Abdullahi Hawa, Mohamud Asia Mohamed, Ahmed Maryan Abdulkadir, Omar Mohamed Ahmed, Dalmar Abdirisak A, Tappis Hannah, Elnakib Shatha
Research, Somali Research and Development Institute, Mogadishu, Somalia.
Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Front Glob Womens Health. 2025 Jan 17;5:1480914. doi: 10.3389/fgwh.2024.1480914. eCollection 2024.
Midwives play an important role in maternal and newborn care, yet are in short supply globally. The shortage in midwives is particularly acute in sub-Saharan African countries, many of which are conflict-affected. Midwives face many challenges that impact their workforce participation and retention, and these challenges are often compounded in conflict settings. Somalia ranks among the countries with the highest maternal mortality rate, with an estimated shortage of 20,000 midwives compared to the WHO recommended standard. Yet, limited research has explored the lived experience of midwives in conflict. This qualitative study seeks to explore the experiences, plans, and aspirations of midwifery students and recent graduates from nine midwifery schools in Somalia and to understand how the safety and security situation impacts their educational experience and willingness to join the profession.
This is a sub-study embedded within a broader prospective multi-cohort study of midwifery students and early career midwives conducted in 2023 and which will continue until 2025. We invited graduates and students in their final year from eight schools in Mogadishu and one school in Galgadud to participate in the study. This study draws on findings from five focus group discussions conducted with midwifery students and graduates who were included in the parent cohort study, for a total sample size of 33 students and graduates. We conducted thematic analysis using a combination of inductive and deductive coding.
Our data illustrates powerful motivation among midwifery students and graduates to join the profession. Motivation was mostly intrinsic, with participants describing their desire to help the mother-baby dyad and to reduce maternal mortality in their communities as the predominant driving force for joining the profession. Yet, participants cited several barriers to entering the workforce, including harmful gender norms that prioritize women's domestic roles over professional aspirations and societal mistrust toward young midwives. Participants stated that their age and gender undermined them professionally and noted the community's preference for older midwives and traditional birth attendants. Safety and security significantly impacted participants' acceptance of job placement in remote areas and students' ability to attend school regularly. In terms of perceived preparedness, graduates felt well prepared for their role but identified gaps in abortion care, neonatal resuscitation, and usage of basic ultrasound.
The challenges faced by midwifery students and newly graduated midwives have direct implications for the health outcomes of mothers and infants in conflict-affected settings. The recurring themes of inadequate training, security risks, and restrictive gender norms require holistic and systematic interventions that address these issues in order to improve motivation and workforce participation among this important health cadre.
助产士在孕产妇和新生儿护理中发挥着重要作用，但全球范围内助产士短缺。撒哈拉以南非洲国家的助产士短缺问题尤为严重，其中许多国家都受到冲突影响。助产士面临着诸多影响其劳动力参与和留用的挑战，而这些挑战在冲突环境中往往更加复杂。索马里是孕产妇死亡率最高的国家之一，与世界卫生组织建议的标准相比，估计短缺20000名助产士。然而，针对冲突环境中助产士实际经历的研究有限。这项定性研究旨在探索索马里九所助产学校的助产专业学生和应届毕业生的经历、计划和抱负，并了解安全保障状况如何影响他们的教育经历以及从事该职业的意愿。
这是一项子研究，嵌入在2023年开展并将持续至2025年的一项针对助产专业学生和早期职业助产士的更广泛前瞻性多队列研究中。我们邀请了摩加迪沙八所学校和加勒古杜德州一所学校的应届毕业生和最后一年的学生参与该研究。本研究借鉴了与纳入母队列研究的助产专业学生和毕业生进行的五次焦点小组讨论的结果，样本总数为33名学生和毕业生。我们使用归纳编码和演绎编码相结合的方法进行主题分析。
我们的数据表明，助产专业学生和毕业生有强烈的从业动机。动机大多是内在的，参与者将他们帮助母婴以及降低所在社区孕产妇死亡率的愿望描述为从业的主要驱动力。然而，参与者提到了进入劳动力市场的几个障碍，包括有害的性别规范，这些规范将女性的家庭角色置于职业抱负之上，以及社会对年轻助产士的不信任。参与者表示，他们的年龄和性别在职业上对他们不利，并指出社区更喜欢年长的助产士和传统接生员。安全保障严重影响了参与者对偏远地区工作安排的接受程度以及学生定期上学的能力。在自我认知的准备程度方面，毕业生觉得自己对工作角色准备充分，但指出在堕胎护理、新生儿复苏和基本超声使用方面存在差距。
助产专业学生和新毕业助产士面临的挑战对受冲突影响地区母婴的健康结果有直接影响。培训不足、安全风险和限制性性别规范等反复出现的主题需要全面系统的干预措施来解决这些问题，以提高这一重要卫生专业人员队伍的积极性和劳动力参与度。
