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Community midwifery initiatives in fragile and conflict-affected countries: a scoping review of approaches from recruitment to retention

Miyake, Sachiko; Speakman, Elizabeth M.; Currie, Sheena; Howard, Natasha


Sachiko Miyake

Elizabeth M. Speakman

Sheena Currie

Natasha Howard


Background: Birth assisted by skilled health workers is one of the most effective interventions for reducing maternal and neonatal mortality. Fragile and conflict-affected states and situations (FCAS), with one-third of global maternal deaths, face significant challenges in achieving skilled care at birth, particularly in health workforce development. The importance of community-level midwifery services to improve skilled care is internationally recognized, but the literature on FCAS is limited. This review aimed to examine community midwifery (CMW) approaches, from recruitment to retention, in FCAS.

Methods: This scoping review design adapted Arksey and O'Malley's six-stage framework. Data collection included systematic searching of seven databases, purposive hand-searching of reference lists and web sites, and stakeholder engagement for additional information. Potential sources were screened against inclusion and exclusion criteria. Included sources were appraised for methodological quality using the McGill University Mixed Methods Appraisal Tool. Data were analysed thematically, using deductive (i.e. cadre definition, recruitment, education, deployment and retention) and inductive coding (i.e. capacity, gender and insecurity).

Results: Twenty-three sources were included, of 2729 identified, discussing community midwifery programmes in six FCAS (i.e. eight for Sudan, six for Afghanistan, three each for Mali and Yemen, two for South Sudan and one for Somalia). Source quality was relatively poor, and cadre definitions were context dependent. Major enablers for effective CMW programmes were community linkages and acceptance, while barriers included inappropriate recruitment, non-standardized education, weak supportive environment, political insecurity and violence.

Conclusions: While community engagement and acceptance were crucial, CMW programmes were weakened by inappropriate recruitment and training, lack of support and general insecurity. Further research and implementation evidence is needed to aid policy-makers, donors and implementing agencies in developing and implementing effective CMW programmes in FCAS.


Miyake, S., Speakman, E. M., Currie, S., & Howard, N. (2017). Community midwifery initiatives in fragile and conflict-affected countries: a scoping review of approaches from recruitment to retention. Health Policy and Planning, 32(1), 21-33. https://doi.o

Journal Article Type Article
Acceptance Date Jun 16, 2016
Online Publication Date Jul 28, 2016
Publication Date 2017-02
Deposit Date Jan 23, 2020
Publicly Available Date Jan 28, 2020
Journal Health Policy and Planning
Print ISSN 0268-1080
Electronic ISSN 1460-2237
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 32
Issue 1
Pages 21-33
Public URL


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