The midwifery profession, as defined by the International Confederation of Midwives (ICM), is new in India. India, like many countries is moving towards embedding midwifery into its health system as a way to improve sexual, reproductive, maternal and newborn health outcomes. For example, in 2015-16 the caesarean birth rate in India was 17.2%; this grew considerably in just a few years, and in 2019-21 was 21.5% (National Family Health Survey 2021). At the same time, the WHO states that national rates of caesarean birth above 10-15% do not improve outcomes for mothers or newborns.
Following Independence in 1947, the Indian Nursing Council merged nursing and midwifery, and the midwifery education elements diminished thereafter. After that, the official model of maternity care in India centred on obstetricians as lead providers, assisted by a cadre of “nurse-midwives” with low status, brief midwifery training and regarded generally as “an appendage of obstetrics” working under the direction of obstetricians in institutional facilities.
In a landmark move in 2018, the Government of India initiated the formation and institutionalisation of a new staffing cadre designated “Nurse Practitioner in Midwifery” (NPM) as part of an initiative to ensure high-quality, dignified and respectful care for women and newborns. Midwife-Led Care Units (MLCUs) are part of this initiative to ensure. NPMs educated according to ICM Standards are the first point of contact at these units.
The title of the new role includes the word “nurse” but we hope this is just a step in our journey as we continue to advocate for the distinct role of midwives in the health system, in alignment with the ICM Essential Competencies, Standards for Education, Scope of Practice and Professional Framework.
In a country where 25 million babies are born every year, establishing a cadre of professional midwives is the way to move beyond improving access to facility-based birth to ensuring that all women and their babies receive high-quality maternal and newborn care.
Three national midwifery training institutes have been established in the states of Maharashtra, Uttar Pradesh, and Madhya Pradesh, alongside one state midwifery training institute in Patna, Bihar. These training institutes are linked to MLCUs that function as clinical practice sites for the NPM learners and provide midwifery care in communities. These MLCUs offer antenatal, labour, birth and postnatal care to healthy pregnant women and newborns.
As this is a first-of-its-kind effort in the country, Nurse Practitioner Midwife Educators (NPMEs) are also being educated by handpicked faculty from India and from countries with well-established midwifery-led systems. The specialised cadre of NPMs will help the government improve maternal and newborn care. During the first phase, five national midwifery training institutes have been established in the states of Assam, Maharashtra, Gujarat, Tamil Nadu and Uttar Pradesh. All pregnant women will first be screened at midwifery-led care units, which will be established at public health facilities.
In addition to these measures, in June 2021 the Ministry of Health and Family Welfare released a detailed Scope of Practice for Midwifery Educator and NPMs which applies to specialised midwifery care competencies. This document is combined with and adapted from the ICM Essential Competencies for Midwifery Practice (2019) and sets out the contours for NPM practice in India.
Dr. Ani Grace Kalaimathi RN, RM, PhD, Registrar,
Tamilnadu Nurses and Midwives Council,
Chennai, South India