Skip to main content
Download PDF
  • Systematic Review
  • Open access
  • Published:

Ninety-one years of midwifery continuity of care in low and middle-income countries: a scoping review

BMC Health Services Research volume 25, Article number: 463 (2025) Cite this article

Abstract

Background

Midwifery continuity of care during pregnancy, childbirth, and postpartum is essential for improving maternal and neonatal health outcomes. In low- and middle-income countries (LMICs), however, challenges such as healthcare worker shortages, limited infrastructure, poor healthcare access, and cultural barriers often hinder the effective provision of midwifery services. These issues contribute to unsustainable and inadequate care, adversely affecting maternal and newborn health. This study examines the impact of these challenges on the midwifery continuity of care and its subsequent effect on maternal and neonatal outcomes.

Methods

A scoping review was conducted following Arksey and O’Malley’s framework. We analyzed 43 articles published between 1932 and 2023 across four databases. Included studies were conducted in LMICs, focused on continuous care models, and published in English. The review aimed to capture the varied impacts of midwifery care on health outcomes.

Results

The review found that midwifery continuity of care in LMICs significantly improves maternal and newborn health by reducing medical interventions, increasing physiological births, and enhancing maternal satisfaction and breastfeeding rates. The approach also lowers newborn mortality and morbidity. Success factors include community acceptance, midwives’ cultural competence, and collaboration with traditional birth attendants. Barriers such as insufficient funding and resistance to change persist. Midwife-led continuity of care (MLCC) was associated with a 16% reduction in neonatal loss and a 24% reduction in pre-term births. Also, MLCC decreases newborn mortality by 10–20% and increases breastfeeding rates by up to 30%. Effective implementation requires integrating midwifery services into existing health systems, securing funding, expanding training, and strengthening community partnerships.

Conclusions

Midwifery continuity of care enhances maternal and neonatal health in LMICs by minimizing unnecessary medical interventions and improving maternal satisfaction and breastfeeding outcomes. However, cultural and socioeconomic factors influence its acceptance. Further research is needed to integrate traditional birth attendants into formal health systems, overcome resistance to change, and develop strategies for effective collaboration between traditional and professional care providers.

Peer Review reports

Background

The midwifery profession promotes women-centred care and normal physiological childbirth as a vital part of the maternal healthcare system. Midwives are highly trained healthcare professionals who provide a continuum of care to women during pregnancy, birth, and postpartum period. Continuity of care involves a dedicated midwife or a small team providing consistent and comprehensive support, ensuring personalized attention throughout pregnancy, childbirth, and postpartum. This strategy differs from fragmented and episodic care, in which women may receive care from multiple providers at different phases, often resulting in disjointed and unsatisfactory outcomes. High-quality midwifery care can significantly decrease maternal and neonatal mortality and morbidity in high, low, and lower-middle-income nations. It must be supported by efficient education [1].

Midwifery continuity of care has emerged as a key and promising maternal and newborn healthcare approach. Quality midwifery care during pregnancy, labour, and postpartum is critical for mothers and neonatal health outcomes [2]. Based on the current evidence in high-income countries, implementing midwifery continuity of care has improved maternal and neonatal health outcomes. Continuity of care has been linked to lower rates of interventions such as cesarean sections, episiotomies, and instrumental births, enhanced maternal satisfaction, and an increased likelihood of commencing and maintaining breastfeeding [3]. However, in many low and middle-income countries (LMICs), births and deaths have a significant impact on women, their families, and health services. Low resources, insufficient infrastructure, and unequal access to healthcare services can also promote sub-optimal maternal and newborn outcomes [2] There is an interest to investigate the potential benefits of midwifery continuity of care in LMICs, where maternal and newborn death rates remain unacceptably high [3].

Despite the evidence of midwifery continuity of care as a viable method, little is known about its implementation and effectiveness in LMICs. These countries frequently confront unique problems, such as underdeveloped health systems, insufficient infrastructure, cultural beliefs and practices, socioeconomic inequities, and geographical constraints, which can impact the feasibility and outcomes of continuity-of-care approaches. The evidence basis for midwifery continuity of care in LMICs is relatively underreported. Available studies are fragmented, inconclusive, and lack detailed synthesis.

This scoping review aims to provide an updated overview of midwifery continuity of care in LMICs. It offers insights into its potential to improve maternal and newborn health outcomes in these contexts. By addressing these questions, the review will inform policy and practice, guide future research, and contribute to strengthening maternity and newborn healthcare systems in resource-constrained settings. Understanding the role of midwifery continuity of care is essential as the global community works towards achieving the Sustainable Development Goals (SDGs), particularly those focused on maternal and child health.

Methods

Scoping reviews are an increasingly popular method for evaluating evidence in health research. This study utilized the scoping review methodology proposed by Arksey and O’Malley [4] As delineated by this framework, there are six distinct stages: (1) formulation of the research question; (2) identification of related studies; (3) study selection; (4) data collection; and (5) compilation, summarization, and reporting of findings.

