title: Do the pre-service education programmes for midwives in India prepare confident 'registered midwives'? A survey from India.
abstract: Objective The graduates of the diploma and degree programmes of nursing and midwifery in India are considered skilled birth attendants (SBAs). This paper aimed to assess the confidence of final-year students from pre-service education programmes (diploma and bachelor's) in selected midwifery skills from the list of midwifery competencies of the International Confederation of Midwives (ICM). Design A cross-sectional survey was conducted in Gujarat, India, involving 633 final-year students from 25 educational institutions (private or government), randomly selected, stratified by the type of programme (diploma and bachelor's). Students assessed their confidence on a four-point scale, in four midwifery competency domains - antepartum, intrapartum, postpartum, and newborn care. Explorative factor analysis was used to reduce skill statements into separate subscales for each domain. Results Overall, 25-40% of students scored above the 75th percentile and 38-50% below the 50th percentile of confidence in all subscales for antepartum, intrapartum, postpartum, and newborn care. The majority had not attended the required number of births prescribed by the Indian Nursing Council. Conclusions The pre-service education offered in the diploma and bachelor's programmes in Gujarat does not prepare confident SBAs, as measured on selected midwifery competencies of the ICM. One of the underlying reasons was less clinical experience during their education. The duration, content, and pedagogy of midwifery education within the integrated programmes need to be reviewed.
authors.affiliation: a Department of Women's and Children's Health , Karolinska Institutet , Solna , Sweden.|b Centre for Management of Health Services , Indian Institute of Management , Ahmedabad , India.
authors.forename: Bharati
authors.initials: B
authors.lastname: Sharma
authors.affiliation: a Department of Women's and Children's Health , Karolinska Institutet , Solna , Sweden.|c Department of Nursing Mid Sweden University , Sundsvall , Sweden.|d Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden.
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Hildingsson
authors.affiliation: e Global Health Karolinska Institutet , Solna , Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Johansson
authors.affiliation: f Academy of Nursing Studies and Women's Empowerment Research , Hyderabad , India.
authors.forename: Malvarappu
authors.initials: M
authors.lastname: Prakasamma
authors.affiliation: b Centre for Management of Health Services , Indian Institute of Management , Ahmedabad , India.
authors.forename: K V
authors.initials: KV
authors.lastname: Ramani
authors.affiliation: a Department of Women's and Children's Health , Karolinska Institutet , Solna , Sweden.
authors.forename: Kyllike
authors.initials: K
authors.lastname: Christensson
keywords: India; confidence; midwifery skills; nurses