Experiences of a new cadre of midwives in Bangladesh: findings from a mixed method study

Rashid U Zaman,Adiba Khaled,Della Sherratt,Joe Varghese,Shehlina Ahmed,Shahidul Islam,Sophie Witter,Muhammod Abdus Sabur

doi:10.1186/s12960-020-00505-8

Rashid U Zaman, Adiba Khaled + Show 6 more

Open Access

https://doi.org/10.1186/s12960-020-00505-8

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Abstract

BackgroundBangladesh did not have dedicated professional midwives in public sector health facilities until recently, when the country started a nation-wide programme to educate and deploy diploma midwives. The objective of the findings presented in this paper, which is part of a larger study, was to better understand the experience of the midwives of their education programme and first posting as a qualified midwife and to assess their midwifery knowledge and skills.MethodsWe applied a mixed method approach, which included interviewing 329 midwives and conducting 6 focus group discussions with 43 midwives and midwifery students. Sampling weights were used to generate representative statistics for the entire cohort of the midwives deployed in the public sector health facilities.ResultsMost of the midwives were satisfied with different dimensions of their education programme, with the exception of the level of exposure they had to the rural communities during their programme. Out of 329 midwives, 50% received tuition fee waivers, while 46% received funding for educational materials and 40% received free accommodation. The satisfaction with the various aspects of the current posting was high and nearly all midwives reported that a desire to work in the public sector in the long run. However, a significant proportion of the midwives expressed concerns with equipment, accommodation, transport and prospect of transfers. The scores on the knowledge test and self-reported skill levels were varied but reasonably high.ConclusionWhile the midwives are highly motivated, satisfied with many aspects of their current jobs and have adequate knowledge and skills, there are some bottlenecks and concerns that, if unaddressed, may derail the success of this programme. To capture the career progress of these midwives, additional research, including a follow-up study with the same cohort of midwives, would be beneficial to this programme.

Highlights

Bangladesh did not have dedicated professional midwives in public sector health facilities until recently, when the country started a nation-wide programme to educate and deploy diploma midwives
Various initiatives have been taken in Bangladesh over the last four decades to increase the number of healthcare workers with the competencies to assist women and newborn to make pregnancy and childbirth safer
While the results presented in this paper show the new midwives deployed at the health facilities are largely motivated, some expressed dissatisfactions regarding the education programme, crucially in relation to hands-on practice and working with women at the community level; the work many are currently performing include tasks outside and unrelated to midwifery and for which they are not appropriately educated for

Summary

Introduction

Bangladesh did not have dedicated professional midwives in public sector health facilities until recently, when the country started a nation-wide programme to educate and deploy diploma midwives. There is significant global evidence that women and their newborns receiving midwife-led care are less likely to develop complications and that scaling up professional midwifery can avert maternal deaths, stillbirths and neonatal deaths [1, 2]. In 2014, only 4 out of 73 high-burden countries (countries with 92% of global maternal and neonatal mortality) had a midwifery workforce that was adequate to meet the needs and there is a consensus that more midwives are needed to improve maternal and newborn survival [4, 5]. The nursing colleges have attempted to integrate and provide supplementary midwifery education to nurses to produce nurse-midwives to work in health facilities [9]. Community maternal and child health services are provided mainly by family welfare visitors (FWVs), who are trained in the country’s public health administration and training institutions, named family welfare visitors’ training institutes (FWVTIs), under direction of the Family Planning Directorate (FPD)

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