Local Midwives Finish Last: Findings From a Demographic and Work Environment Survey Among Auxiliary Midwives in Mali




What is the demographic profile and work environment for auxiliary midwives in Mali?


Describe the demographics and work environment for auxiliary midwives in Mali.


We used a mixed-methods, embedded design. Survey data were analyzed using one and 2-sample t-tests and multiple linear regression. Interview data were analyzed using thematic analysis. One hundred and twelve midwives participated in the survey, and 32 in interviews.


In Mali's context of high maternal mortality, auxiliary midwives attend more births than all other formally trained health care workers combined. Yet, there are almost no data on their actual work environment or implications of their social situations at their work. If we understood these factors, we could more effectively recruit, train, and support these critical health workers.


Analysis is ongoing. Preliminary results suggest median midwife age range of 41 to 45 years with mean 6.4 years of education. Almost all are married with children. Half are from the village where they serve and 86% are in rural villages. With respect to supplies, 65% had working blood pressure cuff, 41% a thermometer, half had easy access to water, and 68% had access to reliable lighting. Supplies that were significantly less available to rural midwives were adequate light, water, and partograms. Most midwives work with a colleague, about half with a nurse. Forty-one percent had not been paid regularly in the last 3 months. Two-thirds used mobile phones for work; many reported the phones decreased referral time. Rural midwives who work in the village where they are from (vs having been sent to a rural area from the city) faced challenges: they were 2.5 times less likely to have equipment, to have been paid regularly, or be as well educated. Midwives described a variety of caring and disrespectful behaviors toward women. Qualiative data supported survey data.


Midwives in rural Mali work in challenging environments with few resources. The picture is particularly bleak for rural midwives who are from the village where they serve. In order to support and retain these critical health care workers, strategies must recognize the difference in social status of certain midwives.