Stage 1. Formulation of the research question

This review paper aims to answer the following essential questions by methodically examining and summarising the current evidence: What is the current knowledge about implementing midwifery continuity of care strategies in LMICs? What are the lived experiences among women and families in LMICs linked with midwifery continuity of care? What barriers and enablers exist to adopting midwifery continuity of care in LMICs? How do contextual factors such as cultural beliefs, socioeconomic status, and health system capacity affect the effectiveness of midwifery continuity of care models in LMICs?

Stage 2. Identification of related studies

The investigators searched the title and abstract of peer-reviewed and grey literature published since 1 January 1932 using synonyms and MeSH terms. We chose 1 January 1932 as the starting date because, in the early 1930s, most practicing midwives were based in LMICs and attended about half of all births. A comprehensive search was conducted across multiple databases, including PubMed, Embase, Scopus, and Web of Science, utilizing carefully selected keywords and Medical Subject Headings (MeSH) terms. Although the Maternal and Infant Care database is highly relevant to our topic, we were unable to include it in our search as none of the authors had institutional access. To capture relevant grey literature, we also included sources such as the Partnership for Maternal, Newborn, and Child Health, the Maternal Health Task Force, the Healthy Newborn Network, UNICEF, and the World Health Organization. A total of 3,408 unique publications were identified in the initial search that met the criteria for screening based on their title and abstracts. Furthermore, in addition to the articles already included, we examined the reference lists of the reviews identified during the title and abstract screening.

We applied keyword searches with filters to refine the results based on a predetermined framework. The chosen keywords were: (continuity) AND (midwifery care) AND (low middle-income countries). To ensure a systematic selection process, the authors established the inclusion and exclusion criteria outlined in Table 1.

Table 1 Inclusion and exclusion criteria
Full size table

Stage 3. Study selection

During the preliminary search, 3,408 articles were identified and archived in the Zotero bibliography management system. We then applied our framework to exclude articles that did not meet the inclusion criteria. The results were documented, including the number of articles retained. A PRISMA flow diagram was created to illustrate the screening process.

After removing 1,841 duplicate records, largely due to articles appearing in multiple databases, 1,567 papers remained. Subsequently, 1,003 publications were excluded based on irrelevant titles and abstracts. Two researchers with relevant expertise and shared research interests further assessed 157 publications. The evaluation focused on studies that provided key insights into the implementation of continuity of care in LMICs, the lived experiences of women and families, contextual factors such as cultural beliefs, socioeconomic status, and health system capacity, as well as the impact of midwifery continuity of care models in LMICs.

Ultimately, 114 publications were excluded for not meeting the inclusion criteria. A total of 43 papers were finally included in the study. Figure 1 illustrates the screening process and its outcomes.

Fig. 1
figure 1

PRISMA flow diagram for scoping review process

Full size image

Stage 4. Data collection

Two researchers initially refined the search results by screening titles and abstracts before conducting a full-text assessment of potentially relevant papers. A total of 43 articles were selected, and their key results were documented. To systematically gather data, we used a standardized extraction form that included each study’s title, authors, year, country, objectives, design, population, and main findings. The extracted data also included findings on midwifery continuity of care models, measured outcomes, and reported maternal and neonatal health results.

Qualitative studies were further categorized based on factors that facilitated or hindered midwifery continuity of care. Two researchers independently conducted data extraction, and any discrepancies were resolved by a third reviewer.

Stage 5. Compilation, summarization, and reporting of findings

Following the selection of 43 final studies (Fig. 1), appropriate methods were used to assess the methodological rigor of each included study, as outlined in Table 2. For quantitative research involving analytical cross-sectional studies, cohort studies, and randomized controlled trials, we applied the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. For qualitative studies, we used the JBI Critical Appraisal Checklist for Qualitative Research, and for scoping reviews and research syntheses, we employed the corresponding JBI checklist.

Table 2 Summary of key findings
Full size table

Each article was evaluated based on multiple criteria. A numerical score was assigned to each assessment item. Two researchers independently conducted the quality assessment, and any discrepancies were resolved through discussion or consultation with a third evaluator. Low-quality studies were not excluded; instead, they were considered in the overall analysis of study conclusions.

Given the expected diversity in study methodologies, populations, and outcomes, we adopted a narrative synthesis approach. A structured database was used to systematically categorize the extracted data and address the research objectives. Our analysis provides an overview of maternal and neonatal health outcomes and examines factors that facilitate or hinder the continuity of midwifery services in LMICs. Where feasible and appropriate, subgroup analyses may be conducted, considering variables such as geographic location, healthcare setting, and specific midwifery continuity of care models.

Ethical considerations

Although this scoping review did not involve direct interaction with participants, ethical considerations remain important. The review utilized only data from previously published and publicly available studies. The reviewed studies complied with relevant ethical standards. All study data were obtained from legitimate sources and did not violate copyright or privacy.

