Document Type


Country of Origin



School of Nursing and Midwifery, Pakistan



Pakistan has a high rate of maternal and infant mortality, and a shortage of skilled birth attendants (SBAs). Many efforts have been made through the health sector and the international agencies to resolve the problem of both a high Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), but the desired outcomes have not been achieved so far. Literature shows that midwifery plays a significant role in the reduction of MMR and IMR in other parts of the world, and the implementation of a Midwifery-led Service Provider Model could help reduce these rates in Pakistan. This study aims to identify the factors affecting the development of Midwifery-led Service Provider Model in Pakistan.


This was a quantitative, descriptive study conducted in the Pakistani districts of Chitral, Dera Ghazi Khan, Multan and Sahiwal. A sample of 48 midwives was selected through stratified random sampling from two health centres in Chitral, two government health centres and two private health centres in Dera Ghazi Khan, Multan, and Sahiwal, and two independent midwife practitioners in Multan were also included.


Factors were categorized under “Environment”, “Empowerment” and “Encouragement” according to the model described by Marion-Davis. Factors identified under Environment include: autonomy, supervisor support and awards to work effectively; under Empowerment were core competencies and attitudes; and under Encouragement they were salary, opportunity for professional development, and availability of SBAs, equipment and essential drugs.


This study presents some implications for midwifery practice, education, research, institutional administrators, and policy-makers. Recommendations include: the provision of autonomy in practice, higher education, opportunities professional development opportunities, better salary and incentives for midwives, the availability of equipment at health facilities, and the involvement of nursing/midwifery leaders in policy-making.