Midwives’ experiences and perceptions of midwife-led continuity of care models in low-and middle-income countries: A qualitative evidence synthesis

TY - JOUR

T1 - Midwives’ experiences and perceptions of midwife-led continuity of care models in low-and middle-income countries

T2 - A qualitative evidence synthesis

AU - Myrhaug, Hilde Tinderholt

AU - Mortensen, Berit

AU - Munabi-Babigumira, Susan Kyomuhendo

AU - Kaasen, Anna

AU - Devold Pay, Aase Serine

AU - Naab, Florence

AU - McFadden, Alison

AU - Schauer, Tine

AU - Lafontan, Sara Rivenes

N1 - © 2025 The Authors

PY - 2025/10

Y1 - 2025/10

N2 - Background: There is a need to scale-up midwife-led continuity of care (MLCC) in low- and middle-income countries (LMICs), where midwives are the key to successful implementation. There is limited knowledge about their experiences and perceptions of MLCC models. Aim: To explore midwives’ experiences and perceptions of working with MLCC models in LMICs, their views of barriers to and facilitators of MLCC models, including to assess our confidence in the evidence. Methods: Two information specialists conducted systematic searches in eight databases from year 2000 until June 2024. The methodological quality of the included studies was assessed using a modified version of the Critical appraisal tool (CASP). We conducted a thematic analysis and used Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE CERQual) approach to assess our confidence in each review finding. Results: This synthesis included five studies exploring midwives’ experiences and perceptions of MLCC in LMICs. Three analytic themes were generated: Equity and access; professional development and recognition; and enhancing midwifery practices and policies. In addition, we identified ten associated sub-themes that were assessed by GRADE CERQual. These findings varied from moderate to very low confidence. Conclusion: While midwives highlighted the benefits of continuity of care, they identified essential components for successful implementation of MLCC in LMICs including reducing structural and geographical barriers, the continuous need for sustained capacity building and learning, and optimal resource allocation and availability. Findings assessed as low or very low confidence need to be explored further.

AB - Background: There is a need to scale-up midwife-led continuity of care (MLCC) in low- and middle-income countries (LMICs), where midwives are the key to successful implementation. There is limited knowledge about their experiences and perceptions of MLCC models. Aim: To explore midwives’ experiences and perceptions of working with MLCC models in LMICs, their views of barriers to and facilitators of MLCC models, including to assess our confidence in the evidence. Methods: Two information specialists conducted systematic searches in eight databases from year 2000 until June 2024. The methodological quality of the included studies was assessed using a modified version of the Critical appraisal tool (CASP). We conducted a thematic analysis and used Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE CERQual) approach to assess our confidence in each review finding. Results: This synthesis included five studies exploring midwives’ experiences and perceptions of MLCC in LMICs. Three analytic themes were generated: Equity and access; professional development and recognition; and enhancing midwifery practices and policies. In addition, we identified ten associated sub-themes that were assessed by GRADE CERQual. These findings varied from moderate to very low confidence. Conclusion: While midwives highlighted the benefits of continuity of care, they identified essential components for successful implementation of MLCC in LMICs including reducing structural and geographical barriers, the continuous need for sustained capacity building and learning, and optimal resource allocation and availability. Findings assessed as low or very low confidence need to be explored further.

KW - Midwife-led continuity of care models

KW - Midwifery

KW - Facilitators

KW - Barriers

KW - Low and middle-income countries

KW - qualitative research

KW - Evidence synthesis

KW - Qualitative research

KW - Low-and middle-income countries

UR - https://www.scopus.com/pages/publications/105013115548

U2 - 10.1016/j.midw.2025.104565

DO - 10.1016/j.midw.2025.104565

M3 - Review article

C2 - 40815912

SN - 0266-6138

VL - 149

JO - Midwifery

JF - Midwifery

M1 - 104565

ER -