Registration of the study protocol

We preregistered the scoping review protocol in the Open Science Framework (OSF) before starting our analysis, helping to improve transparency and minimize potential bias. The protocol can be accessed through this link https://doiorg.publicaciones.saludcastillayleon.es/10.17605/OSF.IO/8E3GM.

Findings

The scoping review aimed to provide insights into the present knowledge addressing midwifery continuity of care in LMICs. The review synthesized a large body of literature to accomplish this. A total of 43 research contributed to a deeper understanding of the implementation, outcomes, facilitators, and challenges related to midwifery continuity of care models in LMICs.

  1. 1.

    Characteristics of the Studies That Were Included

The publication time frame for the included studies ranged from 1980 to 2023, and they came from various LMICs in various parts of the world. The evaluation covered a wide range of research methodologies, including randomized controlled trials (RCTs), cohort studies, and qualitative investigations.

  1. 2.

    Establishment of a Continuity of Care Model for Midwifery

According to the review findings, LMICs have introduced midwifery continuity of care models to provide care centred on the woman and enhance the health of both mothers and newborns. These approaches entailed delegating comprehensive care provision during the prenatal, intrapartum, and postpartum periods to either a single known midwife or a group of midwives working together as a team. Here was a wide range of continuity, with some studies focusing on continuity of care during labour and deliveries and others extending continuity into the postpartum period [46].

The training and competency of midwives, collaboration with other healthcare professionals, integration into existing health systems, and community engagement were all necessary components to successfully implement midwifery continuity of care. Due to the adaptability of these models, local cultural norms and practices could be incorporated into the design [47]. However, several obstacles have been highlighted as hurdles to the plan’. These challenges include inadequate resources, inadequate infrastructure, and staff shortages. The most effective midwifery education is very important in providing high quality, life-saving services that can improve the health and well-being of mothers and babies [1].

  1. 3.

    Health Outcomes Regarding the Mother and the Newborn Child

An increasing body of evidence suggests that continuity of care provided by midwives has a positive influence on mother and newborn health outcomes in LMICs, as revealed by a synthesis of studies.

  1. a.

    A Lower Incidence of Medical Interventions: Several studies have found that women who receive midwifery continuity of care experience a lower incidence of medical interventions such as cesarean sections, instrumental births, and episiotomies. This decline was ascribed to the midwives’ increased focus on physiological birthing and other non-invasive labour and delivery techniques [48]

  2. b.

    Higher Rates of Physiological Birth: Continuity of care provided by midwives was associated with higher rates of physiological births, defined as vaginal deliveries that do not include any medical interventions. Women who received midwife care typically had shorter labour durations and fewer difficulties during childbirth [49]

  3. c.

    Maternal Satisfaction: Women who had continuity of care provided by a midwife reported higher overall satisfaction with their birthing experiences. The nurturing and individualized care provided by midwives contributed to a sense of control and empowerment for the client [50]

  4. d.

    Breastfeeding Initiation and Duration: Researchers found a correlation between midwifery continuity of care and higher rates of breastfeeding initiation and longer durations of exclusive breastfeeding. Providing breastfeeding education and assistance was an essential role that midwives performed [51]

  5. e.

    Neonatal Outcomes: Women who received midwifery continuity of care showed encouraging trends in neonatal outcomes, including lower newborn mortality and morbidity. This was one of the findings of the study. The individualized care and early postpartum assistance provided by midwives improved the health of newborns [52]

  1. 4.

    Factors That Help and Those That Hinder

Studies using qualitative methods shed light on the factors that make it easier and those that make it more challenging to implement midwifery continuity of care in LMICs.

  1. a.

    Facilitators: It was found that community acceptance of midwifery treatment, cultural competence on the part of midwives, and collaboration with traditional birth attendants were all factors that acted as facilitators. The capability of the midwives to negotiate the local norms and traditions was a contributing factor to the implementation’s overall success [53]

  2. b.

    Obstacles: The difficulties encountered were insufficient funding, a lack of governmental support, and opposition to change within healthcare systems. Obstacles were presented in the form of gender norms and societal expectations, which prevented the complete integration of midwifery care [13]

This scoping review highlights the growing evidence that supports the deployment of midwifery continuity of care models in LMICs. This analysis indicates that midwifery continuity of care models can improve maternal and neonatal health outcomes by reducing unnecessary interventions, promoting physiological birth, enhancing maternal satisfaction, supporting breastfeeding, and positively influencing neonatal well-being. The highlighted enablers and barriers give significant insights for policymakers and healthcare practitioners in LMICs interested in improving maternal and newborn care in LMICs through midwifery continuity of care. These findings contribute to the worldwide dialogue on improving mother and child health and underscore the need for individualized treatment focused on women in contexts when resources are limited [46].

Discussion

To provide a more in-depth understanding of midwifery continuity of care in low and middle-income countries, the scoping review analyzed and summarized a vast amount of relevant research literature. Focusing on the significance of midwifery continuity of care in LMICs, the challenges encountered, and potential avenues for improving maternal and newborn health outcomes, this discussion section delves into the implications, limitations, and future directions that arise from the findings of this updated scoping review.

