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Galkayo University, in an ongoing partnership with Benadir University and the Karolinska Institutet, reports on the co-creation of a mentorship program for midwifery educators at Galkayo University. This program was initiated in Spring 2023 with the aim of sharing experiences on midwifery education between educators from Sweden and Somalia—both countries with long traditions of midwifery care. By leveraging the expertise of Swedish and Somali midwifery educators, the mentorship program seeks to bridge gaps in knowledge and skills, ultimately contributing to better midwifery education and care in both Somalia and Sweden. This commentary describes the significance of the program and its potential for impact if scaled up after contextualization.

BACKGROUND: A neonatal mortality prediction score can assist clinicians in making timely clinical decisions to save neonates' lives by facilitating earlier admissions where needed. It can also help reduce unnecessary admissions.

OBJECTIVE: The study aimed to develop and validate a prognosis risk score for neonatal mortality within 28 days in public hospitals in the Amhara region, Ethiopia.

METHODS: The model was developed using a validated neonatal near miss assessment scale and a prospective cohort of 365 near-miss neonates in six hospitals between July 2021 and January 2022. The model's accuracy was assessed using the area under the receiver operating characteristics curve, calibration belt, and the optimism statistic. Internal validation was performed using a 500-repeat bootstrapping technique. Decision curve analysis was used to evaluate the model's clinical utility.

RESULTS: In total, 63 of the 365 neonates died, giving a neonatal mortality rate of 17.3% (95% CI: 13.7-21.5). Six potential predictors were identified and included in the model: anemia during pregnancy, pregnancy-induced hypertension, gestational age less than 37 weeks, birth asphyxia, 5 min Apgar score less than 7, and birth weight less than 2500 g. The model's AUC was 84.5% (95% CI: 78.8-90.2). The model's predictive ability while accounting for overfitting via internal validity was 82%. The decision curve analysis showed higher clinical utility performance.

CONCLUSION: The neonatal mortality predictive score could aid in early detection, clinical decision-making, and, most importantly, timely interventions for high-risk neonates, ultimately saving lives in Ethiopia.

Background Ensuring the quality of midwifery education is critical for producing a qualified and competent midwifery workforce for sexual, reproductive, maternal, and newborn care services. While global standards advocate for quality enhancement and accreditation systems, challenges persist, particularly in low-income countries like Bangladesh. Aim To validate and culturally adapt a Quality Assurance Assessment tool aligned with global midwifery education standards for application in Bangladesh. The goal of the tool is to guide and assess an internal quality education assurance process tailored to meet the national accreditation standards. Methods A modified Delphi technique was conducted with a panel of 55 experts, including educators, principals, and researchers from Bangladesh, India, and Sweden. The study underwent three rounds: tool development, field testing, and consensus building. Results The first round was completed by 25 workshop panel members, the second was completed by 30 participants during field testing, and the third was completed by the 25 workshop panel members from the first round. The developed Quality Assurance Assessment Tool demonstrated face and content validity through expert consultation and field testing, aligning with both global education and national accreditation standards. Minor revisions enhanced clarity and feasibility. Conclusion The Delphi rounds resulted in a validated Quality Assurance Assessment Tool that offers a robust framework for assessing and enhancing midwifery education quality, aiding progress towards meeting national accreditation standards. This study provides a valuable resource for countries seeking to develop similar tools aligned with global and national education priorities.

BACKGROUND: The purpose of this study was to compare the effects of two caregiving models on full-term healthy infants' wakefulness, rooting and sucking reflexes, initiation of breastfeeding, and physiological parameters when reunited with their mothers after a mother-infant separation of 130 min after elective cesarean birth.

METHODS: Ninety-five mother-infant pairs participated in a randomized controlled trial, in which full-term healthy infants were allocated to be either dressed in their mothers' arms (n = 56) or skin-to-skin with their mother (n = 39) when reunited with the mother within 130 min after cesarean birth. Data were collected by the Neonatal Behavioral Assessment Scale (NBAS) to assess the infants' wakefulness and prebreastfeeding behaviors. Physiological parameters were assessed at 15 min intervals, from 130 to 205 min after birth. Time to first breastfeed was measured in minutes from the reunion with the mother.

RESULTS: The primary finding was that physiologic parameters did not differ but time for initiation of breastfeeding after the reunion with the mother was significantly faster in the skin-to-skin group compared to the infants in the mothers' arms group (p = 0.005). Over the full study period, a more relaxed state and drowsy were found in the skin-to-skin group compared to the infants in the mothers' arms group.

CONCLUSION: Healthy full-term infants born by elective cesarean, who were cared for by their mothers when reunited within 130 min of separation and cared for by their fathers during the mother-infant separation, initiated breastfeeding successfully and showed stable physiological patterns.

BACKGROUND: Addressing the evidence-to-practice gap in midwifery is vital for improving maternal and newborn health outcomes. Despite the potential of involving midwives in quality improvement interventions to address this gap, such interventions are understudied. In a Ugandan urban hospital, midwifery practices with a significant evidence-to-practice gap have been identified as areas for clinical improvement.

OBJECTIVES: The primary objective of the Quality Improvement was to increase the uptake of identified and essential midwifery practices through a quality improvement approach led by midwives.

PARTICIPANTS: We enrolled 703 women aged 18 years and older with uncomplicated full-term pregnancies (between 37+0 and 42+0 weeks) who gave birth at the facility.

INTERVENTION: The intervention focused on evidence-based practices with an identified evidence-to-practice gap: dynamic birth position, including women's involvement in birth position decision-making, perineal protection and intrapartum support. A team of midwives led a seven-month co-created quality improvement intervention. The intervention used Plan-Do-Study-Act (PDSA) cycles, following the Model for Improvement and included a train-the-trainer approach and weekly online support meetings.

DATA COLLECTION: In this single-case prospective observational study, we compared pre-, during and post-intervention uptake of evidence-based practices. Trained research assistants collected data through interviews and observations.

RESULTS: We observed improvements in the uptake of all clinical improvement areas. Dynamic birth positions increased from 0 % to 79 %, decision-making of birth positions from 0 % to 75 %, perineal protection measures from 62 % to 92 % and intrapartum support from 7 % to 67 %.

CONCLUSION: A multifactorial midwife-led Quality Improvement resulted in significant and sustained improvements in the uptake of evidence-based practices in maternal and newborn healthcare. If given the mandate and time, midwives can successfully lead Quality Improvements, which enhance the quality of care and close the evidence-to-practice gaps in maternal and newborn health. The study's results underscore the significance of developing effective strategies to enhance care quality and promote the adoption of evidence-based midwifery practices.

