Factors responsible for low retention of community midwives (CMWs) in Sind, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


The developing countries are still facing unfortunate maternal and infant mortality as worth mentioning general public health issue. As mentioned by the World Health Organization (WHO) in its report, 536,000 female globally die each year due to causes related to pregnancy, labor or postpartum. Developing countries account 99% of these mortalities. This can be decreased by access of the women to good quality care during pregnancy, childbirth and postpartum. One million infants are facing deaths on the same day of the birth and almost two million lose their lives in the first week. In Pakistan, the neonatal mortality rate per 1000 lives is 42 whereas the stillbirth rate is 47; in 2013 alone annual number of neonatal death was 193,718. Community Midwives (CMWs) have proven their effectiveness in providing quality care at the doorsteps of the population/clients across the globe [1]. This study is aimed to explore the factors responsible for low retention of CMWs in district Tando Muhammad Khan, and to identify the barriers at the community level for CMWs during their duty times. Methodology: The qualitative descriptive exploratory design was used. Purposive sampling was done and data was collected through FGDs and IDIs. FGDs were conducted with CMWs who are working in the field and IDIs were conducted with those CMWs who have left the program. All the stakeholders including women of that catchment area were also carefully chosen who have utilized the services from those CMWs for FGDs. CMWs and mothers were approached through Lady Health Supervisor (LUIS) and their participation was made by a written consent. IDIs were conducted with District Focal Person (DFP) of CMW Program Tando Muhammad Khan and Provincial Program Director (PPD) of MNCH Program and a Technical Advisor of an international NGO dealing with CMWs program. Findings: Some of the major barriers towards low retention of CMWs in the program have appeared both at managerial level and at the MNCH policy-making levels. The findings regarding low retention of CMWs are classified in main themes. These are the factors for low retention of CMWs including awareness of communities about CMWs and their services, compromised monitoring and evaluation of CMWs program from MNCH monitoring and evaluation cell, the threat of insecurity, lack of equipment, dissatisfaction, deficient policies and financial constraints (details are discussed later). Conclusion: Although CMWS have proven their positive role at the community level in many countries but in Pakistan, they are still struggling for recognition of their identity. Despite all challenges and gaps, these CMWs are striving hard to provide services at doorsteps in deprived and far-flung areas of Sindh. Now it is the time to motivate and retain them through career-oriented CMW cadre which needs financial investment, job security, further capacity building and backup support in the field. Review of MNCH program policies by policymakers is in need to address the deprived rural health services, infant mortality rate (IMR) and maternal mortality rate (M MR) in marginalized communities.

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