PURPOSE:
This midwifery twinning toolbox offers practical guidance for midwives, midwifery associations, and other organizations establishing international partnerships to strengthen health systems or professional associations. Drawing on the Royal College of Midwives (RCM)'s decade of experience in twinning with midwifery associations in the global South (e.g., Bangladesh, Cambodia, Nepal, Uganda), this resource is further informed by evaluation of a five-year twinning partnership with the Bangladesh Midwifery Society (BMS), funded by UNFPA. The toolbox supports all phases of twinning partnerships: planning, delivery, learning, and phasing out, while signposting to additional resources.

DISCUSSION:
The toolbox is structured into four key sections: 1. Deciding to twin: building foundations. Emphasizes thorough preparation, including goal setting, risk assessment, and clear decision-making involving senior leaders. Includes a quick decision-making guide. 2. Implementing twinning: delivering together. Focuses on effective management of people, time, and funds. Highlights best practices like equitable resource mobilization, project planning tools, effective communication, and shared governance. 3. Learning together: reflective twinning practice. Stresses the importance of continuous reflection and learning, with explicit components for knowledge creation and research. 4. Sustaining outcomes: scaling up, or moving on from, twinning. Addresses best practices for partnership conclusion, including clear communication, shared decision-making on exit and sustainability, and disseminating lessons learned.

EVIDENCE WHERE RELEVANT:
The RCM/BMS partnership evaluation demonstrated impact on thinking, policy, practice, and network building, significantly enhancing BMS's organizational capacity and empowering participating midwives into leadership roles. This partnership also provided reciprocal learning for the RCM and the wider UK midwifery community. Recognized for its commitment to gender equity and social inclusion, the RCM/BMS partnership exemplifies how strengthening midwives' associations can contribute to achieving the Sustainable Development Goals (SDGs).

KEY MESSAGE:
Twinning can foster innovative systems to support the growth and function of midwives’ associations. This toolbox provides a practical framework for successful, impactful, and sustainable twinning partnerships. Association strengthening 2 (including three-minute presentation competition)