PROBLEM: Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden.

BACKGROUND: Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities.

AIM: To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings.

METHODS: Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis.

FINDINGS: The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures.

DISCUSSION: Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy.

CONCLUSION: To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.

BACKGROUND: The research gap regarding Attention Deficit Hyperactivity Disorder (ADHD) in people who were assigned female at birth has led to a lack of knowledge and adequate approaches in clinical practice, as well as diagnosis processes. Recent studies report potential associations between reproductive hormones and ADHD, but existing research remains scarce.

AIM: This study aims to explore the experiences of people who perceive an association between their menstrual cycle and their ADHD symptoms.

METHODOLOGY: Design and Method. A qualitative research design with an inductive approach was used. Ten participants were interviewed, using semi-structured, in-depth interviews. The data was transcribed, coded, and analyzed using reflexive thematic analysis according to Braun and Clarke.

RESULTS: Findings show participant's perceived associations between their ADHD and their menstrual cycle: participants reported experiencing ADHD symptom mor severe during the mid-luteal phase of the menstrual cycle. Other results showed uncertainty around ADHD medication in relation to the cycle and varied experiences with health care encounters as well as heightened challenged around menstrual health management.

CONCLUSIONS: This study provides insights to how perceived associations between ADHD and the menstrual cycle might be experienced. This report highlights the need for further research and theory about the potential associations between ADHD and reproductive hormones. The researchers strongly suggested that forthcoming ADHD studies consider times of key hormonal changes, such as puberty and menarche, menopause, hormonal birth control, pregnancy, hormone treatment, and more.

Caring is a universal phenomenon that influences nurse-patient interactions and feelings, forming the foundation of the nursing profession. How nurses perceive and experience caring in low-income settings is not well understood. Therefore, the purpose of this study was to explore Ethiopian nurses' perceptions and experiences of caring using a qualitative descriptive design. Individual semi-structured interviews were conducted with 13 nurses aged 28-57. Interviews were analyzed inductively using reflexive thematic analysis guided by the recommendations of Braun and Clarke. The analysis resulted in three themes: caring is the heartbeat of patient care, constraints to the provision of care, and ways to overcome constraints. The results revealed that nurses were committed to fulfilling their professional obligations and meeting patients' needs despite experiencing multiple constraints. The findings provide a comprehensive perspective in understanding nurses' experiences of caring. Their narratives demonstrate that they face constraints in their clinical practice, which limit the quality of care, including rotation and lack of resources. Cooperation between health policymakers and nurse authorities is essential for shifting the clinical environment from the prevailing traditional task-oriented approach to patient-centered care.

While Bangladesh has made gains in maternal health provisions, there are still gaps and unmet need for services. Bangladesh has trained over 7 000 midwives, and many more midwifery educators are needed to serve the country’s population of 140 million with midwifery services. In April 2016 the first nursing faculty teaching midwifery students at nursing institutes across Bangladesh were enrolled in a blended online and onsite master’s programme with the Dalarna University, Sweden. The programme content focused the subject sexual, reproductive and perinatal health and was the first of its kind in Asia. The graduating faculty members were expected to be in a position to deliver higher quality education to the midwifery students (1, 2). To date, the team of teachers from Dalarna University has trained 150 midwifery educators (3). The current proposal from the University is that an equivalent to the Swedish Master's programme should be established in Bangladesh. While Bangladesh has made gains in education of midwives, there are still gaps and unmet need for educators with skills and knowledge in the subject of midwifery. During a period of transition, open seminars will be held at Dalarna University for all alumni who want to attend, with the hope on the part of the team of Dalarna university teachers being that they provide inspiration for high-quality midwifery education in Bangladesh. © 2023, South Asian Midwives Association (SAMA). All rights reserved.

BACKGROUND: As people grow old, they pass through various life courses. Thus, it is important to realize aging in the context of each of these stages, as aging is not only physiological and psychological processes. To understand the lifeworld experiences of the phenomenon "being an elderly person" from the individual perspective was important, in this study, within day-to-day life in Metropolitan cities of northwestern Ethiopia.

OBJECTIVE: The aim of this study was to describe the lifeworld of elderly persons living in Bahir Dar and Gondar Cities, Northwest Ethiopia.

METHODS: A community based qualitative study conducted from October 29, 2021 to November 6, 2021. A purposive sampling technique and in-depth interviews were used for sampling and data collection, respectively. To explore the life experience /life-world/ of the elderly, a descriptive phenomenological study was conducted among 15 elderly persons. The audio records were transcribed and the field notes incorporated. Transcribed texts were translated into the English language, and a descriptive phenomenological analysis was done.

RESULTS: In this study, the essence of the phenomenon, being an elderly person, means, in an ebb and flow motion, balancing a life change characterized by changing perspective, ambiguity to body functions, and preparing for being released. The elderly experienced physical, mental, and psychosocial changes. They had encountered positive and negative situations throughout their life span. They also expressed that their time was over and wished to prepare for God's Kingdom.

CONCLUSION: The use of phenomenology for this research provided an opportunity for a deeper understanding of the experiences of elderly persons. With knowledge from this study, nurses and other health professionals can understand and support the elderly from an individual point of view.

BACKGROUND: The Government of India has committed to educate 90,000 midwives functioning in midwifery-led care units (MLCUs) to care for women during labour and birth. There is a need to consider local circumstances in India, as there is no 'one size fits all' prescription for MLCUs.

AIM: To explore contextual factors influencing the implementation of MLCUs across India.

METHOD: Data were collected through six focus group interviews with 16 nurses, midwives, public health experts and physicians, representing six national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis.

FINDINGS: Four generic categories describe the contextual factors which influence the implementation of MLCUs in India: (i) Perceptions of the Nurse Practitioner in Midwifery and MLCUs and their acceptance, (ii) Reversing the medicalization of childbirth, (iii) Engagement with the community, and (iv) The need for legal frameworks and standards.

CONCLUSION: Based on the identified contextual factors in this study, we recommend that in India and other similar contexts the following should be in place when designing and implementing MLCUs: legal frameworks to enable midwives to provide full scope of practice in line with the midwifery philosophy and informed by global standards; pre- and in-service training to optimize interdisciplinary teamwork and the knowledge and skills required for the implementation of the midwifery philosophy; midwifery leadership acknowledged as key to the planning and implementation of midwifery-led care at the MLCUs; and a demand among women created through effective midwifery-led care and advocacy messages.

