Where midwives are not yet recognised: a feasibility study of professional midwives in Nepal

the professional midwife is a key person for promoting maternal and family health. Not all countries have yet reached the professional standard for midwives set by the International Confederation of Midwives (ICM) and Nepal is one of these countries. This study explores the feasibility to establish a professional midwifery cadre in Nepal that meets the global standards of competencies, and to define a strategy to reach this.

a mixed-methods study comprised (1) policy-review (2) interviews and (3) observations. An assessment tool was designed for data collection and analysis using variables from three sources: ICM's Global Standards, the skilled birth attendant programme in Nepal, and JHPIEGO's site assessment tool for maternal health and new-born programmes. Data were collected in a desk review of education and policy documents, interviews with stakeholders, and site assessment of five higher education institutions and their hospital-based maternity departments. The analysis resulted in a recommended strategy.

six levels of education of nurse staff providing midwifery care were identified; all regulated under the Nepal Nursing Council. No legislation was in place authorising midwifery as an autonomous profession. A post-basic midwifery programme on first cycle-bachelor level was under development. A well-organised midwifery association was established consisting of nurses providing maternal health care. Four university colleges offering higher education for nurses and clinicians had a capability to run a midwifery programme and the fifth had a genuine interest in starting a midwifery programme at bachelor level. The proposed strategy includes four strategic objectives and interventions in relation to four components identified by UNFPA: Legislation and regulation; Training and education; Deployment and utilisation; and Professional associations.

the study has delivered a proposed strategy for the Government of Nepal for effective management of the midwifery workforce in order to enhance midwives' contribution in maternity care and thus promoting improved maternal and new-born health. The developed analytical framework could be used as an assessment tool also in other countries to establish professional midwifery cadres that meets the global standards of competencies.