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Background: The quality of midwifery education and the quality of care are influenced by the capabilities of those who educate future midwives. In Bangladesh, where midwifery is a new profession, it is crucial that midwifery educators are supported, prepared and equipped to teach in both academic and clinical settings. This study aimed to identify the professional development needs of midwifery educators in Bangladesh. Methods: A cross-sectional online survey consisting of closed and open-ended questions, and statements answered using a four- and five-point response scale, was conducted. A total of 118 individuals responded to the survey, of whom 113 met the inclusion criteria and were included in the final analysis. Data were analysed using descriptive statistics including frequencies and percentages and inferential statistics (Spearman’s rank-order correlation and ANOVA). Internal consistency was evaluated using Cronbach’s alpha coefficient. Responses to the open-ended questions were analysed using systematic text condensation. Results: Among 113 respondents, working as an educator the majority (78%) held a master’s degree. The most reported development needs were in midwifery theory (41.6%), face-to-face teaching (41.6%) and clinical simulation (39.8%). Research capacity was also a key area, with 38.1% reporting a need for support in scientific manuscript writing. Leadership and management development were prioritised by 37.2%. Educators preferred face-to-face programme delivery (53.1%) and short, intensive formats (74%). Open-ended responses underscored a need for structured pedagogical training, as well as research and leadership mentorship. Conclusions: Continuous professional development for educators in Bangladesh is needed, particularly in education, research, and leadership. To address these needs, the study highlights the importance of incorporating its identified needs into a national educator development programme. We propose co-creating such a programme, guided by the ICM Global Standards for Midwife Faculty Development, to ensure a structured, relevant, and sustainable response. © The Author(s) 2026.

This Commentary examines the growing number of doctoral midwives across Europe and the persistent challenges they face, including limited clinical-academic career pathways, insufficient funding, and uneven institutional support. Drawing on a 2024 pan-European survey, it outlines the needs and priorities of 189 midwives who expressed interest in establishing a European Network of Doctoral Midwives. Among the 107 respondents from 24 countries, there was strong support for a coordinated platform to strengthen research collaboration, knowledge exchange, mentorship, and the visibility of midwifery scholarship. Establishing such a network presents a valuable opportunity to consolidate expertise, foster cross-national collaboration, and bridge clinical and academic midwifery. With sustainable structures and strong partnerships, it could become a cornerstone for advancing the midwifery profession and enhancing outcomes for women, newborns, and families.

Background Menopause will personally affect half the population and can cause severe symptoms and increase long-term health risks. Despite this, gaps in menopausal knowledge and unequal access to menopausal healthcare have been identified in Sweden. Limited knowledge among women undermines informed choice and delays care-seeking. To address these gaps, this study purports to critically examine how menopause is represented in Swedish digital health communication and to explore the implications for informed choice and equitable care. In Sweden, the Patient Act and national quality standards guarantee accessible, evidence-based information to support autonomy and equity. It remains unclear whether these principles are met in Sweden's primary official digital healthcare platform (1177.se).

Aim To analyse how menopause is discursively constructed on Sweden's primary official digital healthcare platform (1177.se) and to examine implications for informed choice and health equity.

Method Fairclough's Critical Discourse Analysis guided interpretation of 1177.se texts on menopause across three levels: text, discursive practice and social practice. Analytical rigour was upheld through reflexive practice and theoretical triangulation, achieved via continuous dialogue among the authors.

Results Six intersecting discourses were identified: gendered minimisation, gatekeeping, risk-framing, neoliberal individualism, heteronormativity and intersectional exclusion. These discourses oversimplify complexity, privilege selective biomedical knowledge and moralise personal responsibility, limiting autonomy and health literacy. Such patterns contradict the principles of knowledge-based, equitable care outlined in the Swedish Patient Act and the EU Gender Equality Strategy.

Conclusion Menopause communication on 1177.se reflects systemic tensions between governance ideals and discursive realities. To fulfil policy mandates and advance equity, digital health communication must integrate precise terminology, multilingual access, balanced risk/benefit framing and inclusive perspectives.

OBJECTIVE: This study addresses the need for a validated, consensus-based Implementation Guide for internal quality assurance to strengthen midwifery education in Bangladesh.

BACKGROUND: Quality in midwifery education is central to safe and effective maternal and newborn care, yet discipline-specific guidelines for internal quality assurance are lacking. To address this, Bangladesh developed a PLAN-DO-STUDY-ACT (PDSA) cycle-based internal quality assurance process with a validated self-assessment tool.

AIM: To develop an Implementation Guide for the internal quality assurance process in midwifery education.

METHOD: Using the Delphi technique, a Bangladeshi expert panel (n = 28) developed a PDSA-based Implementation Guide for internal quality assurance. Four consultation rounds were conducted: (i) workshops, (ii) iterative design, (iii) structured validation review and (iv) consensus building.