Background: Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. Methods: We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). Results: At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives’ participation time costs (56 %) for scenario 1 (collaborative), trainers’ material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. Conclusion: Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings. © 2023

BACKGROUND: Women's birthing experience is a sensitive indicator of the quality of childbirth care and can impact the physical and mental health of both women and their neonates. Negligible evidence exists on Indian women's birth experiences and-to the best of authors' knowledge-no questionnaire has been tested in India for measuring women's birthing experiences. This study aimed to test the construct validity and reliability of the Kannada-translated Revised Childbirth Experience Questionnaire.

METHODOLOGY: A cross-sectional survey was carried out among postnatal women (n = 251, up to six months postpartum, with a live healthy neonate) who had given birth at a public or private health facility using the Kannada-translated CEQ2 in two districts of Karnataka. Data were collected at participants' homes after seeking written informed consent. Model fit was determined by Confirmatory Factor Analyses.

RESULTS: The 4-factor model of the CEQ2 showed good fit after deletion of one item (item 8, subcategory "participation") with CMIN = 1.33; SRMR = 0.04; GFI = 0.92, CFI = 0.98, TLI = 0.99, RMSEA = 0.037 and p value 0.002). The Cronbach alpha values were acceptable for the four subscales (0.92, 0.93, 0.97, 0.91) as well as for the overall 21-item scale (0.84).

CONCLUSIONS: The Kannada-translated CEQ2 is a reliable tool to measure the childbirth experiences among Kannada-speaking women and can serve as a reliable ongoing evaluation of women's birth experiences.

BACKGROUND: In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia.

METHOD: A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05.

RESULTS: The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes).

CONCLUSIONS: The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.

INTRODUCTION: Neonatal Near Miss (NNM) refers to neonates with severe complications who almost died but survived immediately after birth. In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale. However, understanding the experiences and perceptions of healthcare providers in the clinical management and care of NNM infants remains unexplored. The aim was to investigate the determinants contributing to the survival of neonatal near-miss babies and to identify any barriers encountered, as reported by the experiences of healthcare providers in public hospitals of Amhara Regional State, northwest Ethiopia.

METHODS: Semi structured interviews were used to collect data from 25 midwives, nurses, and pediatricians with at least six months of prior experience in one of the labor wards or neonatal intensive care units at one of the four public health hospitals in the Amhara Regional state of northwest Ethiopia included in a large intervention study assessing a NNM scale. Purposeful sampling was used, selecting participants based on their experiences related to the aim of this study. The participants had a varying level of education and years of experience to care for NNM infants. The average age of the healthcare providers was 31 years, with 7 years of work experience. The transcripts of the interviews with the healthcare providers were analyzed using qualitative content analysis.

RESULTS: The experience and perceptions of healthcare providers was described in the main category "A sense of hopelessness when caring for the baby" capturing a broader emotional and professional aspect, while the subcategories "Unclear responsibilities discharging one's mission", "Provision of kangaroo mother care" and "Quick action required at birth" are more specific and practical. Healthcare providers perceived a sense of hopelessness when caring for the NNM infant, particularly providing Kangaroo Mother Care (KMC) and quick actions when required at birth to save the life of the infant.

CONCLUSION: Unclear responsibilities and a sense of hopelessness could have acted as barriers, hindering the ability of healthcare providers to fulfill their mission of taking swift actions and providing KMC to NNM infants, thus impacting their ability to save the lives of these infants. Healthcare providers' and parents' attitudes must be changed towards hope rather than hopelessness when caring for NNM infants.

The development of midwives as leaders is a crucial step towards achieving equality in sexual, reproductive, maternal, and neonatal health, Universal Health Coverage (UHC) and Sustainable Development Goals (SDG). However, many midwives work only to implement policies made by others rather than being drivers of policy changes. Little is known and researched about why midwives are not involved in decision and policymaking related to sexual, reproductive, maternal, and neonatal health. Hence, with a focus on midwifery leadership within the global community and the limited opportunities for women to hold leadership positions, this research explores the facilitators influencing midwives' opportunities to become leaders in policy development, education and practice. Inspired by Whittemore and Knafl, this integrative literature review was conducted after twenty-two relevant articles were identified through a search of the following databases: PubMed, CINAHL, and Scopus. Inductive content analysis was applied to analyze data. The result indicates that for midwives to become influential leaders, they must be active in strategic planning at the highest level. This inevitably effects how far midwives can act as agents for change, even if they possess the knowledge and skills for a leadership position. Policies and regulations influence how midwives' status in society is acknowledged and recognized. A clearly articulated educational pathway will enable their professional growth and expertise, making them knowledgeable and skillful as leaders. Enabling midwives to step into leadership positions at government level requires reforms which include midwives in decision-making. Excluding midwives from decision-making processes is detrimental to the goal of achieving universal health coverage. The first step is to provide midwives with a protected title, enabling them to work autonomously in an enabling environment with normal pregnancy and birth to achieve the SDG 2030 goals.

OBJECTIVE: Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital.

METHOD: A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo.

RESULTS: From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital.

CONCLUSION: The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.

OBJECTIVE: To identify and examine barriers to midwife-led care in Eastern Africa and how these barriers can be reduced DESIGN: A qualitative inductive study with online focus group discussions and semi-structured interviews using content analysis SETTING: The study examines midwife-led care in Ethiopia, Malawi, Kenya, Somalia, and Uganda -five African countries with an unmet need for midwives and a need to improve maternal and neonatal health outcomes.

PARTICIPANTS: Twenty-five participants with a health care profession background and current position as a maternal and child health leader from one of the five study countries.

FINDINGS: The findings demonstrate barriers to midwife-led care connected to organisational structures, traditional hierarchies, gender disparities, and inadequate leadership. Societal and gendered norms, organisational traditions, and differences in power and authority between professions are some factors explaining why the barriers persist. A focus on intra- and multisectoral collaborations, the inclusion of midwife leaders, and providing midwives with role models to leverage their empowerment are examples of how to reduce the barriers.

KEY CONCLUSIONS: This study provides new knowledge on midwife-led care from the perspectives of health leaders in five African countries. Transforming outdated structures to ensure midwives are empowered to deliver midwife-led care at all healthcare system levels is crucial to moving forward.

IMPLICATIONS FOR PRACTISE: This knowledge is important as enhancing the midwife-led care provision is associated with substantially improved maternal and neonatal health outcomes, higher satisfaction of care, and enhanced utilisation of health system resources. Nevertheless, the model of care is not adequately integrated into the five countries' health systems. Future studies are warranted to further explore how reducing barriers to midwife-led care can be adapted at a broader level.