  1. 1.

    Importance of Midwifery Continuity of Care in Low- and Middle-Income Countries

The findings of this systematic study highlight the potential of continuity of care provided by midwives to address critical obstacles to maternal and neonatal health in LMICs. Midwifery continuity of care provides a woman-centred, holistic approach that aligns with the ideals of respectful and culturally sensitive care [45]. This method is especially beneficial in contexts where resources are frequently restricted. The global attempt to limit the needless amount of medical intervention during childbirth fits with the focus on physiological birth and fewer interventions by medical professionals. The positive outcomes observed regarding decreased interventions, increased rates of physiological birth, improved maternal satisfaction, and enhanced breastfeeding initiation and duration suggest that midwifery continuity of care holds promise in improving maternal and newborn health outcomes in LMICs [42].

  1. 2.

    Challenges to Overcome and Adaptations

In LMICs, the assessment brought to light several obstacles that must be overcome before midwifery continuity of care can be implemented. Various obstacles, including insufficient resources and infrastructure, a lack of qualified workers, and labour shortages frequently hinder the scalability of midwifery programs. It is possible for socio-cultural factors, such as gender norms and traditional practices, to influence community acceptability of midwifery services and utilization. In addition, there is a lack of governmental backing and opposition to change within healthcare systems, both of which create substantial challenges [28, 29, 41].

Nevertheless, one of the most prominent themes that surfaced was the adaptability and flexibility of the midwifery continuity of care approaches. The ability to adapt these models to the specifics of different cultural settings and contexts is crucial to effective implemention of these models. The possibility of integrating midwifery care within already established health systems is illustrated through projects that involve collaborative efforts between midwives, traditional birth attendants, and other healthcare practitioners. The robustness of midwifery continuity of care approaches is demonstrated by these adjustments, as is their capacity to address the particular issues presented by LMIC settings [14].

Another study highlighted the absence of midwifery continuity of care initiatives in LMICs and emphasized the need for greater investment in establishing effective midwifery systems [46] This should be complemented by ongoing monitoring, evaluation, and research to assess the impact, benefits, and challenges of different models across various contexts. Operational research is essential to identify the barriers, enablers, and constraints affecting the implementation of midwifery continuity of care models, particularly in regions facing midwife shortages. Strengthening midwifery education and regulatory frameworks, along with fostering a supportive healthcare environment, is crucial for ensuring a smooth transition and sustained continuity of midwifery care in LMICs [54,55,56]. The Village Midwife Program in Indonesia exemplifies the successful integration of midwifery services into the national healthcare system by deploying midwives in rural communities to enhance maternal and neonatal healthcare access, supported by continuous training and community partnership [57, 58] This program secured long-term funding through a combination of government budget al.locations and international donor contributions, such as from the World Bank, to support the construction of maternal and child health clinics and training centers [59] Similarly, Nepal’s Skilled Birth Attendant (SBA) initiative has trained over 7,000 midwifery professionals since 2003, significantly reducing maternal mortality rates through competency-based training and strong community engagement [60] Nigeria’s Midwives Service Scheme (MSS) has demonstrated an effective approach in integrating midwifery into rural healthcare by stationing midwives in primary health centers and strengthening referral systems, although challenges in sustainable funding remain [61] In terms of training expansion and strengthening community partnerships, the UNFPA and ICM initiative in Asia has aligned midwifery education standards with national policies, engaging over 60 participants from seven countries to enhance training programs and broaden collaboration with donor organizations and key stakeholders [62, 63] The ability to attract sustained funding in this initiative was largely due to multi-sectoral collaboration, where private sector donors and international development agencies provided financial backing while governments committed to co-financing midwifery education and service integration [64].

  1. 3.

    Public Policy and Professional Practice

The findings of this evidence synthesis have significant ramifications for public policy and clinical practice in LMICs. Policymakers and healthcare administrators should consider integrating midwifery continuity of care models into existing maternal and newborn healthcare systems. For midwifery care programs to be successfully implemented and maintained over time, it is vital to develop strategies to overcome the obstacles that have been identified. These strategies include raising financing, adopting supportive regulations, and fighting for gender equity [14].

Healthcare practitioners, including midwives, play the most crucial role in advocacy and provision of midwifery continuity of care. Therefore, midwives should have unhinged access to comprehensive training programs that emphasize cultural competence, communication skills, and collaboration which will empower them to provide highest quality of care in diverse LMIC environments. Midwifery services can experience significant improvements in both quality and effect if ongoing professional development and capacity-building efforts are implemented [5].

  1. 4.

    Future Research

This scoping review offers valuable insights while highlighting key areas that need further exploration. One promising direction is investigating how digital health technologies can improve midwifery care and address maternal and neonatal health inequities. International health organizations also emphasize the importance of enhancing midwives’ skills to ensure high-quality services for mothers and newborns [65].

