The future of midwifery care and education in Belgium: A discussion paper

•Profound health care and societal transformations complicate the midwife's role.•Midwifery education programs are fundamental to meet these transformations.•Gaps exist between the current midwifery education and future competency demands.•Extension and advancement of the midwifery education program in Belgium is needed.•Discussions with all relevant stakeholders should be initiated to bridge these gaps. Advanced education of midwives acting during the first 1000 days in life is key in optimum care provision for intergenerational health and wellbeing. This paper provides a comprehensive analysis of the current context of midwifery care and (inter)national trends in midwifery education. Gaps for optimizing midwifery education in Belgium are defined. Societal, medical, and technological changes including medicalization of birth impact the midwife's profession and competency requirements. The World Health Organization demands adapted midwifery competency frameworks to meet these changes and achieve universal health coverage by 2030. While the European Union's directives address the recognition of professional qualifications of midwives, basic midwifery programs in Europe range from vocational to master's programs. In Belgium, basic midwifery programs are direct-entry bachelor programs; however, the program length varies according to the region. A horizon scanning by the Belgian Health Care Knowledge Center concluded that an extension and advancement of the current midwifery program are urgently needed to enable midwives to fulfil an autonomous role in accordance with national laws and international directives. Basic midwifery education anno 2023 does not fit (1) the changes in women's health towards 2030; (2) the future demands regarding midwifery competence, and (3) the current and future demands for autonomy according to the legal frameworks. An extension and advancement of the basic midwifery programs are needed to sufficiently arm midwives to meet changes they are confronted with. Therefore, a debate involving all stakeholders concerned with the future of midwifery care and education is recommended.