INTRODUCTION: Objective Structured Clinical Assessment (OSCA) is a way of evaluating students or clinicians in how they are carrying out their duties. The aim of this study was to examine how midwifery educators in Bangladesh perceived using OSCA as an assessment device in midwifery education for student performance in life-saving midwifery interventions.

METHOD: Individual interviews were conducted with 47 academic midwives and clinical midwives using purposive sampling at 38 education institutions in Bangladesh. Content analysis inspired by Elo and Kyngas was used to analyze the data.

RESULTS: The ability of students to perform effectively in the OSCA-evaluated simulation of life-saving skills was related to the educators' understanding of the concept of midwifery. The overarching main category of this study showed that for midwifery educators to be able to effectually teach professional, evidence-based midwifery, they need to be able to synthesize the delivery of practical and theoretical skills with pedagogical skills and knowledge. To implement the OSCA tool more effectively, midwifery educators need to understand the underpinning principles of midwifery values and philosophy including leadership, ownership, responsibility, and personal engagement.

CONCLUSION: There is potential to improve the efficacy of using OSCA to deliver the teaching of life-saving skills. Team sessions with midwives and physicians aiming to practice teamwork and role divisions in life-saving interventions are recommended.

OBJECTIVE: To explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs.

DESIGN: A qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis.

SETTING: The study was conducted in Sweden.

PARTICIPANTS: Swedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth.

FINDINGS: The analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information.

KEY CONCLUSIONS: Miscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns.

IMPLICATIONS FOR PRACTICE: The midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.

Objective: The purpose of this study was to determine patients’ perceptions of nurse caring behaviors and to identify factors associated with these perceptions. Methods: A cross-sectional study was conducted at three referral hospitals in Ethiopia. A consecutive sample of male and female patients (n = 652, response rate 98.8%) was interviewed using the Amharic version of the Caring Behaviors Inventory-16 (CBI-16, including four subscales: Assurance, Knowledge and skill, Respectful, and Connectedness) and the Patient Satisfaction Instrument (PSI). Socio-demographic and clinical factors associated with perceptions of caring behaviors were identified using multiple linear regression analysis. Results: Patients’ perceptions of nurse caring behaviors were high (total Mean = 4.86, SD = 0.72). Behaviors related to the Assurance subscale were rated the highest. The multiple linear regression analysis result showed several socio-demographic and clinical factors statistically significantly associated with patients’ perceptions of caring behaviors (total mean scores). Patients who were 40–49 years (B = −0.19, P = 0.012) and single (B = −0.13, P = 0.03) scored lower on total CBI-16 scores. Whereas, patients who had a higher educational level (B = 0.35, P = 0.001), cared for at surgery units (B = 0.11, P = 0.027), and reported having spent more time with a nurse in the past 8-h shift (B = 0.16, P < 0.001) were more likely to have higher perceptions of the care they received. The CBI-16 was positively correlated with satisfaction with received care, as measured with the Patient Satisfaction Instrument (r = 0.62, P < 0.001). Conclusion: Hospitalized patients in Ethiopia have overall high perceptions of nurse caring behaviors, especially with regard to physical-based caring, while their expectations of emotional-focused care are lower. We identified patients who were in need of care, patients aged 40–49 years and single. The time spent with nurses plays a pivotal role in patients’ perceptions of nurse caring behaviors. © 2023 The Authors

Background: Integrating evidence-based midwifery practices improves healthcare quality for women and newborns, but an evidence-to-practice gap exists. Co-created quality improvement initiatives led by midwives could bridge this gap, prevent resource waste and ensure intervention relevance. However, how to co-create a midwife-led quality improvement intervention has not been scientifically explored. Objective: The objective of this study is to describe the co-creation process and explore the needs and determinants of a midwife-led quality improvement targeting evidence-based midwifery practices. Methods: A qualitative deductive approach using the Consolidated Framework for Advancing Implementation Science was employed. An analysis matrix based on the framework was developed, and the data were coded according to categories. Data were gathered from interviews, focus group discussions, observations and workshops. New mothers and birth companions (n = 19) were included through convenience sampling. Midwives (n = 26), professional association representatives, educators, policymakers, managers, and doctors (n = 7) were purposely sampled. Results: The co-creation process of the midwife-led Quality Improvement intervention took place in four stages. Firstly, core elements of the intervention were established, featuring a group of midwife champions leading a quality improvement initiative using a train-the-trainers approach. Secondly, the intervention needs, context and determinants were explored, which showed knowledge and skills gaps, a lack of shared goals among staff, and limited resources. However, there was clear relevance, compatibility, and mission alignment for a midwife-led quality improvement at all levels. Thirdly, during co-creation workshops with new mothers and companions, the consensus was to prioritise improved intrapartum support, while workshops with midwives identified enhancing the use of birth positions and perineal protection as key focus areas for the forthcoming Quality Improvement intervention. Lastly, the findings guided intervention strategies, including peer-assisted learning, using existing structures, developing educational material, and building stakeholder relationships. Conclusions: This study provides a practical example of a co-creation process for a midwife-led quality improvement intervention, which can be relevant in different maternity care settings. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Introduction:Bangladesh has made remarkable strides in the development of the midwifery profession. However, the COVID-19 pandemic has had profound effects on healthcare systems worldwide, including those related to reproductive, perinatal, and maternal health. Given the recent advancements in the midwifery field in Bangladesh, it is crucial to examine the pandemic's impact on existing barriers and the capacity of midwifery professionals to deliver high-quality care. The aim of this study is to describe the possibility of midwives being able to provide quality midwifery care in Bangladesh during the COVID-19 pandemic.

Methods:To gather insights, data were collected from July to October 2020 via four qualitative focus group discussions online; 23 actively practicing midwives, nurses specializing in midwifery care, and midwifery educators, participated. The data analysis employed reflexive thematic analysis.

Results:The COVID-19 crisis posed significant threats to women's safety and health, with lockdowns exacerbating gender inequalities in society. Midwives faced added challenges due to their relatively low professional status and increased workloads. Insufficient policy implementation further compromised midwives' safety. Fear of contracting the virus and working during their free time also raised concerns about the quality of care provided. Nevertheless, the pandemic provided opportunities for midwives to demonstrate their ability to deliver independent midwifery care in Bangladesh.

Conclusions:The pandemic underscored the importance of creating respectful and dignified working conditions for midwives. It revealed that professional midwives can work independently when provided with the necessary space and a supportive work environment. This opens the door for the implementation of a midwifery-led care model. Further research is recommended to investigate the medical safety and efficacy of independent midwifery care in the context of Bangladesh.