Further studies should also explore the cost-effectiveness of midwifery continuity of care models in LMICs. Economic evaluations comparing these models with existing healthcare systems can offer policymakers critical insights to guide resource allocation and decision-making [6] Also, investigating the long-term impact of midwifery continuity of care on maternal and child health beyond the immediate postpartum period is essential.

Another key research priority is exploring how cultural and socioeconomic factors shape the acceptance and implementation of midwifery continuity of care. Qualitative studies examining traditional beliefs, community perspectives, and sociocultural dynamics can inform the development of culturally responsive midwifery care models tailored to specific regional needs. This approach is vital for ensuring effective implementation, sustainability, and long-term success [27].

Limitations of the study

This study has several limitations. First, the reliance on studies published in English may introduce language bias, potentially excluding relevant research in other languages. Also, the inclusion of studies spanning a long timeframe (1932–2023) may result in data heterogeneity due to evolving healthcare systems, policies, and practices over time.

Despite these limitations, this study provides valuable insights into the impact of midwifery continuity of care on maternal and neonatal outcomes in low- and middle-income countries (LMICs). Furthermore, it comprehensively discusses the challenges associated with implementing these models and explores potential strategies to address them.

Conclusion

The review highlights how midwifery continuity of care can transform maternal and newborn health in LMICs. When mothers receive consistent, compassionate care throughout pregnancy, childbirth, and postpartum, their health outcomes improve significantly. This model also supports Sustainable Development Goal (SDG) 3.2, which focuses on reducing preventable newborn and child deaths by 2030.

Midwifery continuity of care is more than a healthcare model. It is a commitment to trust, dignity, and ensuring that every mother and baby, regardless of where they live, receive the best possible start in life. By addressing the real challenges in resource-limited settings, it not only improves health outcomes but also fosters equity, giving women the power to make informed choices about their care.

Its impact extends far beyond the birth room. With a proven ability to reduce unnecessary medical interventions and support physiological birthing practices, midwifery continuity of care stands as a cornerstone of future maternal and newborn health strategies. Its resilience and adaptability make it a vital approach for strengthening health systems, particularly in low- and middle-income countries, where the burden of maternal and newborn mortality remains high.

To realize its full potential, policymakers, healthcare practitioners, and researchers must prioritize investments in midwifery-led care. Scaling up these models, integrating them into existing health systems, and expanding training opportunities will not only improve maternal and newborn health outcomes but also contribute to broader efforts toward equitable health care in the future.

Data availability

All pertinent materials and data that support the findings of this review are included within the manuscript.

Abbreviations

ANC:

Antenatal Care

CE:

Community Engagement

CHWs:

Community Health Workers

EmOC:

Emergency Obstetric Care

ENC:

Essential Newborn Care

HRH:

Human Resources for Health

JBI:

Joanna Briggs Institute

LMICs:

Low- and Middle-Income Countries

mHealth:

Mobile Health

MNH:

Maternal and Newborn Health

OCN:

Obstetric Care Navigation

RCTs:

Randomized Controlled Trials

SBA:

Skilled Birth Attendant

SDGs:

Sustainable Development Goals

TBA:

Traditional Birth Attendant

WHO:

World Health Organization

References

  1. Adatara P, Amooba PA, Afaya A, Salia SM, Avane MA, Kuug A et al. Challenges experienced by midwives working in rural communities in the upper East region of Ghana: a qualitative study. BMC Pregnancy Childbirth. 2021;21(1).

  2. Shakespeare C, Merriel A, Bakhbakhi D, Baneszova R, Barnard K, Lynch M, et al. Parents’ and healthcare professionals’ experiences of care after stillbirth in low- and middle‐income countries: a systematic review and meta‐summary. BJOG. 2019;126(1):12–21.

    CAS  PubMed  Google Scholar 

  3. Mangham-Jefferies L, Pitt C, Cousens S, Mills A, Schellenberg J. Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: A systematic review. BMC Pregnancy Childbirth. 2014;14(1).

  4. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Social Res Methodology: Theory Pract. 2005;8(1):19–32.

    Google Scholar 

  5. Aregay A, Oconnor M, Stow J, Ayers N, Lee S. Strategies used to Establish palliative care in rural low-and middle-income countries: an integrative review. Health Policy Plan. 2020;35(8):1110–29.

  6. Austad K, Juarez M, Shryer H, Moratoya C, Rohloff P. Obstetric care navigation: results of a quality improvement project to provide accompaniment to women for facility-based maternity care in rural Guatemala. BMJ Qual Saf. 2020;29(2):169–78.

    PubMed  Google Scholar 

  7. Bartlett L, Weissman E, Gubin R, Patton-Molitors R, Friberg IK. The impact and cost of scaling up midwifery and obstetrics in 58 low- and middle-income countries. PLoS ONE. 2014;9(6).

  8. Bolan N, Cowgill KD, Walker K, Kak L, Shaver T, Moxon S, et al. Human resources for Health-Related challenges to ensuring quality newborn care in Low-and Middle-Income countries: A scoping review. Global Health Sci Pract. 2021;9(1):160–76 Available from: www.ghspjournal.org.

