The experience of setting up midwife-led birth centers in Pakistan: a case study

Midwife-led birth centers (MLBCs) exist in Pakistan in various financial and operational capacities. Some operate independently, providing maternity services for a small user fee. Others operate through public-private partnerships involving collaboration between the government and NGOs. Currently, there is insufficient evidence available on the experiences of community midwives as maternal health care providers in MLBCs. There is also a lack of evidence about how midwives can operate in the private sector, although MLBCs are becoming more widespread nationwide. The study aimed to explore how MLBCs operate, to identify innovative approaches to improving women-centred care services.

In-depth interviews were conducted with 6 stakeholders working in senior or leadership roles and 20 MLBC clients receiving maternity care services. Four Focus Group Discussions (FGDs) were organized with 25 individuals currently working as healthcare workers in MLBCs including midwives and nurses.

Five key themes were identified to describe MLBCs in Pakistan, especially women's experiences. The themes were (i) Having competent midwives, (ii) Providing comprehensive and accessible services that women need and want, (iii) Providing quality of care, (iv) Being disconnected from the healthcare system and (vi) Managing the cost.

This study contributes to the understanding of MLBCs in Pakistan, their functioning, and providing quality, accessible, and affordable maternity care. Midwives provide humane and client-centered care at much lower prices, making their services accessible to a larger audience. The gap for women who want affordable high-quality care but cannot afford the premium fees of the private sector can be filled by establishing MLBCs and integrating them into the national health system. The policymakers and stakeholders should prioritize actionable steps in securing sustainable finance, continued medical, and integration of MLBCs into the larger public health system to harness the full potential of MLBCs in delivering high-quality, safe, and dignified maternity care to all, regardless of socioeconomic status.