Barriers and facilitators for quality midwifery care exist on different levels in the health systems. After decades of challenges and varied degrees of success, a stakeholder leader-to-leader collaboration could provide added value through knowledge sharing on how to integrate the midwifery cadre into an existing health system. Initiated by The Midwifery Society of Nepal, Dalarna University Sweden and MAMTA-Health Institute for Mother and Child India, a research network focusing midwifery has been formed. The background, purpose and activities of this network has been described in this News and Events paper.

BACKGROUND: Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services.

METHODS: Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh.

RESULTS: One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories.

CONCLUSION: The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.

BACKGROUND: Around 20% of births in Somaliland take place at health facilities staffed by trained healthcare professionals; 80% take place at home assisted by Traditional Birth Attendants (TBAs) with no formal training. There has been no research into women's choice of place of birth.

OBJECTIVE: In this study, we explore multipara women's needs and preferences when choosing the place of birth.

METHOD: An explorative qualitative study using individual in-depth interviews analysed inductively using content analysis. The interviews were conducted in Somaliland with 25 multiparous women who had experience of giving birth both at home and at a health facility within the past three years.

RESULTS: The results provide a description of how, for women in Somaliland, a lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical need. The women in this study desired intentionality in their role as mothers and sought some measure of control over the environment where they planned to give birth, depending on the circumstances of that particular birth. The results describe what quality care means for multipara women in Somaliland and how women choose birthplace based on previous experiences of care. The expectation of respectful care was a vital part for women when choosing a place of birth.

CONCLUSION: To meet women's needs and preferences in Somaliland, further investments are needed to strengthen the midwifery profession and to define and test a context specific midwife-led continuity of care model to be scaled up. A dialogue to create new roles and responsibilities for the TBAs who attend most home births is further needed to link them to the formal healthcare system and assure timely healthcare seeking during pregnancy and birth.

BACKGROUND: Anticipated stigma related to chronic illness patients undermines diagnosis, treatment, and successful health outcomes. The study aimed to assess the magnitude and factors associated with anticipated stigma among patients with chronic illness attending follow-up clinics in Amhara Region Referral Hospitals, Ethiopia.

METHODS: A cross-sectional institution-based study was conducted in Amhara Region Referral Hospitals from 01 March to 15 April 2021. A simple random sampling technique was used to select the three Referral Hospitals in the region and study subjects. Data were collected using a pre-tested interview-based questionnaire. Data were entered and cleaned with Epi-Info version 6 and exported for analysis STATA version 14. Multiple linear regression was used to show the association between anticipated stigma and potential factors. Associations were measured using ß coefficients and were considered statistically significant if the p-value > 0.05.

RESULTS: A total of 779 patients were included for analysis with a response rate of 97%. Their mean (Standard deviation) of anticipated stigma was estimated at 1.86 and 0.5, respectively. After running an assumption test for multiple linear regression; educational status, cigarette smoking, psychological distress, medication adherence, alcohol consumption, and social part of the quality of life were statically significantly associated with anticipated stigma.

CONCLUSION AND RECOMMENDATION: The result showed a high level of anticipated stigma reported among the participants. Emphasizing improving their social part of the quality of life, avoiding risky behaviors like alcohol consumption and cigarette smoking, access to health education for chronically ill patients, integrating mental health in all types of chronic disease, and developing strategies and protocols which will help to improve patient medication adherence to their prescribed medication will be crucial. This can provide a foundation for government andnon-governmental organizations, and researchers implementing evidence-based interventions and strategies on chronic care to address factors related to anticipated stigma.

BACKGROUND: In 2013 the first midwives in Bangladesh to be educated according to international standards completed their course and were awarded a diploma. Sixty percent of their training took place in clinical placement sites. In order to achieve appropriate mentor support while in clinical practice, a mentorship programme was initiated whereby local doctors were appointed by Save the Children. The aim of this study is to describe the mentors' purpose and the actions they took to improve midwifery care at clinical placement sites. Their appointment was intended to support local Health Care Providers (HCPs) at clinical placement sites meant for educating midwifery students in evidence-based midwifery care.

METHODS: An open-ended interview study with 14 mentors. The data was analysed using content analysis.

RESULTS: The main category, the theme that emerged from the analysis was "Creating commitment". "Creating commitment" describe how the mentors; the medical doctors employed by Save the Children, "Motivate", "Educate", "Mentor", "Advocate" and "Communicate" (subcategories) to creating commitment for quality midwifery care "In the organization of care" and "In clinical care practices" (categories). As intended, they enabled HCPs, midwifery students, and newly graduated midwives to provide quality midwifery care.

CONCLUSIONS: Using medical doctors' status and power to support the development of a newly emerging midwifery cadre in a country where midwifery is just emerging as a profession is because midwives integrated in the health system will improve the birthing process, improve life chances for newborns, and reduce morbidity and mortality in Bangladesh. It is recommended for implementation in other similar national contexts.

The Indian Government has committed to educate 90,000 midwives in accordance with international norms. This goal is critical as midwives provide evidence-based, high-quality midwifery care. There is a need to explore the contextual factors influencing this new midwifery education programme. Hence, the aim of this study is to explore contextual factors influencing the implementation of the national midwifery education programme for midwifery educators and the future Nurse Practitioners in Midwifery (NPMs) in India. A qualitative research design was used, with data collected through focus group discussions (n = 8) with a total of 27 participants representing seven national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis. This study on contextual factors influencing the implementation of the new midwifery education programme in India showed that organisational and administrative processes are complex and the development of midwifery educators and nurse practitioners in midwifery needs to be fast tracked. The education of educators and future midwives in India, and elsewhere in similar settings, could benefit from efforts to simplify the organisational and administration processes and, in parallel, mobilize innovative teaching and learning approaches to bridge theory and practice.

BACKGROUND: A midwife led care project targeting to decide what to do to achieve the SDG 2030 in maternal and child health, made a project team develop a tool to analyse what health care systems need, to adopt the MIDWIZE Conceptual Framework. The MIDWIZE Conceptual Framework wish to introduce the comprehensive midwifery-managed care provided women in Sweden to other countries, regions, and units where the framework is not fully applied.

METHODS: In order to determine what resource needs would have to be met to improve midwife led care, a tool was developed using Delphi study technique.

RESULTS: Using Delphi study technique together with on-site visits to two Sub-Saharan African countries, members of a project team went to Ethiopia and Uganda, where they visited governments, clinical or educational institutions and together with African leaders developed availability and efficiency of a tool to determine resource needs.

