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Community midwives' workplace experiences: A case study from a resource-poor country

02 December 2015
Volume 23 · Issue 12



To explore community midwives' (CMs') experiences with respect to deployment policies and processes developed and used in Pakistan.


A qualitative, descriptive, exploratory design was used; 11 CMs' perspectives were gained through two focus groups.


The findings are summarised under a key theme, ‘Surviving as community midwives', and four related categories: (1) lack of identity and recognition; (2) state of helplessness; (3) depletion of competence and confidence; (4) unavailability of resources and financial support.


The study findings highlight the need for revising the deployment policies, especially those related to the preparation of CMs for working independently in communities; introducing the CMs and their roles within the communities; establishing independent work stations (birthing centres); and streamlining the remuneration processes. The findings recommend greater preparation of district and regional-level government officials by policy makers for the implementation of the new CMs' deployment plan.

In 2004, a joint statement issued by the World Health Organization (WHO), the International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) identified skilled birth attendants (SBAs), such as midwives, as an effective intervention for achieving Millennium Development Goal (MDG) 4—to reduce the neonatal mortality rate (NMR)—and MDG 5, to reduce the maternal mortality rate (MMR). In 2006, the Lancet series further emphasised the use of midwives as SBAs (Koblinsky et al, 2006). More recently, the 2014 Lancet series evaluated midwives' contribution and recognised them as the backbone of maternal, neonatal and child health services, and a strong, cost-effective resource for preventing maternal and neonatal mortality (Ten Hoope-Bender et al, 2014; Homer et al, 2014; Van Lerberghe et al, 2014). The SBA is defined as a professional who has acquired midwifery skills through accredited training by a local nursing and midwifery board to assist woman safely throughout the birth process (Koblinsky et al, 2006).

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