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Sara Gabrielsson

Sara Gabrielsson

Senior Lecturer

Sara Gabrielsson

Maternal health leaders’ perceptions of barriers to midwife-led care in Ethiopia, Kenya, Malawi, Somalia, and Uganda

Author

  • Johanna Blomgren
  • Sara Gabrielsson
  • Kerstin Erlandsson
  • Miriam C.A. Wagoro
  • Mariam Namutebi
  • Eveles Chimala
  • Helena Lindgren

Summary, in English

Objective: To identify and examine barriers to midwife-led care in Eastern Africa and how these barriers can be reduced Design: A qualitative inductive study with online focus group discussions and semi-structured interviews using content analysis Setting: The study examines midwife-led care in Ethiopia, Malawi, Kenya, Somalia, and Uganda -five African countries with an unmet need for midwives and a need to improve maternal and neonatal health outcomes. Participants: Twenty-five participants with a health care profession background and current position as a maternal and child health leader from one of the five study countries. Findings: The findings demonstrate barriers to midwife-led care connected to organisational structures, traditional hierarchies, gender disparities, and inadequate leadership. Societal and gendered norms, organisational traditions, and differences in power and authority between professions are some factors explaining why the barriers persist. A focus on intra- and multisectoral collaborations, the inclusion of midwife leaders, and providing midwives with role models to leverage their empowerment are examples of how to reduce the barriers. Key conclusions: This study provides new knowledge on midwife-led care from the perspectives of health leaders in five African countries. Transforming outdated structures to ensure midwives are empowered to deliver midwife-led care at all healthcare system levels is crucial to moving forward. Implications for practise: This knowledge is important as enhancing the midwife-led care provision is associated with substantially improved maternal and neonatal health outcomes, higher satisfaction of care, and enhanced utilisation of health system resources. Nevertheless, the model of care is not adequately integrated into the five countries' health systems. Future studies are warranted to further explore how reducing barriers to midwife-led care can be adapted at a broader level.

Department/s

  • LUCSUS (Lund University Centre for Sustainability Studies)

Publishing year

2023

Language

English

Publication/Series

Midwifery

Volume

124

Document type

Journal article

Publisher

Elsevier

Topic

  • Health Care Service and Management, Health Policy and Services and Health Economy

Keywords

  • Barriers
  • Gender norms
  • Leaders
  • Midwife-led care
  • MLC
  • Organisation

Status

Published

ISBN/ISSN/Other

  • ISSN: 0266-6138