CONCLUSION: If at some future time, a single country, region or unit, might want to use the tool for quality improvement purpose of midwife led care, then the tool might aid in taking the first step to determine what resources might be required and what changes might be recommended as concerns policy at the clinical or educational institution level that are part of already existing health care structures.

OBJECTIVE: This study aimed to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care (EmOC) with a focus on cesarean deliveries in a referral hospital and maternal and child health centers in Somaliland.

METHODS: An exploratory qualitative approach using focus group discussions was employed at the main referral and teaching hospital and four maternal and child health centers in Hargeisa, Somaliland. Twenty-eight HCPs were divided into groups of 6-8 for discussions lasting 1 to 2 h. All HCPs included in the study had experiences with the provision of EmOC. Data were analyzed using thematic analysis.

RESULTS: Collective family decision making was identified by HCPs as a barrier to the provision of EmOC. This tradition of decision making at a group level was perceived as time-consuming and delayed HCPs from obtaining informed consent for EmOC. Low socioeconomic status and poor knowledge about maternal healthcare among users affected care seeking among women. Suboptimal EmOC at the hospital was reported to be due to miscommunication, inadequate interprofessional collaboration and lack of infrastructure.

CONCLUSIONS: HCPs encountered difficulties with the provision of EmOC. A broad array of strategies targeting the community and healthcare system is needed, including training of HCPs on intracultural communication competence, interprofessional collaboration and use of alternative birth methods other than CS. Antenatal care can be used to prepare families for potential obstetric emergencies and as an opportunity to obtain written informed consent.

OBJECTIVE: To describe the incidence and causes of severe maternal outcomes and the unmet need for life-saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland.

METHODS: A prospective cross-sectional study was conducted from April 15, 2019, to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data was collected using the World Health Organization (WHO) and sub-Saharan Africa (SSA) maternal near-miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions and ratios.

RESULTS: The MNM ratio were 56 (SSA criteria) and 13 (WHO criteria) per 1,000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric haemorrhage (13%), pregnancy-related infection (10%) and hypertensive disorders (7.9%) according to the SSA MNM criteria. Most women giving birth received prophylactic oxytocin for postpartum haemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after three hours.

CONCLUSION: There is a need to improve the quality of maternal health services through implementation of evidence-based obstetric interventions and continuous in-service training for health care providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low-resource contexts.

Background: Professional midwives are being introduced as a long-term solution to improve maternal and newborn health in Bangladesh and to contribute to Universal Health Coverage. Professional midwives’ associations are a core element of a strong midwifery profession according to the International Confederation of Midwives (ICM). The Bangladesh Midwifery Society (BMS) was formed in 2010 to advocate for the introduction of professional midwifery in Bangladesh. Since 2017 BMS has benefitted from an international twinning partnership with the Royal College of Midwives (RCM) UK and has undergone significant organizational development.

Objective: The study aimed to describe the experiences, knowledge and attitudes of selected members of the Bangladesh Midwifery Society (BMS) about how the society was supporting its members and the wider profession of midwifery.

Methods: Semi-structured individual interviews with eighteen BMS members and executive board members.

Results: This study demonstrated that in Bangladesh the midwives’ association has played a dual role in supporting its members and in driving the profession forward.

Conclusions: This study confirms that the BMS, collaborating nationally and internationally with strategic partners, is a key player in establishing and supporting the nascent profession of midwifery in Bangladesh. It complements other data about efforts to build BMS’ capacity and influence and it makes recommendations for future practice, policy and research.

Background: The Caring Behaviors Inventory-16 (CBI-16) is a comprehensive instrument measuring caring behaviors as experienced by patients. The study aimed to translate, culturally adapt and evaluate the psychometric properties of the CBI-16 among adult patients who speak the Amharic language.

Methods: The measure was completed by 304 hospitalized patients. Construct validity was evaluated via exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and contrasted groups' validity. Total CBI-16 scores were compared between groups that differed in self-rated satisfaction with care (Patient Satisfaction Instrument) to examine the contrasted groups' validity. Reliability was assessed using internal consistency (Cronbach's alpha).

Results: The EFA suggested a four-factor model accounting for 66.1% of the total variance. The items loaded onto the subscales were similar to the CBI-24. The CFA supported the four-factor model with acceptable fit indices: normed Chi-square value 2.65 (X² = 259.60, df = 98), SRMR = 0.06, and RMSEA = 0.07, CFI = 0.88 and TLI = 0.86. The contrasted groups' validity was supported by significantly higher CBI-16 scores reported by patients more satisfied with their care (t = 3.66, p &lt; 0.001). The reliability of the instrument was satisfactory (Cronbach's alpha = 0.83).

Conclusions: The Amharic version of the CBI-16 displayed a four-factor solution and was shown to be a valid and reliable instrument for the assessment of the perceptions of caring behaviors in Ethiopia.

Objective This study aimed to determine the level of life satisfaction and identify associated factors among elderly people living in two cities in northwest Ethiopia. Design Community-based cross-sectional study. Setting Two cities in northwest Ethiopia (Gondar and Bahir Dar). Participants 816 elderly people age 60 years and above living in Gondar and Bahir Dar, northwest Ethiopia. Systematic random sampling was used to select study participants. Main outcome measure Level of life satisfaction. Considering the mean and SD, three levels of satisfaction appeared to suffice as the basis for analysis and discussion: 23.5-34.4 dissatisfied, 34.5-56.5 averagely satisfied and 56.6-67.5 satisfied. Multivariable ordinal regression analysis was done to control the confounders. Since the outcome variable has an ordinal category, ordinal regression analysis is appropriate. A p≤0.05 and AOR (adjusted OR) with a 95% CI were considered to determine the statistically significant variables and strength of the association. Results The mean age of the respondents was 68.2 years with an SD±7.2. The level of life satisfaction was: dissatisfied 17.2%, moderately satisfied 63.8% and well satisfied 19.0%. Overall, 45.8% (95% CI 42.2% to 49.2%) of the participants had a score equal to or above the mean. Regarding associated factors; retired current occupation (AOR=2.23, 95% CI 1.09 to 4.55), good self-rated health status (AOR=2.54, 95% CI 1.29 to 4.99), having no chronic disease (AOR=1.48, 95% CI 1.03 to 2.11), somewhat-good (AOR=2.15, 95% CI 1.12 to 4.13) and good (AOR=4.51, 95% CI 2.40 to 8.45) self-perception on ageing life, moderate functional impairment on daily living activities (AOR=5.43, 95% CI 1.81 to 16.24), high sense of coherence (AOR=3.80, 95% CI 2.04 to 7.08), house rent as a source of finance (AOR=2.60, 95% CI 1.49 to 4.52) and high perceived social support (AOR=2.13, 95% CI 1.44 to 3.16) had statistically significant association with the life satisfaction. Conclusion The life satisfaction level in our study group was lower than in some more highly developed countries. To improve the level of life satisfaction in Ethiopia, a holistic programme of nursing care for elderly people, particularly as concerns about their health and psychosocial conditions is crucial in both community and clinical settings.

