Factors influencing turnover intention among midwives: a systematic review

Attrition of midwives is a growing global challenge that threatens the sustainability of maternal and newborn health services. Turnover intention (TI) is a strong predictor of actual workforce exit and often develops long before resignation. Despite increasing research on this topic, evidence on the factors associated with TI among midwives remains fragmented. This systematic review aimed to identify, categorize, and synthesize factors associated with turnover intention among midwives worldwide.

A systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed, Web of Science, and Scopus were searched for quantitative studies published between January 2010 and August 2025. Eligible studies examined at least one factor associated with turnover intention among midwives and reported midwife-specific data. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sectional studies. Due to heterogeneity in outcome measures and reported factors, a narrative synthesis was performed. Identified factors were organized using the Job Demands-Resources (JD-R) model.

A total of 30 studies from 17 countries, encompassing 17,608 midwives, were included in this review. The synthesis identified 121 factor occurrences associated with TI. Guided by the JD-R model, these factors were categorized into three primary domains: Job Demands (e.g., high workload, burnout, work-life conflict, and stressful work environments), Inadequate Job Resources (e.g., low job satisfaction, inadequate salary, lack of managerial support, and restricted autonomy), and Sociodemographic and Personal Factors. The findings indicate that TI is predominantly driven by the exhaustion from excessive job demands coupled with a lack of structural resources.

Turnover intention among midwives is a complex, multifactorial phenomenon deeply rooted in organizational and systemic structures rather than individual shortcomings. To effectively retain the midwifery workforce, policymakers and healthcare administrators must prioritize systemic improvements, including reducing excessive workloads, enhancing managerial and professional support, and fostering healthier work environments. Future research should focus on longitudinal and interventional studies to evaluate the effectiveness of specific retention strategies.

This systematic review was not registered.