Introduction: Midwives reduce maternal and infant mortality globally. However, there is a shortage of midwives in Nigeria, particularly in the north eastern region of the country, with devastating consequences for the health of childbearing women and their babies. The country has the highest maternal and perinatal mortality in sub-Saharan Africa. This study explores factors relating to the shortage of midwives in the north eastern region of Nigeria. Methods/Methodology: Case-study methodology in three sites was conducted by collecting data from parents, pregnant and recently delivered women, religious and opinion leaders, prospective student midwives, heads of the schools of nursing and midwifery and the primary healthcare boards. Data were generated through focus group discussions, in-depth interviews, and desk review of routinely collected quantitative data. Thematic analysis was conducted using the template analysis approach to identify themes in the data. Findings: The social ecological model approach in public health was used to explain or understand the range of factors that influence health and well-being across different levels of influence underscoring the effectiveness of multi-level interventions in addressing health challenges in the society. A mixture of factors at different ecological levels of influence within Nigeria was associated with the shortage of midwives. The influences are found at the policy level, community level, family level and at the individual level. Most barriers to the training of midwives were found at the policy level of influence, such as the huge shortage of training places and training infrastructure, despite the availability of qualified local students willing to study midwifery, lack of transparency in the admission process due to limited spaces which gave rise to political interference in the selection of qualified students to become midwives. Poor working conditions in rural areas, such as a lack of good accommodation, electricity, poor salary, lack of incentives and lack of continuing professional development, were also implicated. Other factors include insecurity, poor quality education for girls and lack of sponsorship for children from low-income families.At the community level of influence, religion, and socio-cultural factors such as early marriage, preference for female skilled birth attendants, ignorance associated with the birthing position and perceived practice of witchcraft associated with birth attendants were the major findings. The Boko Haram insurgency in north eastern region of Nigeria was another barrier impacting the study of midwifery. Financial barriers at the family level of influence denied children from low-income families access to quality education. The individual level of influence included negative perceptions of midwives, such as perceptions of being wicked people, lacking compassion and having a poor attitude to work due to limited understanding of their role as professionals within the healthcare delivery system. Conclusion: The shortage of midwives in north eastern region of Nigeria has multi-dimensional causation and is located at different ecological levels of influence. However, opportunities exist that have the potential to increase the availability of midwives in this part of Nigeria.
| Date of Award | 18 Dec 2024 |
|---|
| Original language | English |
|---|
| Supervisor | Melanie Rogers (Main Supervisor), John Wattis (Co-Supervisor), Rajeeb Kumar Sah (Co-Supervisor) & Andrea Gaynor (Co-Supervisor) |
|---|