Making Midwifery Services Accessible to People of Low SES: A Qualitative Descriptive Study of the Barriers Faced by Midwives in Ontario
Elizabeth K. Darling, RM, PhD, Tonya MacDonald, RM, MSc, Lisa Nussey, RM, BSc, Beth Murray-Davis RM, PhD, and Meredith Vanstone, PhD
Midwifery care is associated with health benefits for disadvantaged groups but continues to be accessed less frequently in Ontario by people who are of lower socio-economic status (SES). We conducted a qualitative descriptive study investigating the work midwives do to make midwifery care accessible to people of low SES and explored the barriers they encounter in doing this work. We interviewed 13 Ontario midwives who serve people of low SES in a wide range of clinical settings. Participants faced multiple challenges in their work to make midwifery care more accessible. They described barriers that they had encountered which pertained to the nature of the work itself, to professional and organizational factors, and to systemic factors. Midwives engaged in this work are deeply committed to it and take on extra unpaid work. The barriers they face threaten the sustainability of their work, and as a result, many participants identified a high risk of burnout. Our findings provide new insight into ways in which gaps in the curriculum of undergraduate midwifery education, lack of opportunities for mentorship, and debate within the midwifery profession about who is suitable for midwifery care serve as barriers to midwives taking on a greater role in providing care to people of low SES and particularly to those who struggle to access primary maternity care services. Systemic changes are needed to overcome these barriers and to expand the work of making midwifery care more accessible while ensuring its sustainability.
midwifery; health services accessibility; social class; health care quality, access, and evaluation; maternal health services; barriers