FINDINGS: In the first round, an expert panel (n = 20) defined the steps, activities and actions in the PDSA-cycle. In the second round, the panel (n = 22) revised the initial draft by refining the language, strengthening the focus on follow-up, and clarifying accountability and institutional ownership. During third round, a panel of midwifery educators and government officials (n = 6) confirmed that guide demonstrated strong face and content validity and was considered acceptable and applicable for use in midwifery education in Bangladesh. Finally, in the fourth round, the complete Implementation Guide was consolidated through consensus among 22 experts, with consensus ≥85% agreement on all statements among the total 28 participants.

KEY CONCLUSIONS: This study produced a validated, consensus-based Implementation Guide offering a practical, context-sensitive approach to strengthening internal quality assurance in midwifery education in Bangladesh, with potential applicability in similar contexts.

Background Menopause is a universal life stage, yet many women face persistent knowledge gaps, misconceptions, and unequal access to care. Existing instruments assess isolated aspects of menopause but do not capture women's access to the conditions necessary for making informed choices about their health.

Objective The aim of this study was to develop and establish content and face validity of a menopause-specific questionnaire designed to assess women's access to the preconditions for making informed choices about their health during the menopausal transition and beyond, using a modified Delphi technique.

Design A modified Delphi study.

Methods Five Delphi rounds were conducted in 2025 involving an expert group (n = 9), a Public and Patient Involvement (PPI) group (n = 7), and a pilot test group (n = 48). Experts reviewed and refined an initial 39-item draft, the PPI group assessed face validity and readability, and experts conducted item prioritization using predefined consensus thresholds. Pilot testing evaluated usability and respondent burden. Final consensus required ≥80% expert agreement. The study followed CREDES guidelines.

Results Following content and face validation, the final instrument comprised 29 items. Expert review informed revisions to terminology, neutrality of menopausal hormone therapy items, and language accessibility. PPI contributors highlighted readability challenges and supported clearer wording. Nine items were removed, five merged into two, and one item added. Pilot testing confirmed acceptable usability and respondent burden. Final expert consensus reached 87.5%.

Conclusion A consensus-based, user-informed questionnaire was developed, following content and face validation, to assess women's access to conditions for informed choice during menopause. The instrument may support the identification of barriers and facilitators to informed decision-making in menopause-related care and research.

Background: Primigravida women experience increased labor pain and emotional distress. Midwife-led continues labor support offers emotional benefits and reduces maternal and newborn complications; however, its effects on primigravidas’ labor pain, satisfaction, and newborn admissions has not been studied in Ethiopia. Objective: This study aimed to evaluate the effect of midwife-led continuous labor support on primigravida women's labor pain, satisfaction, and newborn admission rates. Methods: A quasi-experimental study compared midwife-led continuous labor support with routine care among 419 primigravida women at four Ethiopian hospitals (two intervention, two control). Data were collected from July to December 2024 through interviews and records. Senior midwives and the principal investigator trained all midwives at the intervention sites, as well as two additional midwives for overload periods. Support averaged 90 min per woman. Fisher's Exact test e assed changes (P < 0.05). Results: Midwife-led continuous labour support increased maternal satisfaction among primigravida women from 147 (71.4%) in the control group to 167 (78.4%) in the intervention group, a net increase of 7% (P < 0.001). It reduced pain from 136 (66%) to 98 (46%), a net decrease of 20% (P < 0.037). Neonatal intensive care unit admissions decreased from 23 (11.2%) to 12 (5.6%), a net reduction of 6.6% (P < 0.004). There was no effect on newborn death rates. Conclusions: Midwife-led support effectively reduced pain, increased satisfaction, and decreased NICU admission for primigravida women in Ethiopia through continues psychological and physical support, improving maternal and newborn wellbeing. Implementing this approach facility-wide and evaluate sustainability in routine care is necessary. © 2026 The Authors. Published by Elsevier B.V. on behalf of INDIACLEN. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/

BACKGROUND: Multimorbidity is increasing over time and causes a major global health challenge among individuals with type 2 diabetes (T2D). The growing prevalence of multimorbidity coupled with its complex management leads to a significant concern for the healthcare system. Evidence of existing studies on multimorbidity showed inconsistencies across different regions in the world. This study aimed to summarize and estimate the pooled global prevalence of multimorbidity and its associated factors among patients with T2D.

METHODS: A systematic review and meta-analysis were conducted, including studies up to January 2025. PubMed, HINARI, CINAHL/EBSCO, the Cochrane Library, ProQuest, Google Scholar, and Google were used to search studies. The quality of the selected articles was evaluated using the Joanna Briggs Institute (JBI) checklist. The pooled prevalence was estimated using a random effect model with a 95% confidence interval (CI), while a fixed effect model was used to assess the pooled adjusted odds ratios (AORs) for the exposure variables. Heterogeneity was assessed using I² statistics and Cochran’s Q test (p-value). Subgroup analysis and meta-regression were used to identify the sources of variation. Publication bias was assessed using a funnel plot and Egger’s test (p-value < 0.05).

