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Background: Midwifery leadership is considered to improve health of women and children as well as midwives’ working environment. Globally, only a few reporting countries have midwives in their National Ministry of Health. Therefore, with a focus on midwifery leadership from the global community and with limited opportunities for women to hold leadership positions it is important to examine factors affecting midwives’ possibilities to become leaders for change in policy and practice globally.

Aim: The aim of the research is to explore the opportunities and barriers affecting midwives’ possibilities to become leaders for change in policy and practice globally.

Methods: This study was an integrative systematic literature review. The databases PubMed, CINAHL and Scopus were used to identify relevant articles for data gathering. 19 articles which met the criteria were included in the inductive content analysis.

Result: The result identified the opportunities and barriers for midwives to become leaders. The opportunities and barriers are categorized as “Structures and strategies influence midwifery leadership”, “Attitudes of personnel and interpersonal role relates to midwifery leadership”, “Work conditions and midwives’ work autonomy as a vital component to midwifery leadership" and “Individual development, training and skill strengthens midwife’s role”.

Conclusion and clinical implications: Midwives stepping up into leadership position within their government’s national ministry of health and other levels requires comprehensive policy reforms where midwives are included in decision makings with a protected status to autonomously practice midwifery in order to have an enabling environment towards universal health coverage and SDG 2030 goals achievement.