Midwives’ experiences and perceptions of midwife-led continuity of care models in low-and middle-income countries: A qualitative evidence synthesis

Background: There is a need to scale-up midwife-led continuity of care (MLCC) in low- and middle-income countries (LMICs), where midwives are the key to successful implementation. There is limited knowledge about their experiences and perceptions of MLCC models. Aim: To explore midwives’ experiences and perceptions of working with MLCC models in LMICs, their views of barriers to and facilitators of MLCC models, including to assess our confidence in the evidence. Methods: Two information specialists conducted systematic searches in eight databases from year 2000 until June 2024. The methodological quality of the included studies was assessed using a modified version of the Critical appraisal tool (CASP). We conducted a thematic analysis and used Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE CERQual) approach to assess our confidence in each review finding. Results: This synthesis included five studies exploring midwives’ experiences and perceptions of MLCC in LMICs. Three analytic themes were generated: Equity and access; professional development and recognition; and enhancing midwifery practices and policies. In addition, we identified ten associated sub-themes that were assessed by GRADE CERQual. These findings varied from moderate to very low confidence. Conclusion: While midwives highlighted the benefits of continuity of care, they identified essential components for successful implementation of MLCC in LMICs including reducing structural and geographical barriers, the continuous need for sustained capacity building and learning, and optimal resource allocation and availability. Findings assessed as low or very low confidence need to be explored further.