    Google Scholar 

  9. Carlo WA, McClure EM, Chomba E, Chakraborty H, Hartwell T, Harris H, et al. Newborn care training of midwives and neonatal and perinatal mortality rates in a developing country. Pediatrics. 2010;126(5):e1064–71.

    PubMed  Google Scholar 

  10. Chowdhury ME, RC, KJ AI, GK, DGS. Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study. Lancet. 2006;367(9507):327–32.

    PubMed  Google Scholar 

  11. Dada S, De Brún A, Banda EN, Bhattacharya S, Mutunga Z, Gilmore B. A realist review protocol on communications for community engagement in maternal and newborn health programmes in low- and middle-income countries. Syst Rev. 2022;11(1).

  12. Dowswell T, Carroli G, Duley L, Gates S, Gülmezoglu AM, Khan-Neelofur D, et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2015;2015(7):CD000934. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/14651858.CD000934.

  13. Filby A, McConville F, Portela A. What prevents quality midwifery care? A systematic mapping of barriers in low and middle income countries from the provider perspective. PLoS ONE. 2016;11(5).

  14. Garces A, McClure EM, Espinoza L, Saleem S, Figueroa L, Bucher S, et al. Traditional birth attendants and birth outcomes in low-middle income countries: A review. Semin Perinatol. 2019;43(5):247-51.

  15. Gathara D, Zosi M, Serem G, Nzinga J, Murphy GAV, Jackson D, et al. Developing metrics for nursing quality of care for low- and middle-income countries: A scoping review linked to stakeholder engagement. Hum Resour Health. 2020;18:34.

  16. Gavine A, MacGillivray S, McConville F, Gandhi M, Renfrew MJ. Pre-service and in-service education and training for maternal and newborn care providers in low- and middle-income countries: an evidence review and gap analysis. Midwifery. 2019;78:104–13.

    PubMed  Google Scholar 

  17. Goldman N, Glei DA. Evaluation of midwifery care: results from a survey in rural Guatemala. Soc Sci Med. 2003;56(4):685–700.

  18. Golladan FL. Community health care in developing countries. Finance Dev. 1980;17(3):35–9.

    CAS  PubMed  Google Scholar 

  19. Grady K, Ameh C, Adegoke A, Kongnyuy E, Dornan J, Falconer T, et al. Improving essential obstetric and newborn care in resource-poor countries. J Obstet Gynaecol (Lahore). 2011;31(1):18–23.

    CAS  Google Scholar 

  20. Harrison KA. Maternal mortality in developing countries. BJOG. 1989;96(1):1–3.

    CAS  Google Scholar 

  21. Hundley VA, Avan BI, Braunholtz D, Fitzmaurice AE, Graham WJ. Lessons regarding the use of birth kits in low resource countries. Midwifery. 2011;27(6).

  22. Ismaila Y, Bayes S, Geraghty S. Midwives’ strategies for coping with barriers to providing quality maternal and neonatal care: a glaserian grounded theory study. BMC Health Serv Res. 2021;21(1).

  23. Joseph G, Da Silva ICM, Wehrmeister FC, Barros AJD, Victora CG. Inequalities in the coverage of place of delivery and skilled birth attendance: analyses of cross-sectional surveys in 80 low and middle-income countries. Reprod Health. 2016;13(1).

  24. Kurji Z, Premani ZS, Mithani Y. Review and analysis of quality healthcare system enhancement in developing countries. J Pak Med Assoc. 2015;65(7):776–81.

    PubMed  Google Scholar 

  25. Ladur AN, van Teijlingen E, Hundley V. Male involvement in promotion of safe motherhood in low- and middle-income countries: A scoping review. Midwifery. 2021;103:103089.

    PubMed  Google Scholar 

  26. Metcalfe R, Adegoke AA. Strategies to increase facility-based skilled birth attendance in South Asia: a literature review. Int Health. 2013;5:96–105.

    PubMed  Google Scholar 

  27. Michel-Schuldt M, McFadden A, Renfrew M, Homer C. The provision of midwife-led care in low-and middle-income countries: an integrative review. Midwifery. 2020;84:102659.

  28. Mohseni M, Mousavi Isfahani H, Moosavi A, Dehghanpour Mohammadian E, Mirmohammadi F, Ghazanfari F, et al. Health system-related barriers to prenatal care management in low- and middle-income countries: A systematic review of the qualitative literature. Prim Health Care Res Dev. 2023;24:e15.

  29. Munabi-Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2017;2018:2.

    Google Scholar 

  30. Nove A, Bazirete O, Hughes K, Turkmani S, Callander E, Scarf V, et al. Which low- and middle-income countries have midwife-led birthing centres and what are the main characteristics of these centres? A scoping review and scoping survey. Midwifery. 2023;123:103717.

  31. Peven K, Bick D, Purssell E, Rotevatn TA, Nielsen JH, Taylor C. Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: A systematic review. Health Policy Plan. 2021;35(Supplement 2):ii47-65.

