Authorization of midwives to perform basic emergency obstetric and newborn care signal functions in Argentina, Ghana, and India: A multi-country validation study of a key global maternal and newborn health indicator
Date
2023
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS ONE
Abstract
Background
Midwives’ authorization to deliver the seven basic emergency obstetric and newborn care
(BEmONC) functions is a core policy indicator in global monitoring frameworks, yet little evidence supports whether such data are captured accurately, or whether authorization demonstrates convergence with midwives’ skills and actual provision of services. In this study,
we aimed to validate the data reported in global monitoring frameworks (criterion validity)
and to determine whether a measure of authorization is a valid indicator for BEmONC availability (construct validity).
Methods
We conducted a validation study in Argentina, Ghana, and India. To assess accuracy of the
reported data on midwives’ authorization to provide BEmONC services, we reviewed
national regulatory documents and compared with reported country-specific data in Countdown to 2030 and the World Health Organization Maternal, Newborn, Child and Adolescent
Health Policy Survey. To assess whether authorization demonstrates convergent validity
with midwives’ skills, training, and performance of BEmONC signal functions, we surveyed
1257 midwives/midwifery professionals and assessed variance
Results
We detected discrepancies between data reported in the global monitoring frameworks and
the national regulatory framework in all three countries. We found wide variations between
midwives’ authorization to perform signal functions and their self-reported skills and actual
performance within the past 90 days. The percentage of midwives who reported performing
all signal functions for which they were authorized per country-specific regulations was 17%
in Argentina, 23% in Ghana, and 31% in India. Additionally, midwives in all three countries
reported performing some signal functions that the national regulations did not authorize.
Conclusion
Our findings suggest limitations in criterion and construct validity for this indicator in Argen tina, Ghana, and India. Some signal functions such as assisted vaginal delivery may be
obsolete based on current practice patterns. Findings suggest the need to re-examine the
emergency interventions that should be included as BEmONC signal functions.
Description
Research Article
Keywords
midwives, obstetric, Argentina, Ghana, India
Citation
Citation: Ramesh S, Chakraborty S, Adanu RM, Bandoh DAB, Berrueta M, Gausman J, et al. (2023) Authorization of midwives to perform basic emergency obstetric and newborn care signal functions in Argentina, Ghana, and India: A multi country validation study of a key global maternal and newborn health indicator. PLoS ONE 18(4): e0283029. https://doi.org/10.1371/journal. pone.0283029