Severe shortages of midwives persist across low- and middle-income countries, particularly in conflict-affected settings.

In these contexts, midwifery is hindered by inadequate staffing, poor infrastructure, supply shortages, education gaps, and issues of public trust. Gender inequality, limited recognition, restrictive scope of practice, and economic hardships further compromise quality care. Insecurity exacerbates these issues leading to expanded job responsibilities, inconsistent salaries, safety threats, and potential trauma.  These conditions impede career progression and deter people from pursuing a career in midwifery.   

The EQUAL research consortium is conducting a prospective multi-cohort study of midwives in NE Nigeria and Somalia. This research aims to:

1. Generate evidence on factors affecting midwifery students’ and early career midwives’ aspirations, workforce participation, performance, and retention by tracking a cohort of students and graduates over time

2. Document early career midwives’ experiences working in conflict-affected areas, including changes in responsibilities, personal and professional stressors, and support networks during periods of increased insecurity

3. Understand midwifery students’ perceptions and experiences of the learning environment and generate recommendations on how to improve midwifery education in study sites. 

Study Design: This is a prospective multi-cohort study of midwifery students and early career midwives running from 2023 until 2025.  The study employs a sequential explanatory mixed methods design using qualitative methods – focus group discussions and in-depth interviews – to explain and expand survey findings. To explore this study in more detail including the design and methodology, download the research brief!

Embedded within this broader cohort study is a qualitative study examining the experiences, plans, and aspirations of midwifery students and recent graduates, while also assessing how safety and security conditions affect their educational experience and career readiness. As part of this, focus group discussions (FGDs) were held with graduates to explore their intentions regarding practicing midwifery, their job search experiences, their job expectations, and how conflict impacts their experiences and desire to join the workforce. Separate FGDs were held with students to investigate their experiences within the program, the extent to which they feel their education is preparing them to become midwives, and the challenges they face, particularly those arising from conflict and insecurity. Explore the qualitative study including findings from both countries in the briefs linked below.

QUALITATIVE STUDY