Scope of practice and workload of nurse-midwives in low and middle income countries

Mother and baby

International attention increasingly recognises that midwives are “the single most critical person for effective care at the time of birth” (Lawn et al 2009) and that in countries with the best pregnancy outcomes, midwives are the primary providers of care to pregnant women (Hatem et al 2008). However, there is limited evidence on the working lives of midwives in low- and middle-income countries.


This PhD research uses a mixed methods approach to understand the scope of practice and workload of midwifery cadres working in low- and middle-income countries with Bangladesh and Malawi as field examples.

1029 midwifery cadres working in health facilities designated to provide Basic (BEmOC) and Comprehensive (CEmOC) Emergency Obstetric and Newborn Care responded to a questionnaire on their scope of practice and workload. Document analysis, diary-keeping, key informant interviews and small group discussions have been used to review the evidence on the education, scope of practice and professional organisations of midwifery cadres, as well as collect their views on the enablers and challenges they face during their shifts to providing quality midwifery care.

Enablers to providing maternity care span across infrastructural factors including water and electricity, functioning equipment, sufficient supplies and human resource factors such as teamwork and having enough midwives and support workers on duty. Challenges included shortages of midwives and support workers, busy clinics, frequently working beyond their shift hours and having no meal breaks.

The fieldwork in Bangladesh was supported through an International Fellowship Award (2015) funded by the Royal College of Midwives (RCM), Wellbeing of Women (WOW) and the Burdett Trust for Nursing. The Malawi fieldwork was supported through a UNICEF Malawi operational research grant.