Global prevalence of midwives' turnover intention: A systematic review and meta-analysis

Midwives' turnover poses a serious global challenge to maternal and newborn health. This study was conducted with the aim of providing the first worldwide meta-analytic estimate of turnover intention among midwives.

A systematic review and meta-analysis was conducted based on PRISMA guidelines. Databases (PubMed, Web of Science, Scopus) were searched from January 2000 to August 2025 for observational studies reporting prevalence of turnover intention among midwives. Methodological quality was assessed using the Joanna Briggs Institute checklist. Pooled prevalence estimates with 95% confidence intervals (95% CI) were calculated using a random-effects model. Heterogeneity was evaluated using I², and publication bias was assessed via funnel plots and Egger's test. Analyses were performed in Comprehensive Meta-Analysis (CMA) software.

Of 624 identified records, 27 studies involving 17,427 midwives were included. The pooled prevalence of intention to leave (ITL) was 39.0% (95% CI: 32.2-46.3; I² = 98.6%). Subgroup analyses revealed significantly lower ITL in Europe (27.7%; p = 0.005) compared to other regions, and in high income countries (HICs =33.8%) compared to low- and middle-income countries (LMICs =52.6%; p = 0.001). No evidence of publication bias was observed (p = 0.387).

This meta-analysis demonstrates that a substantial proportion of midwives are considering leaving their jobs particularly in LMICs. Urgent policy action is needed to improve working conditions, strengthen leadership, and address systemic inequities to retain this essential workforce and achieve global maternal and newborn health targets.