Calvert Boe, Homer Caroline S E, Bar-Zeev Sarah, Ferguson Alicia, Scarf Vanessa
University of Technology, Sydney (School of Nursing and Midwifery), Sydney, Australia.
Burnet Institute (Women's, Children's and Adolescent's Health), Melbourne, Australia.
Appl Health Econ Health Policy. 2025 Mar 19. doi: 10.1007/s40258-025-00962-z.
Midwives are essential in achieving universal health coverage targets and the health targets of the Sustainable Development Goals, yet a significant global shortfall exists in the midwifery workforce. Economic evaluations of midwifery are scarce but can assist in supporting evidence-informed decision-making for sustainable and equitable health care for women and girls.
This review aimed to systematically identify, map and report on available literature regarding economic evaluations conducted on midwifery service provision and the midwifery workforce in all settings.
A scoping review was conducted following the Joanna Briggs Institute methodology. A comprehensive search strategy was developed and run in six health databases. Peer-reviewed studies and unpublished research theses conducting economic evaluations on midwifery service provision or midwifery workforce strategies were included. Sources were limited to English-language literature published in the past 20 years. Identified sources were screened and reviewed, and data from included sources were extracted, reviewed, mapped and synthesised to report findings. Quality appraisal was conducted on all included sources using the Joanna Briggs Institute Critical Appraisal Checklist for Economic Evaluations.
A total of 32 studies were included in the review. Most were from high-income countries (26/32), and very few were from low- and middle-income countries (6/32). The quality of included studies varied greatly. Under half of the studies conducted full economic evaluations (15/32), and the remainder were partial economic evaluations (17/32). Most studies evaluated midwifery service provision (29/32) through either midwife-led models of care (15/29) or by place of birth (13/29), mostly for low-risk women (23/29) from the perspective of healthcare funders. Evaluation of midwifery education programs was less common, and these were all conducted in low- and middle-income countries (3/32). Most studies concluded that midwifery service provision was cost-saving, cost-effective or cost-beneficial.
Our review identified a significant gap in economic evaluation of midwifery from low- and middle-income countries. However, there is ongoing need for robust, quality economic evaluations on midwifery service provision and workforce strategies in all global regions. Such studies would further support health policymakers and governments to make evidence-informed decisions to address midwifery workforce shortages and provision of evidence-based and respectful care that meets the healthcare needs of women and girls.
助产士对于实现全民健康覆盖目标和可持续发展目标中的健康目标至关重要，但全球助产士劳动力存在显著短缺。关于助产的经济评估很少，但有助于为为妇女和女孩提供可持续、公平的医疗保健提供循证决策支持。
本综述旨在系统地识别、梳理和报告所有环境下有关助产服务提供和助产士劳动力经济评估的现有文献。
按照乔安娜·布里格斯研究所的方法进行了一项范围综述。制定了全面的检索策略并在六个健康数据库中运行。纳入了对助产服务提供或助产士劳动力策略进行经济评估的同行评审研究和未发表的研究论文。来源限于过去20年发表的英文文献。对识别出的来源进行筛选和评审，并从纳入的来源中提取、评审、梳理和综合数据以报告结果。使用乔安娜·布里格斯研究所经济评估关键评审清单对所有纳入的来源进行质量评估。
本综述共纳入32项研究。大多数来自高收入国家（26/32），来自低收入和中等收入国家的很少（6/32）。纳入研究的质量差异很大。不到一半的研究进行了全面的经济评估（15/32），其余为部分经济评估（17/32）。大多数研究通过助产士主导的护理模式（15/29）或出生地点（13/29）评估助产服务提供（29/32），主要针对低风险女性（23/29），从医疗保健资助者的角度进行评估。对助产教育项目的评估较少见，且均在低收入和中等收入国家进行（3/32）。大多数研究得出结论，助产服务提供具有成本节约、成本效益或成本效益。
我们的综述发现低收入和中等收入国家在助产经济评估方面存在重大差距。然而，全球所有地区仍需要对助产服务提供和劳动力策略进行有力、高质量的经济评估。此类研究将进一步支持卫生政策制定者和政府做出循证决策，以解决助产士劳动力短缺问题，并提供满足妇女和女孩医疗保健需求的循证、尊重性护理。