'The midwife's role in achieving the Sustainable Development Goals: Protect and Invest Together' is a report providing the reader the opportunity for understanding and appreciating the history of midwifery in Sweden and the interlinked nature of the United Nation's SDGs supporting health and wellbeing of women and children. To realise the opportunity to have a country with well-educated midwives of high academic standard, and, at the same time, promoting gender equality and equity we need to protect and invest together in midwives. This paper provides the foundation for a revitalised discussion on midwives' role for women and child health in the 21st century. The full Swedish Midwifery report was published in October 2021.

OBJECTIVE: Familiarity with the unique tradition and experience of Swedish midwives during the more than 300 years in which midwife-led care has contributed to one of the lowest maternal and neonatal mortality and morbidity ratio in the world might encourage professionals in other countries to follow the Swedish example. The framework described below, reflecting the midwife's role in the Swedish health care system, might, after implementation, strengthen maternal and neonatal outcomes if contextualized to other settings.

RESULTS: Using a four-step procedure we identified our topic, made a literature review, identified the key components and their internal relationship, and finally developed the MIDWIZE conceptual framework. In this framework, the midwives in collaboration with obstetricians, provide evidence-based care with continuous quality improvements during the whole reproductive life cycle. Teamwork including specialists for referral and a responsive, relational, trust-based practice is the foundation for provision of midwife-led care for healthy women with a normal pregnancy. The well-educated midwife, of high academic standard, promoting gender equality and equity is the hub in the team and the primary care provider.

BACKGROUND: Stigma is common among patients with chronic illnesses. It affects the delivery of healthcare for not addressing the psychological components and may interfere with the patient's attendance to necessary health care services. Therefore, a valid and reliable instrument to measure anticipated stigma related to chronic illness is vital to inform possible interventions. This study aimed to translate the Chronic Illness Anticipated Stigma Scale (CIASS) into the Amharic language and evaluate its psychometric properties in Ethiopia.

METHODS: The CIASS was translated into Amharic language using standard procedures. The Amharic version was completed by 173 patients (response rate 96%) with chronic illness from three referral hospitals in the Amhara region. Internal consistency was examined through Cronbach's alpha. Construct validity was evaluated by confirmatory factor analysis and convergent validity by using a Pearson correlation of P-value less than or equal to 0.05.

RESULTS: The internal consistency was estimated at Cronbach alpha of 0.92. By using a structural equation model, and modification indices a model fitness testing was run and shows a root mean squared error of approximation 0.049 (90% CI, 0.012-0.075). The structural validity results in 78.8% of confirmatory factor analysis showed from the extraction of the three-dimension (components). Validity tests for convergent by using Pearson correlation positively correlated with common mental distress and negatively correlated with quality of life-BREF, and the construct validity shows a good valid tool to CIASS.

CONCLUSION: The Amharic language version of the chronic illness anticipated stigma scale shows a satisfactory level of reliability and validity on different psychometric measures of assessment. The tool may be useful for future researchers and patients with chronic illness in the Amharic-speaking population. Moreover, it will be used to see the psychological burden related to chronic illness and for comparison among international population groups.

BACKGROUND: The concept of a neonatal near miss is used to explain neonates who nearly died but survived a life-threatening complication in the first 28 days of life. We have left many ill surviving (near-miss) neonates, due to a lack of valid and reliable assessment scale, particularly in Ethiopia.

AIM: We aim to psychometrically validate the neonatal near-miss assessment scale (NNMAS) for Ethiopia.

METHODS: A total of 465 live birth neonates were included with the assumption of a participant-to-item ratio of 15:1. A new contextually validated NNMAS was used to collect data. The Kaiseri--Mayer--Olkin (KMO) measure of sampling adequacy with a cutoff value of ≥0.50 for each item was applied. For reliability and validity of NNMAS, exploratory factor analysis using principal component analysis with oblique varimax rotation was used. Internal consistency and reliability were assessed using Cronbach's alpha. Convergent and discriminant validity was assessed using composite reliability (CR) and average variance extracted (AVE).

RESULTS: The Kaiser--Mayer--Olkin (KMO = 0.74) measure of sampling adequacy and Bartlett's Sphericity test for the appropriateness of the identity matrix (χ² = 2903.9, df = 276, and P = 0.000) were suitable for exploratory factor analysis (EFA). The correlation matrix determinant of the study was 0.002. The principal component analysis (PCA) identified six factors and together explained 54.3% of the variation in the Neonatal Near miss. The Cronbach-alpha coefficient was 0.80 for the entire scale. The composite reliability values of the factors ranged from 0.87 to 0.95. The AVEs, CR, and factor loadings were above 0.5 for all factors indicating that convergent validity was met. The square roots of the AVEs were greater than factor correlation values. It was revealed that discriminated validity was also met.

CONCLUSION: The neonatal near-miss assessment scale was found to be valid and reliable in the present context. The scale can be used to identify near-miss neonates in Ethiopia.

Background: Violence against women is a significant problem affecting public health and human rights worldwide. The midwife profession is identified as a key profession in identifying violence against women and to provide first line support. In Bangladesh, there is a national plan aiming for a society free from violence against women and children by 2025. Midwifery is relatively new to Bangladesh and it is central to investigate how the topic is addressed within midwifery education.

Objective: To examine how violence against women is addressed in midwifery education in Bangladesh and identify potential needs for improvement, from the perspective of midwifery educators and clinical midwives.

Methods: Five focus group discussions were conducted with 29 midwifery educators and clinical midwives from different parts of the country, with a topic guide based on the WHO clinical and policy guidelines for response to intimate partner violence and sexual violence against women. The data were analysed by qualitative content analysis. 15

Results: The need to linking theory and practice was highlighted. A broad base of theoretical knowledge and possibilities for clinical practice will enable future midwives to identify, communicate and support women subjected to violence, and to link with available services. An improved curriculum, aligned to the needs of the women among whom future midwives will work is essential, as are knowledgeable midwifery educators, in relation to the topic and to varied pedagogics.

