Improving maternal-neonatal outcomes through implementing Quality Midwifery Services in India: a case study of facilitators and barriers

印度每年约有4.5万名妇女死于与妊娠有关的原因，全球证据表明，如果合格的助产士提供熟练的助产服务，83%的死亡是可以避免的。印度没有独立的助产士。将助产学作为护理学学习的一部分的印度护士在公共和私营部门的大多数保健设施中担任护士助产士。鉴于印度正在努力到2030年将孕产妇死亡率从每10万例活产130例降至70例；印度政府承认，按照国际标准引进和加强助产服务可能是实现这一目标的有效战略。印度政府支持对一些护士助产士进行额外培训，使她们成为古吉拉特邦和特伦加纳邦助产护理执业护士。这些助产护士被派往偏远/农村/交通不便地区的公共卫生设施。在古吉拉特邦，一些助产士执业护士也被派驻到城市家庭福利中心。一个印度-英国研究人员联盟提出了这项题为“通过在印度实施高质量助产服务来提高护理质量：促进因素和障碍的案例研究”的研究建议。该项目将在12个月的时间内实施。本研究的目的是记录妇女、家庭、社区影响者的看法和经验；助产学执业护士、其他助产护士和产科医生；以及在印度建立独立助产机构的促进因素和障碍。该研究还将强调护理质量方面的差距，并确定可用于评估助产是否有效的重要结果。我们的研究工作将包括定性深入访谈/焦点小组讨论/与妇女和社区影响者（共40人）以及助产士执业护士、其他护士-助产士和产科医生（共40人）的小组访谈。将对印度和国际文献进行审查，以确定关键的孕产妇-新生儿结局指标；将对每个州的5例孕产妇和新生儿死亡情况进行审查，以确定死亡情况审查是否是确定护理差距的好方法。这项研究将为未来几年进一步研究评估助产护理对孕产妇和新生儿结局的影响铺平道路；并为制定干预措施奠定基础，以加强在印度推广助产护理。该项目还将培训处于早期阶段的印度研究人员的研究技能。

Approximately 45,000 women die of pregnancy-related causes each year in India, and global evidence shows that 83% of these death can be prevented if competent midwives provide skilled birth attendance. India does not have independent midwives. Indian nurses, who have studied midwifery as part of their nursing studies work as the nurse-midwives in most of the health facilities in public and private sectors. Since India is striving to bring the maternal deaths down from 130 to 70 per 100,000 live births by 2030; the Government of India has acknowledged that introducing and strengthening midwifery in line with the international standards could be an effective strategy to achieve the target.The Government of India has supported additional training of some nurse-midwives to prepare them as Nurse Practitioners in Midwifery in the states of Gujarat and Telangana. These Nurse Practitioners in Midwifery have been posted in public health facilities serving remote/rural/difficult-to-access geographical areas. In Gujarat, some Nurse Practitioners in Midwifery have been posted in Urban Family Welfare Centers too.An Indo-UK consortium of researchers have developed this research proposal titled "Improving quality of care through implementing quality midwifery services in India: a case study of facilitators and barriers". This project will be implemented over a period of 12 months. The aim of this study is to document the perceptions and experiences of women, families, community influencers; the Nurse Practitioners in Midwifery, other nurse-midwives, and obstetricians about midwifery; and the facilitators and barriers for establishing independent midwifery in India. The study will also highlight gaps in the quality of care and identify important outcomes that could be used assess whether midwifery is effective.Our research work will involve qualitative in-depth interviews/focus group discussions/group interviews with women, and community influencers (40 in total) and also with Nurse Practitioners in Midwifery, other nurse-midwives, and obstetricians (40 in total). Reviews of Indian and international literature will be carried out to identify the key maternal-neonatal outcome indicators; and 5 maternal and neonatal deaths from each state will be reviewed to see if reviews of death are a good way to identify gaps in care.This study will pave the way to do further research to evaluate the impact of midwifery care on maternal and neonatal outcomes in the coming years; and lay the foundation to develop interventions to strengthen rolling-out midwifery care in India. The project will also train early-stage Indian researchers in research skills.