Shaping the midwifery profession in Nepal - Uncovering actors' connections using a Complex Adaptive Systems framework.

OBJECTIVES: To explore how actors connect in a system aiming at promoting the establishment of a midwifery profession in Nepal. METHODS: A qualitative explorative study based on the framework of Complex Adaptive Systems. Semi-structured interviews were conducted with 17 key people representing eight different organisations (actors) promoting the development of the midwifery profession. RESULTS: The actors' connections can be described with a complex set of facilitators for and barriers to promoting the establishment of a midwifery profession. The identified facilitators for this establishment in Nepal are (1) a common goal and (2) a desire to collaborate, whilst the barriers are (1) different political interests and priorities, (2) competing interests of the nursing profession and societal views, (3) divergent academic opinions on a midwifery profession, and (4) insufficient communication. The results also showed that Nepalese society cannot distinguish between nursing and midwifery and that the public support for a midwifery profession was hence minimal. CONCLUSION: The move of midwifery from an occupation to a profession in Nepal is an on-going, challenging process. The study indicates the importance of understanding the motivations of, and barriers perceived by, actors that can promote or obstruct the establishment of the midwifery profession. It also points to the importance of informing the wider public about the role and responsibility of an autonomous midwifery profession

Midwifery education still lacking in Nepal

Background: Midwifery is one of the few health professions with a global curriculum set by International Confederation of Midwives (ICM). Nepal is one of a few countries which has not yet reached these professional standards for midwifery. Objective: This paper explores the feasibility of establishing midwifery in Nepal to ICM’s Global Standards and Competencies. The central goal of such strategy would be to ensure that safe and competent midwives provide high standards of maternity care to every woman. Method: Using a mixed methods approach comprising: (1) a review of policy and education documents; (2) interviews; and (3) site observations and assessment of five higher education institutions and assiciated hospital-based maternity departments. Permission for the research was granted by the Ministry of Health & Population and the Nepal Nursing Council. Findings: Our study identified six levels of education of nurse staff providing midwifery care, all regulated under the Nepal Nursing Council. A midwifery bachelor programme was under development. Although midwifery is not officially recognised as a separate profession from nursing in Nepal, the country has an established midwifery association (MIDSON). This professional association is largely made up of nurses who are involved in delivering maternity care. The study identified four university colleges that could offer a midwifery curriculume as they are already involved in teaching nurses and doctors. A further college was also keen to establish a midwifery bachelor degree. This research also resulted in a paper in the international journal Midwifery

Nepal needs midwifery

This paper is published as a Commentary. It has no abstract, but the paper links the Millennium Development Goals to the maternity workforce in Nepal and highlights to need for recognition of the midwifery profession in that country