Implementing quality midwifery services in India: a case study of facilitators and barriers to the integration of midwives

Alison McFadden, Paridhi Jha, Andrew Symon, Bharati Sharma, Sowmya Thota, Neha Singh, Joyce L. Marshall, Jitender Nagpal, Sowmya Ramesh

Research output: Contribution to conferencePaperpeer-review


The Indian Government's key strategy to improve quality of maternal and newborn care and reduce mortality and morbidity is implementing quality midwifery services. As India does not have independent midwives, additional training to international standards is provided to prepare nurse-midwives as Nurse Practitioners in Midwifery (NPM).


An Indo-UK consortium conducted this study in two Indian states (Gujarat and Telangana) to: assess women's perceptions of maternity services and the acceptability of midwives as key providers; and identify barriers and facilitators to integrating professional midwives into maternity services.

The qualitative study combined case study with human-centred design underpinned by ecological systems theory and quality care frameworks. The two case studies comprised interviews and focus group discussions with women and community influencers and interviews with healthcare providers and stakeholders. Data were collected in 2021/2. Analysis using the framework method of thematic analysis is nearing completion.


The study included 26 pregnant/newly-delivered women, 14 community influencers, 43 healthcare providers (NPMs, nurses, obstetricians) and six stakeholders. Preliminary findings suggest that women appreciate the care provided by NPMs, but face challenges at health facilities e.g., lack of privacy and cleanliness. The NPM participants reported that they gained good knowledge and skills from their training, but institutional barriers such as lack of a career pathway, unclear distinction between NPM and nursing roles, and lack of acceptance/confidence by obstetricians limited their scope of practice. Community awareness of midwives was limited but was increasing through mother-to-mother recommendations.

The findings will identify barriers and facilitators to the integration of NPMs into the health system, and highlight gaps in the quality of maternity care. The findings will be valuable in informing implementation of midwifery in countries that do not have professional midwives.

Key message:
Integration of quality midwifery services in India should address institutional barriers and community awareness, alongside education and employment of midwives.
Original languageEnglish
Publication statusPublished - 12 Jun 2023
EventInternational Confederation of Midwives 33rd Triennial Congress: Together again: from evidence to reality - Nusa Dua Convention Centre, Bali, Indonesia, Denpasar, Indonesia
Duration: 11 Jun 202314 Jun 2023
Conference number: 33


ConferenceInternational Confederation of Midwives 33rd Triennial Congress
Internet address


  • Midwifery
  • Quality care
  • Implementation
  • Case study
  • India


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