Conclusions: Educators need to be innovative when finding ways for midwifery students to link theory about violence against women to practice. To highlight the unique contribution midwifery can make to the field, networking with local and community authorities is central. If space was provided for midwifery educators to improve the content related to violence against women in the midwifery curriculum the confidence of both midwifery educators and future midwives would be strengthened.

BACKGROUND: The concept of neonatal near miss is used to identify neonates who nearly died but survived a life-threatening complication in the first 28 days of life. Neonatal mortality is the tip of the iceberg. Quality improvement through utilization of a validated scale and reduction in adverse neonatal outcome is a priority for achieving sustainable development goals.

OBJECTIVES: To develop and assess the content validity of neonatal near-miss scale in the public health hospitals in Amhara Regional State, northwest Ethiopia.

METHODS: A literature review was performed prior to the development of the neonatal near-miss assessment scale. An expert panel committee was formed by health facility practitioners and by the members of the academia. Two rounds of meetings were conducted with the expert panel to reach consensus on the face and content validity. The content validity index, Kappa statistics, and the content validity ratio were computed to estimate the content validity scale of neonatal near miss.

RESULTS: In this study, four domains (pragmatic, clinical, management, and lab-investigations) with 32 items were identified. The item-level content validity index ranged from 0.7 to 1. The overall scale content validity (S-CVI) (average) for the domains (pragmatic, clinical, management, and lab-investigations) were 0.98, 0.95, 0.96, and 0.96, respectively. The overall S-CVI (universal) was 0.78 to 1, whereas the overall S-CVI (average) of neonatal near miss assessment scale was found to be 0.96. The content validity ratio and Kappa statistics values ranged from 0.6 to 1 and 0.9 to 1 for the respective domains.

CONCLUSION: The identified four domains and the respective items were valid enough (content-wise) to be used as identification criteria for neonatal near-miss cases. The scale will contribute to neonatal near-miss identification and also improve the quality of neonatal management care.

OBJECTIVE: To capture care providers' perceptions of defibulated immigrant women's sexual and reproductive health, illuminated by their experiences as care providers for these women.

METHODS: Individual interview study with 13 care providers at Swedish healthcare facilities: six gynaecologists and seven midwives caring for defibulated immigrant women, analysed with a phenomenographic method.

FINDINGS: One of the care providers' perceptions of women who had been defibulated was that they had an altered genital function, meaning a wider introitus, improved vaginal intercourse, and more ease urinating and menstruating. The care providers also perceived that women who were defibulated had to balance their wellbeing, struggling between a positive self-image and handling their emotions. Existing in-between cultural values led to a fear of being excluded while at the same time having a desire to be included in the new culture.

CONCLUSION: Defibulation affects women's sexual and reproductive health and calls for a holistic perspective when providing services, individualized according to the woman's care needs. Support and counselling, should include information about defibulation already during the adolescent years to promote sexual and reproductive health and well-being.

BACKGROUND: With a diversity in midwifery education across the South-East Asia region, and with the knowledge about the lifesaving competency of the midwife profession, this study's aim is to describe facilitators of and barriers to providing high-quality midwifery education in South-East Asia.

METHODS: Inspired by Whittemore and Knafl, we conducted a systematic integrative literature review including the five key stages of problem identification, literature search, data evaluation, data analysis, and presentation of results. The literature searches were conducted in October 2020 in the databases CINAHL, PubMed, and Scopus. A deductive data analysis based on global standards was performed.

RESULTS: The search identified 1257 articles, 34 of which were included. Countries in South-East Asia did not fully comply with the ICM global standards. Midwifery education was not separated from that of nursing, and educators lacked formal qualifications in midwifery. Curriculum implementation in the clinical area was a key barrier to achieving learning outcomes. Higher academic education for midwifery educators and mentorship programs facilitated the pedagogic and assessment process, focusing on the abilities of critical thinking, reflection, and decision-making.

CONCLUSIONS: Countries in South-East Asia still have a long way to go before they can provide high-quality midwifery education. The identified facilitators can lead to a difference in students' academic achievement and confidence in their clinical work. Coordinated actions will enable the progress in achieving competent midwives matching national health priorities. The findings highlight a need for more research on midwifery education in both theory and practice across the region.

A new four-year Ph.D. programme in nursing and midwifery, the first of its kind in Ethiopia, was started in 2018/2019 at the University of Gondar when eight doctoral students in nursing and midwifery entered the program. We who have been involved see this as an appropriate time to evaluate what has been accomplished to date and to look toward future possibilities. Our aim in carrying out such an evaluation and presenting our findings is in part to determine if similar programs might be developed in other similar settings and in part to learn what modifications to the present program might be considered. The key elements of a questionnaire survey with closed and open response alternatives were based on the content, structure and learning outcomes of the home university Ph.D. programme as described in the curriculum. The questionnaire responses captured changes that would be needed to maintain a fully satisfactory programme that blends onsite instruction and online access to faculty resulting in a twenty-first century blended Ph.D. programme. Improved dialogue between the home university faculty and the external supervisors is needed. The programme can provide a career pathway that midwifery and nursing educators can follow in their own country rather than having to leave to study in another country. The findings provide insight into the feasibility of extending similar Ph.D. programmes to other parts of East Africa and with the SDG 5 in mind with an increased focus on women leadership. The justification for this initiative is to meet the need for more nursing and midwifery faculty who can provide quality midwifery and nursing education in East African countries. Retention of these professionals will help to deal with the shortage of healthcare personnel and will provide better care for the general population. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

The Swedish care model MIDWIZE defined as midwife-led interdisciplinary care and zero separation between mother and newborn, was implemented in 2020–21 in Ethiopia, Kenya, Malawi, and Somalia in a capacity building programme funded by the Swedish Institute. Objective: To determine the feasibility of using an internet-based capacity building programme contributing to effective midwifery practices in the labour rooms through implementation of dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of newborns in the immediate postnatal period. Methods: The design is inspired by process evaluation. Focus group discussions with policy leaders, academicians, and clinicians who participated in the capacity building programme were carried out. Before and after the intervention, the numbers for dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of the newborn in the immediate postnatal period were detected. Results: Participants believed the internet-based programme was appropriate for their countries’ contexts based on their need for improved leadership and collaboration, the need for strengthened human resources, and the vast need for improved outcomes of maternal and newborn health. Conclusion: The findings provide insight into the feasibility to expand similar online capacity building programmes in collaboration with onsite policy leaders, academicians, and clinicians in sub-Saharan African countries with an agenda for improvements in maternal and child health. © 2021