Maternal health leaders' perceptions of barriers to midwife-led care in Ethiopia, Kenya, Malawi, Somalia, and Uganda

Objective: To identify and examine barriers to midwife-led care in Eastern Africa and how these barriers can be reducedDesign: A qualitative inductive study with online focus group discussions and semi-structured interviews using content analysisSetting: The study examines midwife-led care in Ethiopia, Malawi, Kenya, Somalia, and Uganda -five African countries with an unmet need for midwives and a need to improve maternal and neonatal health outcomes.Participants: Twenty-five participants with a health care profession background and current position as a maternal and child health leader from one of the five study countries. Findings: The findings demonstrate barriers to midwife-led care connected to organisational structures, traditional hierarchies, gender disparities, and inadequate leadership. Societal and gendered norms, organisational traditions, and differences in power and authority between professions are some factors explaining why the barriers persist. A focus on intra- and multisectoral collaborations, the inclusion of midwife leaders, and providing midwives with role models to leverage their empowerment are examples of how to reduce the barriers.Key conclusions: This study provides new knowledge on midwife-led care from the perspectives of health leaders in five African countries. Transforming outdated structures to ensure midwives are empowered to deliver midwife-led care at all healthcare system levels is crucial to moving forward. Implications for practise: This knowledge is important as enhancing the midwife-led care provision is associated with substantially improved maternal and neonatal health outcomes, higher satisfaction of care, and enhanced utilisation of health system resources. Nevertheless, the model of care is not adequately integrated into the five countries' health systems. Future studies are warranted to further explore how reducing barriers to midwife-led care can be adapted at a broader level.& COPY; 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Automated summary

This study identifies and examines barriers to midwife-led care in Eastern Africa and suggests ways to reduce these barriers through qualitative research methods. The findings highlight barriers related to organizational structures, traditional hierarchies, gender disparities, and inadequate leadership. Intra- and multisectoral collaborations, inclusion of midwife leaders, and empowering midwives through role models can help overcome these barriers.