Acceptability of Community Midwives in rural communities of Pakistan: A qualitative exploratory study

Abstract Introduction The Government of Pakistan initiated the Community Midwifery program in 2006 to provide skilled birth attendance to women living in rural areas. However, the acceptability of midwives and what impact these community midwives have made on overall maternal morbidity and mortality remains an unanswered question. We explored the perceptions of health officials, midwifery students, midwives and community women about the factors that influence the acceptability of community midwives’ services in the rural district Thatta, Pakistan. Materials and Methods A qualitative exploratory study was conducted in the rural district Thatta of Pakistan. In-depth interviews were conducted with health officials, midwifery students who were currently enrolled in the midwifery program of the district; community midwives providing services in district Thatta, and trained community midwives who are not practicing. Interviews were also conducted with community women. Data were analyzed using the qualitative thematic analysis approach and the deductive analysis method. Results Two overarching themes were identified: (I) community acceptance and support; and (II) dynamics between CMWs and other health care providers. The major hindering factors to CMWs acceptance included their young age challenging social acceptability, patronizing behavior of doctors, high acceptance of traditional birth attendants working in rural areas, and the community’s reluctance towards referral services. The facilitating factors included clients’ privacy maintained at birth stations and the affordability of community midwives’ services. Conclusion There are deep-rooted challenges related to the acceptability of midwifery services at the community level and with other competing healthcare providers which need advocacy to support and accept their services at the community level and by other professionals.