2.8.

2 Variable quality in education and

training standards
Published literature on midwifery skills
education describes a range of health workers,
both professional and non-professional, who are
providing some midwifery skills (14, 55). Among
the various health workers described, there is a
lack of consistency in education programmes
(56) and in the use of the term “midwife” (56).
This means it is not clear which of the health
workers are educated and trained to
international-standard midwifery (16). Nursing
and midwifery education is often combined,
rendering midwifery skills education and training
invisible in policy, as well as in practice (57).
Since 2004 there has been a focus on measuring
skilled birth attendants (SBAs) in LMICs (58).
However, the SBA indicator does not reflect
quality of childbirth care, and may give the false
impression that progress in access to quality
care is being made (4). The definition of the SBA
has recently been updated and since 2018
describes “skilled health personnel (competent
health care professionals) providing care during
childbirth” (58). While contributing to the overall
decrease in mortality, the training, regulation
and deployment of SBAs with a specific focus
on childbirth has varied widely across countries,
with uneven levels of proficiency and regulatory
support (2, 59, 60).
Not all SBAs provide all areas of maternal and
newborn care or are trained to deal with
unexpected complications (60, 61). In a recent
scoping review, only 15% of those working as
SBAs were reported to identify themselves as
“midwives”, and it is not clear whether those
who described themselves as such were
educated to international standards (62).

“In a scoping review of the

health personnel considered
SBAs in 36 LMICs, a total of 102
unique cadres names were
identified. Of the cadres
included, 16% represented
doctors, 16% were nurses, and
15% were midwives. There was
substantial heterogeneity
between and within countries on
the reported definition of an
SBA and the education, training,
skills and competencies that they
were able to perform.”
Hobbs et al. PLoS ONE (62)

2.8.3 Educators lack skills, access to

clinical sites and training materials
Early results from a WHO survey of midwifery
educators in five WHO regions provide a stark
picture of the realities of constrained teaching
and learning environments . Educators are more
confident with theoretical classroom teaching
than clinical teaching. Many are unable to
access clinical settings, or simulation tools, to
support competency-based education with
women and babies.
Large gaps in educator skills are evident,
including basic postnatal care of women and
newborns, and the provision of family planning.
Few educators reported having the education
materials needed. The survey further highlighted
inconsistencies in the content and duration of
education courses, variations in the
competencies required, as well as the plethora
of pathways to becoming a “midwife”, indicating
a wide variation in the standard of education
and training, and thereby variations in the
quality of care provided.