Beyond Numbers of Midwives – A Call for True and Honest Professionalism A Literature Review

Abstract

Background: Despite substantial global declines in maternal mortality over the past two decades, progress has stalled in many low- and middle-income countries, where weak health systems and persistent inequities continue to limit gains. While global strategies have emphasized increasing the number of skilled birth attendants, particularly midwives, emerging evidence suggests that workforce expansion alone is insufficient to improve outcomes. Attention is increasingly shifting toward the quality of care, including the role of health worker motivation, professional engagement, and working conditions.
Objective: Driven by the call from “One Million More Midwives” by the International Confederation of Midwives, which is also a theme for the International Day of the Midwife 2026, this review examines the evidence on factors influencing the motivation and professional engagement of midwives in low-income settings and explores how these factors shape the quality of maternal and newborn care.
Methods: A narrative literature review was conducted drawing on published studies and global reports on midwifery, health worker motivation, and quality of care in low- and middle-income countries. Sources were identified through searches of major databases and relevant institutional publications, with emphasis on studies examining workplace conditions, supervision, workload, and professional identity.
Results: The literature consistently highlights that midwife performance is influenced by a combination of intrinsic and extrinsic factors. Intrinsic motivators, including professional pride, compassion, and a sense of purpose, are critical for sustaining high-quality care, particularly in resource-constrained environments. However, these are frequently undermined by systemic challenges such as high workload, inadequate staffing, weak supervision, and lack of recognition. Evidence also identifies incomplete clinical documentation and gaps in postpartum care as manifestations of broader disengagement and system-level dysfunction. The immediate postpartum period, a critical window for preventing maternal and neonatal deaths, is particularly vulnerable to neglect in overstretched facilities.
Conclusion: Efforts to reduce maternal mortality must move beyond a narrow focus on increasing the number of midwives toward strategies that strengthen motivation, professional identity, and supportive working environments. Policies that invest in mentorship, supportive supervision, recognition, and accountability systems are essential to sustain quality care. Reframing midwifery scale-up to include both numbers and professional engagement is critical for achieving meaningful and sustained improvements in maternal and newborn outcomes.