Associations Between Midwifery Regulatory Environments and Maternal Health Outcomes

Abstract

Midwives are recognized as a cost-effective solution for increasing skilled birth attendance and eliminating preventable maternal deaths, a global priority. However, the full potential of midwifery is often limited by a shortage of midwives and poor-quality care, especially in low- and middle-income countries. Enhancing midwifery regulation is proposed as a means of improving access and care quality in these countries, but its impact is not well understood. To address this, the Midwifery Regulatory Environment Index was developed, a composite measure that characterizes regulatory environments at the country level. A cross-sectional analysis of countries with varying income levels was conducted using data from multiple publicly available databases to assess the relationship between the Midwifery Regulatory Environment Index and two key maternal health-related outcomes – midwifery workforce density and maternal mortality ratio – in 103 International Confederation of Midwives member countries. Findings indicated that both the density of midwives and maternal mortality ratios were significantly associated with midwifery regulatory environments, after controlling for country income group, per capita health spending, income inequality, and Human Development Index.