Exploring the attitudes and beliefs of women regarding the implementation of midwife-led care in India: a mixed methods study

Problem: Despite the recent introduction of midwifery services in India to improve maternal and newborn healthcare, there is limited research on women's perspectives on midwife-led care. Background: The Government of India initiated midwifery services guidelines in 2018 to improve the quality of care for pregnant women and newborns across the country. It is important to develop evidence-based strategies which can optimise the implementation of these new midwifery services. Aim: This study explored women's attitudes and beliefs towards the implementation of midwife-led care in two southern states of India. Methods: A convergent mixed methods design was employed using an online questionnaire and semi-structured online interviews. Quantitative data was analysed using descriptive statistics and qualitative analysis used a framework approach. Data from both sources were then integrated through merging techniques. Findings: A total of 307 women completed the online survey, and 23 participated in in-depth interviews. The study highlighted inadequate knowledge of midwife-led care among women. Despite this, 60 % expressed optimism about its benefits. Key factors to women's acceptance included better understanding outcomes, having trust in midwives, receiving respectful care, and having autonomy in decision-making. They also required midwife-led birthing units would be clean, accessible, and well resourced. Discussion: Most participants perceived midwife-led care as beneficial, valuing its skilled, responsive and compassionate services. Conclusion: Insights from this study have implications for the implementation of midwife-led care which should consider the informational needs, safety standards and cultural contexts of women and their families living in both urban and rural areas of India.