The efficacy of employing full-time midwives in community maternal and child health services

Communities were divided into three categories, those employing full-time midwives (M-communities), and those employing public health nurses (PHNs) either with midwife license (PM-communities) or without (P-communities). Maternal and child health (MCH) services rendered and their intent to employ more midwives were investigated. A questionnaire concerning these achievements and the reasons for considering employing more midwives was sent to 579 communities with a population greater than 50,000 in 2002, and 285 valid responses were obtained. These consisted of 32, 121 and 132 responses from M-, PM- and P-communities, respectively. A statistical analysis was made of the variables by chi-square test. 75.2% of these PM-communities responded for various reasons that they had no greater need for midwives, indicating that the midwife license is not highly valued. M-communities had the highest intention of employing more midwives at 53.1%, and also attained higher fulfillments in MCH services than the others, which provided sub-optimal service in many areas of care. Although some PHNs had midwife licenses, their midwifery expertise was not fully provided for. Considering the often low general level of MCH services and the relatively higher achievements of the M-communities, increased employment of full-time midwives should be considered by the administrators concerned.