Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun;6(6):e004850.
doi: 10.1136/bmjgh-2020-004850.

Health systems factors impacting the integration of midwifery: an evidence-informed framework on strengthening midwifery associations

Cristina Mattison  1 , Kirsty Bourret  2 , Emmanuelle Hebert  3   4 , Sebalda Leshabari  5 , Ambrocckha Kabeya  4 , Patrick Achiga  6 , Jamie Robinson  7 , Elizabeth Darling  2
Affiliations

Health systems factors impacting the integration of midwifery: an evidence-informed framework on strengthening midwifery associations

Cristina Mattison et al. BMJ Glob Health. 2021 Jun.

Abstract

Introduction: Midwifery associations are organisations that represent midwives and the profession of midwifery. They support midwives to reduce maternal and newborn mortality and morbidity by promoting the overall integration of midwifery in health systems. Our objective was to generate a framework for evidence-informed midwifery association strengthening.

Methods: A critical interpretive synthesis complemented by key informant interviews, focus groups, observations, and document review was used to inform the development of concepts and theory. Three electronic bibliographical databases (CINAHL, EMBASE and MEDLINE) were searched through to 2 September 2020. A coding structure was created to guide the synthesis across the five sources of evidence.

Results: A total of 1634 records were retrieved through electronic searches and 57 documents were included in the critical interpretive synthesis. Thirty-one (31) key informant interviews and five focus groups were completed including observations (255 pages) and audio recordings. Twenty-four (24) programme documents were reviewed. The resulting theoretical framework outlines the key factors by context, describes the system drivers that impact the sustainability of midwifery associations and identifies the key-enabling elements involved in designing programmes that strengthen midwifery associations.

Conclusion: Midwifery associations act as the web that holds the profession together and are key to the integration of the profession in health systems, supporting enabling environments and improving gender inequities. Our findings highlight that in order to strengthen midwifery (education, regulation and services), we have to lead with association strengthening. Building strong associations is the foundation necessary to create formal quality midwifery education systems and to support midwifery regulation and accreditation mechanisms.

Keywords: health policies and all other topics; health policy; health systems; maternal health; midwifery.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Process helix of qualitative data collection and theory generation.
Figure 2
Figure 2
Literature search and study selection flow diagram.
Figure 3
Figure 3
Framework for midwifery association strengthening.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Chamberlain J, McDonagh R, Lalonde A, et al. . The role of professional associations in reducing maternal mortality worldwide. Int J Gynaecol Obstet 2003;83:94–102. 10.1016/s0020-7292(03)00185-1 - DOI - PubMed
    1. Lopes SC, Titulaer P, Bokosi M, et al. . The involvement of midwives' associations in policy and planning about the midwifery workforce: a global survey. Midwifery 2015;31:1096–103. 10.1016/j.midw.2015.07.010 - DOI - PubMed
    1. Shaw D. Advocacy: the role of health professional associations. Int J Gynaecol Obstet 2014;127 Suppl 1:S43–8. 10.1016/j.ijgo.2014.08.002 - DOI - PubMed
    1. Shamian J. Interprofessional collaboration, the only way to save every woman and every child. Lancet 2014;384:e41–2. 10.1016/S0140-6736(14)60858-8 - DOI - PubMed
    1. Taylor DJ. Professional leadership in obstetrics and gynecology and its contribution to millennium development goal 5. Int J Gynaecol Obstet 2012;119 Suppl 1:S42–4. 10.1016/j.ijgo.2012.03.015 - DOI - PubMed

Publication types

LinkOut - more resources