Maternal health leaders' perceptions of barriers to midwife-led care in Ethiopia, Kenya, Malawi, Somalia, and Uganda

Johanna Blomgren; Sara Gabrielsson; Kerstin Erlandsson; Miriam C A Wagoro; Mariam Namutebi; Eveles Chimala; Helena Lindgren

doi:10.1016/j.midw.2023.103734

Maternal health leaders' perceptions of barriers to midwife-led care in Ethiopia, Kenya, Malawi, Somalia, and Uganda

Midwifery. 2023 Sep:124:103734. doi: 10.1016/j.midw.2023.103734. Epub 2023 May 26.

Authors

Johanna Blomgren¹, Sara Gabrielsson², Kerstin Erlandsson³, Miriam C A Wagoro⁴, Mariam Namutebi⁵, Eveles Chimala⁶, Helena Lindgren⁷

Affiliations

¹ Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. Electronic address: Johanna.blomgren@ki.se.
² Lund University Centre for Sustainability Studies, Lund, Sweden.
³ Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Institution of Health and Welfare, Dalarna University, Falun, Sweden.
⁴ School of Nursing Science, University of Nairobi, Nairobi, Kenya.
⁵ Department of Nursing, Makerere University College of Health Sciences, Kampala, Uganda.
⁶ School of Maternal, Neonatal and Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
⁷ Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Sophiahemmet University, Stockholm, Sweden.

PMID: 37269678
DOI: 10.1016/j.midw.2023.103734

Abstract

Objective: To identify and examine barriers to midwife-led care in Eastern Africa and how these barriers can be reduced DESIGN: A qualitative inductive study with online focus group discussions and semi-structured interviews using content analysis SETTING: The study examines midwife-led care in Ethiopia, Malawi, Kenya, Somalia, and Uganda -five African countries with an unmet need for midwives and a need to improve maternal and neonatal health outcomes.

Participants: Twenty-five participants with a health care profession background and current position as a maternal and child health leader from one of the five study countries.

Findings: The findings demonstrate barriers to midwife-led care connected to organisational structures, traditional hierarchies, gender disparities, and inadequate leadership. Societal and gendered norms, organisational traditions, and differences in power and authority between professions are some factors explaining why the barriers persist. A focus on intra- and multisectoral collaborations, the inclusion of midwife leaders, and providing midwives with role models to leverage their empowerment are examples of how to reduce the barriers.

Key conclusions: This study provides new knowledge on midwife-led care from the perspectives of health leaders in five African countries. Transforming outdated structures to ensure midwives are empowered to deliver midwife-led care at all healthcare system levels is crucial to moving forward.

Implications for practise: This knowledge is important as enhancing the midwife-led care provision is associated with substantially improved maternal and neonatal health outcomes, higher satisfaction of care, and enhanced utilisation of health system resources. Nevertheless, the model of care is not adequately integrated into the five countries' health systems. Future studies are warranted to further explore how reducing barriers to midwife-led care can be adapted at a broader level.

Keywords: Barriers; Gender norms; Leaders; MLC; Midwife-led care; Organisation.

MeSH terms

Child
Ethiopia
Female
Humans
Infant, Newborn
Kenya
Malawi
Maternal Health
Midwifery*
Pregnancy
Qualitative Research
Somalia
Uganda