RESULTS: In this review, a total of 32 studies and 2,934,500 participants were included. The pooled global prevalence of multimorbidity among T2D was 83.17%, concordant conditions (related to T2D) was 50.21%, discordant conditions (unrelated to T2D) was 47.24%, and combined conditions (having both chronic conditions) was 58.90%. Age 40–59 years (AOR = 2.36, 95% CI: 1.17–3.55), being retired (AOR = 1.31, 95% CI: 0.96–1.66), non-formal education (AOR = 2.93, 95% CI: 1.44–4.42), being widowed (AOR = 2.00, 95% CI: 1.04–2.96), and being a current smoker (AOR = 2.33, 95% CI: 1.16–3.50) were the predictors of multimorbidity. Being an urban resident (AOR: 1.69, 95% CI: 0.95–2.44) was associated with concordant chronic conditions.

CONCLUSIONS: Multimorbidity is highly prevalent among type 2 diabetes, emphasizing a major public health challenge. It is important to develop a well-designed and comprehensive strategy to enhance the prevention and management of multimorbidity. Particular emphasis should be given to older adults, people who have a low level of education, retired individuals, smokers, widowed individuals, and people living in urban residences.

TRIAL REGISTRATION: PROSPERO-CRD42025639310. Registered on January 16/2025.

Background/aims: A neonatal near miss refers to cases where babies almost die in the neonatal period. Exploring healthcare professionals’ experiences and perspectives isvital to understand the dynamics behind neonatal near misses, how to prevent them and how care can be improved. This study’s aim was to explore health care professionals’experiences and perceptions of caring for neonatal near misses in major public hospitalsin the Western 1 region of The Gambia. Methods: Semi-structured interviews were held with purposively selected health care professionals, including 9 midwives, 9 nurses and 9 doctors, who worked at three tertiary hospitals in the Western 1 region. Qualitative content analysis was used to generate themes and subthemes focused on the participants’ experiences of providing care in cases of a neonatal near miss. Results: The main theme was ‘it could be different’, which included two subthemes: ‘always a near miss baby at the ward’ and ‘ready to care’. The participants described how insufficient human and material resources and poor work environments resulted in neonatal near misses, as well as their inability to intervene in the case of many neonatal deaths. Conclusions: This study identified critical gaps in neonatal care, including inadequate investment in health care infrastructure, limited availability of life-saving equipment and insufficient neonatal training programmes. High clinical workload, staff shortages and increasing demand for neonatal services contribute to delays in care, which increase the risk of neonatal near-miss events and mortality. Implications for practice: Effective management of neonatal near-miss cases inlow-resource settings requires strengthened neonatal training, adequate staffing and reliable access to essential equipment. Preventive strategies, including improved antenatal care, efficient clinical workflows and timely referral systems, are essential to improving neonatal outcomes.

Problem Few midwives are given the opportunity to provide continuity of midwife care despite the suggested benefits. Background Translating evidence into practice remains challenging, particularly in low-income settings where workforce limitations, structural constraints, and leadership capacity influence implementation. Although continuity of care models have gained increasing attention globally, little is known about how midwives in low-income countries perceive their readiness and capacity to initiate and sustain such models. Aim To explore how midwives experience and perceive their capacity to implement and lead continuity of midwife care in Ethiopia. Methods A qualitative exploratory design was used. Twenty-one midwives providing continuity of midwife care participated in semi-structured individual online in-depth interviews. The data were analysed using reflexive thematic analysis. Findings The overarching theme, “Opening the door to the full scope of midwifery practice,” captured how continuity of midwife care enabled midwives to utilise their full professional capacity. Four interrelated themes described this capacity: 1) clinical competence and autonomy, 2) individualised care and trustful relationships, 3) motivation, commitment and professional pride, and 4) teamwork and structural support. Discussion The findings suggest that midwives’ capacity was shaped not only by individual competence and motivation, but depended on organisational conditions that enabled autonomy, responsibility, and continued professional development. Conclusion Continuity of midwife care can function as a liberating structure that releases midwives’ existing capacity, when recognised and supported by the system. Enabling midwives to fully exercise their professional role is foundational to delivering respectful, equitable, and effective maternity care in Ethiopia and similar settings worldwide. Copyright © 2026. Published by Elsevier Ltd.

Background: High-quality maternal and newborn care relies on competent midwives, placing high demands on midwifery education. Continuous internal quality assurance is essential for meeting accreditation standards yet remains understudied, particularly in low- and middle-resource settings.

Aim: The aim of this study was to identify contextual factors preparing for implementation of an internal quality assurance process in midwifery education in Bangladesh.

Methods: A qualitative inductive design, guided by process evaluation principles for complex interventions. Data was collected through focus group discussions (n = 10) with a total of 76 midwifery faculty across Bangladesh. Transcribed discussions were analysed using qualitative content analysis.

Findings: This study identified several contextual factors that influence how systematic internal quality assurance is implemented in midwifery education: governance and national leadership culture, institutional constraints and navigating individual engagement.

Conclusion: Internal quality assurance in midwifery education requires more than technical tools. Trust-based leadership, psychological safety and integration into institutional routines and national policies are essential. Aligning national quality goals with local capacity and faculty values supports sustainable quality improvement in low- and middle-income settings.