  32. Pyone T, Sorensen BL, Tellier S. Childbirth attendance strategies and their impact on maternal mortality and morbidity in low-income settings: A systematic review. Acta Obstet Gynecol Scand. 2012;91:1029–37.

  33. Sangy MT, Duaso M, Feeley C, Walker S. Barriers and facilitators to the implementation of midwife-led care for childbearing women in low- and middle-income countries: A mixed-methods systematic review. Midwifery. 2023;122:103696.

  34. Schwerdtle P, Morphet J, Hall H. A scoping review of mentorship of health personnel to improve the quality of health care in low and middle-income countries. Global Health. 2017;13(1).

  35. Sibley L, Armbruster D. Obstetric first aid in the community-partners in safe motherhood a Strategy for Reducing Maternal Mortality. J Nurse Midwifery. 1997;42(2):117–21.

    CAS  PubMed  Google Scholar 

  36. Singh PK, Singh L. Examining inter-generational differentials in maternal health care service utilization: insights from the Indian demographic and health survey. J Biosoc Sci. 2014;46(3):366–85.

    PubMed  Google Scholar 

  37. Stansert Katzen L, Dippenaar E, Laurenzi CA, Rotheram Borus MJ, le Roux K, Skeen S, et al. Community health workers’ experiences of supervision in maternal and child health programmes in low- and middle-income countries: A qualitative evidence synthesis. Health and Social Care in the Community, vol. 30. John Wiley and Sons Inc; 2022. pp. 2170–85.

  38. Stewart L, Usher K. The impact of nursing leadership on patient safety in a developing country. J Clin Nurs. 2010;19(21–22):3152–60.

    PubMed  Google Scholar 

  39. Suryanto PV, Boyle M. Healthcare system in Indonesia. Hosp Top. 2017;95(4):82–9.

    CAS  PubMed  Google Scholar 

  40. Trevisanuto D, Bavuusuren B, Wickramasinghe CS, Dharmaratne SM, Doglioni N, Giordan A, et al. Improving maternal and neonatal departments in high and low resource settings: the opinion of local health providers. J Maternal-Fetal Neonatal Med. 2011;24(10):1267–72.

    Google Scholar 

  41. Ueno E, Adegoke AA, Masenga G, Fimbo J, Msuya SE. Skilled birth attendants in Tanzania: A descriptive study of cadres and emergency obstetric care signal functions performed. Matern Child Health J. 2015;19(1):155–69.

    PubMed  Google Scholar 

  42. Van Lerberghe W, Matthews Z, Achadi E, Ancona C, Campbell J, Channon A, et al. Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality. Lancet. 2014;384(9949):1215–25.

  43. Walker T, Woldegiorgis M, Bhowmik J. Utilisation of skilled birth attendant in low-and middle-income countries: trajectories and key sociodemographic factors. Int J Environ Res Public Health. 2021;18(20).

  44. Kare AP, Gujo AB, Yote NY. Quality of antenatal care and associated factors among pregnant women attending government hospitals in Sidama region, Southern Ethiopia. SAGE Open Med. 2021;9:20503121211058055.

  45. Duysburgh E, Zhang WH, Ye M, Williams A, Massawe S, Sié A, et al. Quality of antenatal and childbirth care in selected rural health facilities in Burkina Faso, Ghana and Tanzania: similar finding. Trop Med Int Health. 2013;18(5):534–47.

    CAS  PubMed  Google Scholar 

  46. Bradford BF, Wilson AN, Portela A, McConville F, Turienzo CF, Homer CSE. Midwifery continuity of care: A scoping review of where, how, by whom and for whom? PLOS Glob Public Health. 2022;2(10):e0000935.

  47. Hanafin S. Considerations in integrating hospital-based midwifery services into the community. Br J Commun Nurs. 2017;22. Available from: www.bjcn.co.uk

  48. Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, et al. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2024;4(4):CD004667.

  49. Lundborg L, Åberg K, Liu X, Norman M, Stephansson O, Pettersson K, et al. Midwifery Continuity of Care During Pregnancy, Birth, and the Postpartum Period: A Matched Cohort Study. Birth. 2024.

  50. Shahinfar S, Abedi P, Najafian M, Abbaspoor Z, Mohammadi E, Alianmoghaddam N. Women’s perception of continuity of team midwifery care in Iran: a qualitative content analysis. BMC Pregnancy Childbirth. 2021;21(1).

  51. Dagla M, Mrvoljak-Theodoropoulou I, Vogiatzoglou M, Giamalidou A, Tsolaridou E, Mavrou M, et al. Association between breastfeeding duration and long-term midwifery-led support and psychosocial support: outcomes from a Greek non-randomized controlled perinatal health intervention. Int J Environ Res Public Health. 2021;18(4):1–18.

    Google Scholar 

  52. Mortensen B, Lieng M, Diep LM, Lukasse M, Atieh K, Fosse E. Improving maternal and neonatal health by a Midwife-Led continuity model of Care– An observational study in one governmental hospital in Palestine. EClinicalMedicine. 2019;10:84–91.

