Department of Obstetrics and Gynecology, The Aga Khan University, Stadium Road, PO Box 350, Karachi, 74800, Pakistan.
Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
BMC Pregnancy Childbirth. 2022 Jun 22;22(1):506. doi: 10.1186/s12884-022-04823-8.
To address the issue of high maternal mortality, the Government of Pakistan initiated a community midwifery program in 2006 to provide skilled birth attendance to women living in rural areas. Despite a large investment in the community midwifery program, research evidence from rural districts of Pakistan suggests that the utilization of maternal and newborn services through community midwives is very low. This exploratory study aimed to understand the facilitators and barriers influencing community midwives' services utilization in district Thatta.
A qualitative study was conducted in the rural district Thatta, Pakistan. Key-informant interviews (KIIs) were conducted with district officials of the Health department (Thatta), Maternal and Newborn Child Health Program, and Midwifery Association of Pakistan (MAP). In-depth Interviews (IDIs) were conducted with midwifery students who were currently enrolled in the midwifery program of the district; trained community midwives providing services in district Thatta, and trained community midwives not continuing their profession. IDIs were also conducted with community women to explore their views about the scope of midwifery practice and the factors influencing the utilization of community midwives' services in district Thatta, Pakistan. Data were analyzed using qualitative thematic analysis.
A total of 25 interviews (KIIs = 5; IDIs = 20) were conducted. Two overarching themes were identified: (I) community midwives' skills and competencies; and (II) ownership and supportive supervision. The major hindering factors for community midwives' service utilization included deficiencies in community midwives' training particularly in clinical hands-on training, lack of ownership of community midwifery program, and lack of service structure by the CMWs regulatory body.
The study has identified serious gaps in the CMWs program at the level of training and supervision of midwives in Pakistan. The study has also identified factors related to the training of CMWs that could facilitate the program in the context of Pakistan and similar settings.
为了解决高孕产妇死亡率的问题，巴基斯坦政府于 2006 年启动了社区助产士计划，为居住在农村地区的妇女提供熟练的分娩护理。尽管在社区助产士计划上投入了大量资金，但来自巴基斯坦农村地区的研究证据表明，通过社区助产士利用产妇和新生儿服务的比例非常低。这项探索性研究旨在了解影响塔塔地区社区助产士服务利用的促进因素和障碍。
本研究在巴基斯坦农村地区塔塔县进行了一项定性研究。对卫生部门（塔塔县）、孕产妇和新生儿保健计划以及巴基斯坦助产士协会的地区官员进行了关键知情人访谈（KII）。对目前在该地区助产士项目中注册的助产士学生、在塔塔县提供服务的经过培训的社区助产士和不再从事该职业的经过培训的社区助产士进行了深入访谈（IDI）。还对社区妇女进行了访谈，以探讨她们对助产士实践范围的看法以及影响巴基斯坦塔塔县社区助产士服务利用的因素。使用定性主题分析对数据进行分析。
共进行了 25 次访谈（KIIs=5；IDI=20）。确定了两个总体主题：（I）社区助产士的技能和能力；和（II）所有权和支持性监督。社区助产士服务利用的主要障碍包括社区助产士培训中的缺陷，特别是在临床实践培训方面，社区助产士计划缺乏所有权，以及 CMW 监管机构缺乏服务结构。
该研究发现，巴基斯坦社区助产士计划在助产士培训和监督方面存在严重差距。该研究还确定了与社区助产士培训相关的因素，这些因素可以促进该计划在巴基斯坦和类似环境下的实施。
