What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students

Abstract

BackgroundWith professional midwives being introduced in Bangladesh in 2013, the aim of this study was to describe midwifery students perceptions on midwives’ realities in Bangladesh, based on their own experiences.MethodData were collected through 14 focus group discussions that included a total of 67 third-year diploma midwifery students at public nursing institutes/colleges in different parts of Bangladesh. Data were analyzed deductively using an analytical framework identifying social, professional and economical barriers to the provision of quality care by midwifery personnel.ResultsThe social barriers preventing midwifery quality care falls outside the parameters of Bangladeshi cultural norms that have been shaped by beliefs associated with religion, society, and gender norms. This puts midwives in a vulnerable position due to cultural prejudice. Professional barriers include heavy workloads with a shortage of staff who were not utilized to their full capacity within the health system. The reason for this was a lack of recognition in the medical hierarchy, leaving midwives with low levels of autonomy. Economical barriers were reflected by lack of supplies and hospital beds, midwives earning only low and/or irregular salaries, a lack of opportunities for recreation, and personal insecurity related to lack of housing and transportation.ConclusionWithout adequate support for midwives, to strengthen their self-confidence through education and through continuous professional and economic development, little can be achieved in terms of improving quality care of women during the period around early and late pregnancy including childbirth.The findings can be used for discussions aimed to mobilize a midwifery workforce across the continuum of care to deliver quality reproductive health care services. No matter how much adequate support is provided to midwives, to strengthen their self-confidence through education, continuous professional and economic development, addressing the social barriers is a prerequisite for provision of quality care.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3447-5) contains supplementary material, which is available to authorized users.

Midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo – An interview study

“…The lack of an equitable remuneration system and insu cient security when going to and from work that was experienced by the DRC midwives in our study has also been con rmed to be highly problematic in other studies in low-and middle-income settings [15,16], leading to serious challenges in managing daily life and accentuating the profession's low status. In settings where salaries are extremely low or unpredictable, proper remuneration is seen as crucial to worker motivation [25][26][27].…”

“…As such, this can contribute to distress and burnout, which in turn prevents midwives from being able to provide quality care and can eventually cause them to leave the profession [15]. This phenomenon does not seem to differ between settings in high -, middle-and low-income countries [16,18]. Therefore, in order to retain midwives in their work positions and enable them to provide quality care, it is crucial to create supportive work environments by ensuring su cient pre-conditions [33].…”

“…Hierarchies of power and gender discrimination were identi ed as barriers to providing high-quality, respectful care for women, newborns, and their families [14]. In low-and middle-income countries, such barriers have been identi ed to include economic, social, and professional areas [15][16][17]. Contributing factors include gender inequalities with a lack of power for women [15,17], low professional autonomy [14,16], and unmanageable workloads [16], the last of which is also identi ed as a signi cant barrier in high-income countries [18].…”

“…In low-and middle-income countries, such barriers have been identi ed to include economic, social, and professional areas [15][16][17]. Contributing factors include gender inequalities with a lack of power for women [15,17], low professional autonomy [14,16], and unmanageable workloads [16], the last of which is also identi ed as a signi cant barrier in high-income countries [18]. In a conceptual model on how health worker motivation is in uenced and how health sector reform can positively affect worker motivation, it has been concluded that motivating factors have a high impact on health worker performance and on general health outcomes in health workers, and that the factors cover both individual, organisational, and cultural dimensions [19].…”

Successes, Challenges and Opportunities Towards Universal Health Coverage for Maternal and Child Health in South East Asian Countries: A Systematic Review

“…Among studies included in the review, a majority was from India (n=30, 48 %) . There were 11 studies from Nepal (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52) , 10 from Bangladesh (53)(54)(55)(56)(57)(58)(59)(60)(61)(62) , six from Indonesia (63)(64)(65)(66)(67)(68) and two from Timor-Leste 69,70 . From Bhutan 71 , Thailand 72 , and Myanmar 73 one from each was identi ed.…”