A Scoping Review Mapping Economic Evaluations of Midwifery Service Provision and the Midwifery Workforce

Midwives are essential in achieving universal health coverage targets and the health targets of the Sustainable Development Goals, yet a significant global shortfall exists in the midwifery workforce. Economic evaluations of midwifery are scarce but can assist in supporting evidence-informed decision-making for sustainable and equitable health care for women and girls.

This review aimed to systematically identify, map and report on available literature regarding economic evaluations conducted on midwifery service provision and the midwifery workforce in all settings.

A scoping review was conducted following the Joanna Briggs Institute methodology. A comprehensive search strategy was developed and run in six health databases. Peer-reviewed studies and unpublished research theses conducting economic evaluations on midwifery service provision or midwifery workforce strategies were included. Sources were limited to English-language literature published in the past 20 years. Identified sources were screened and reviewed, and data from included sources were extracted, reviewed, mapped and synthesised to report findings. Quality appraisal was conducted on all included sources using the Joanna Briggs Institute Critical Appraisal Checklist for Economic Evaluations.

A total of 32 studies were included in the review. Most were from high-income countries (26/32), and very few were from low- and middle-income countries (6/32). The quality of included studies varied greatly. Under half of the studies conducted full economic evaluations (15/32), and the remainder were partial economic evaluations (17/32). Most studies evaluated midwifery service provision (29/32) through either midwife-led models of care (15/29) or by place of birth (13/29), mostly for low-risk women (23/29) from the perspective of healthcare funders. Evaluation of midwifery education programs was less common, and these were all conducted in low- and middle-income countries (3/32). Most studies concluded that midwifery service provision was cost-saving, cost-effective or cost-beneficial.

Our review identified a significant gap in economic evaluation of midwifery from low- and middle-income countries. However, there is ongoing need for robust, quality economic evaluations on midwifery service provision and workforce strategies in all global regions. Such studies would further support health policymakers and governments to make evidence-informed decisions to address midwifery workforce shortages and provision of evidence-based and respectful care that meets the healthcare needs of women and girls.