided by the agency Primum Non Nocere. This led to the introduction of cloth diapers and self-service breakfast options, among other measures.

As early as the late 2000s, we reduced waste by eliminating “Pink Boxes”—a collection of products (disposable diapers, promotional materials, discount coupons, samples) distributed to new parents at the maternity ward, which mostly ended up in hospital trash bins. We replaced them with a “Green Box” concept and eventually discontinued them altogether, as the products didn’t align with the recommendations given to parents during Nesting workshops.

Can you tell us more about the Young Shoots Basket (Paniers Jeunes Pousses) project and the Nesting workshops?

This is a very interesting initiative impacting almost the entire department of Charente. It involves offering organic vegetable baskets to young parents once a week, helping them discover new vegetables, participating in cooking workshops, and attending a Nesting environmental health workshop. With registration at the Angoulême Agglomeration Community, a “green prescription,” and two workshops, they receive free vegetable baskets for six months. Families receiving these organic, locally grown baskets are logically less exposed to food-related pollutants and become more aware of environmental health issues. After six months of free baskets, the goal is for these families to continue buying them.

The Nesting workshops quickly gained popularity, requiring us to increase their frequency. In these workshops, participants learn to identify risky products from daily household items. We also train childminders and local nurseries to deliver the same messages.

How do you think these practices could inspire broader change in the healthcare sector and society?

Following our collaboration with HCWH Europe, we realised we could share our practices at the European level. In a webinar, we met colleagues from Barcelona who inspired us to replace plastic bottles with glass ones for formula-fed babies. We pioneered this change and shared it with all maternity units in Nouvelle-Aquitaine and later across France.

With nurseries, we shared experiences of those already using cloth diapers and demonstrated that if it’s feasible in a maternity unit, it can also be done in a nursery.

This also influenced the industry and infant formula suppliers, as only one supplier could meet our glass bottle requirements between 2022 and 2024. They had exclusivity in our hospital and other maternity units in Nouvelle-Aquitaine. Now, two additional suppliers, including one French company, offer glass bottles and recently signed a contract with Paris hospitals (AP-HP). Supply chain reliability for glass bottles is no longer a concern.

Similarly, the Young Shoots Basket project benefits participating families and positively impacts local farmers. It aligns with the Grand Angoulême area’s broader food autonomy plan, ensuring local producers can easily supply quality products to the community. This project has garnered support from local political leaders, making the Angoulême and Charente regions more attractive to organic farmers.

What future goals or upcoming projects excite you as part of the Born Green Generation initiative?

When we first met the Born Green Generation partners in Brussels, there was some scepticism about the practices we discussed. Those who visited CH Angoulême on 13 November saw firsthand that we are pioneers in many areas. I am eager to deepen exchanges with partners from the UK and Denmark and others in the HCWH Europe network, including the Barcelona colleagues I mentioned earlier.

Exploring the different national healthcare systems, understanding their operations, and sharing our best practices beyond our region and France will be fascinating.

What advice would you give other healthcare professionals or institutions interested in launching similar sustainability projects?

Leadership must drive the initiative and understand its value for such a movement to work in a hospital. Progress cannot happen if management is not engaged—a midwife alone, for instance, cannot independently change practices in her department. The managerial team must support the project alongside her. Support from hospital administration is also essential to facilitate exemplary actions.

Likewise, political backing, particularly at the local level, is crucial. In our case, the Young Shoots Basket project and its impact on the organic food market created a dynamic alignment between healthcare services, public authorities, and local economic players working toward a common goal.

Thanks to Dominique Licaud for answering our questions and Centre Hospitalier Angoulême for participating in the Born Green Generation initiative.