School of Health Sciences, University of Dundee, Dundee, UK.
World Health Organization, New Delhi, India.
Birth. 2020 Dec;47(4):304-321. doi: 10.1111/birt.12498. Epub 2020 Jul 25.
The Indian government has committed to implementing high-quality midwifery care to achieve universal health coverage and reduce the burden of maternal and perinatal mortality and morbidity. There are multiple challenges, including introducing a new cadre of midwives educated to international standards and integrating midwifery into the health system with a defined scope of practice. The objective of this review was to examine the facilitators and barriers to providing high-quality midwifery care in India.
We searched 15 databases for studies relevant to the provision of midwifery care in India. The findings were mapped to two global quality frameworks to identify barriers and facilitators to providing high-quality midwifery care in India.
Thirty-two studies were included. Key barriers were lack of competence of maternity care providers, lack of legislation recognizing midwives as autonomous professionals and limited scope of practice, social and economic barriers to women accessing services, and lack of basic health system infrastructure. Facilitators included providing more hands-on experience during training, monitoring and supervision of staff, utilizing midwives to their full scope of practice with good referral systems, improving women's experiences of maternity care, and improving health system infrastructure.
The findings can be used to inform policy and practice. Overcoming the identified barriers will be critical to achieving the Government of India's plans to reduce maternal and neonatal mortality through the introduction of a new cadre of midwives. This is unlikely to be effective until the facilitators described are in place.
印度政府致力于提供高质量的助产护理，以实现全民健康覆盖并降低孕产妇和围产期死亡和发病的负担。存在多重挑战，包括培养一批符合国际标准的新助产士，并将助产服务纳入具有明确实践范围的卫生系统。本综述旨在研究印度提供高质量助产护理的促进因素和障碍。
我们搜索了 15 个数据库，以寻找与印度提供助产护理相关的研究。将研究结果映射到两个全球质量框架上，以确定在印度提供高质量助产护理的障碍和促进因素。
共纳入 32 项研究。主要障碍包括：产妇保健提供者能力不足、缺乏承认助产士为自主专业人员并限制其执业范围的立法、妇女在经济和社会方面获得服务的障碍、以及基本卫生系统基础设施的缺乏。促进因素包括：在培训期间提供更多实践经验、对工作人员进行监测和监督、充分发挥助产士的作用并建立良好的转诊系统、改善妇女对产妇保健的体验、以及改善卫生系统基础设施。
研究结果可用于为政策和实践提供信息。克服已确定的障碍对于印度政府通过引入新的助产士队伍来降低孕产妇和新生儿死亡率的计划至关重要。在描述的促进因素到位之前，这不太可能有效。