    PubMed  PubMed Central  Google Scholar 

  53. Musie MR, Mulaudzi MF, Anokwuru R, Bhana-Pema V. Recognise and acknowledge Us: views of traditional birth attendants on collaboration with midwives for maternal health care services. Int J Reprod Med. 2022;2022:1–10.

    Google Scholar 

  54. Liu Y, Li T, Guo N, Jiang H, Li Y, Xu C et al. Women’s experience and satisfaction with midwife-led maternity care: a cross-sectional survey in China. BMC Pregnancy Childbirth. 2021;21(1).

  55. Thommesen T, Kismul H, Kaplan I, Safi K, Van Den Bergh G. The midwife helped me. otherwise i could have died: women’s experience of professional midwifery services in rural Afghanistan - A qualitative study in the provinces Kunar and Laghman. BMC Pregnancy Childbirth. 2020;20(1).

  56. WHO. Kesehatan Neonatal Rencana Aksi Nasional. 2014.

  57. WHO. The Republic of Indonesia health system review Asia Pacific observatory on health systems and policies. Health Systems in Transition. 2017;7(1).

  58. UNFPA. Laporan Konsultansi Kebidanan. 2014.

  59. BKKBN KKBUI dan KBK. Strategi Pelaksanaan Program Keluarga Berencana Berbasis Hak untuk Percepatan Akses ke Pelayanan Keluarga Berencana dan Kesehatan Reproduksi yang Terintegrasi dalam Mencapai Tujuan Pembangunan Indonesia. UNFPA; 2018.

  60. Aryal S, Nepal S. An insight into two decades of skilled birth attendants in Nepal. Front Glob Womens Health. 2022;3:899010.

  61. UNFPA. Building a health workforce to meet the needs of women, newborns and adolescents everywhere The STATE OF THE World’s Midwifery. 2021.

  62. UNFPA. Landmark Action on Midwifery. 2011.

  63. ICM. International Confederation of Midwives Annual Report 2018. International Confederation of Midwives; 2018.

  64. UNFPA. Leaving No One Behind in a Global Crisis through Universal Access to Sexual and Reproductive Health Services and Information. 2022.

  65. Nove A, Friberg IK, de Bernis L, McConville F, Moran AC, Najjemba M, et al. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a lives saved tool modelling study. Lancet Glob Health. 2021;9(1):e24–32.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors want to acknowledge Universitas Padjadjaran, Bandung, West Java, Indonesia, for supporting this study.

Funding

Open access funding provided by University of Padjadjaran.

This study was funded by the Review Article grant from Universitas Padjadjaran, Bandung, West Java, Indonesia, with grant number 2289/UN6.3.1/PT.00/2024 to Qorinah Estiningtyas Sakilah Adnani.

Author information

Authors and Affiliations

  1. Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia

    Qorinah Estiningtyas Sakilah Adnani & Ari Indra Susanti

  2. Master of Midwifery Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia

    Ela Nurfitriyani

  3. Midwifery Program, Guna Bangsa Health Sciences School, Yogyakarta, Indonesia

    Yunri Merida

  4. Midwifery Program, Faculty of Health Science, Universitas Muhammadiyah Pekajangan, Pekalongan, Indonesia

    Siti Khuzaiyah

  5. PAP Rashidah Sa’adatul Bolkiah, Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam

    Siti Khuzaiyah & Sarena Haji Hashim

  6. Professional Midwives Program, Faculty of Health Science, Universitas Respati Yogyakarta, Yogyakarta, Indonesia

    Giyawati Yulilania Okinarum

  7. Department of HIV and Infectious Diseases, Jhpiego (an Affiliate of John Hopkins University), Abuja, Nigeria

    Victor Abiola Adepoju

  8. School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia

    Sarena Haji Hashim

Authors
  1. Qorinah Estiningtyas Sakilah Adnani
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Ela Nurfitriyani
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Yunri Merida
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Siti Khuzaiyah
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Giyawati Yulilania Okinarum
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Ari Indra Susanti
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Victor Abiola Adepoju
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Sarena Haji Hashim
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

QESA designed the study, conducted the literature search and participated in its design, analysis, coordination, funding acquisition, wrote and revised the main manuscript. EN conducted a scoping review, which included data collection and analysis. YN contributed to the interpretation of the data and drafted the manuscript. SK provided critical revisions of the manuscript for important intellectual content. GYO and AIS contributed to the literature search and data extraction. VAA and SHH assisted with the methodology and supervised the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Qorinah Estiningtyas Sakilah Adnani.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adnani, Q.E.S., Nurfitriyani, E., Merida, Y. et al. Ninety-one years of midwifery continuity of care in low and middle-income countries: a scoping review. BMC Health Serv Res 25, 463 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12913-025-12612-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12913-025-12612-0

Keywords

BMC Health Services Research

ISSN: 1472-6963

Contact us