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

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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.