title: Education, employment and practice: Midwifery graduates in Papua New Guinea.
abstract: BACKGROUND
  Papua New Guinea has a very high maternal mortality rate (773/100,000), low rates of supervised births and a critical shortage of skilled midwives. A midwifery education initiative commenced in 2012, funded by the Australian Government and led by the National Department of Health. One specific objective of the initiative was to improve the standard of clinical teaching and practice in four schools of midwifery. There were 394 midwives educated over the 4 year period (2012-2015) representing half of all midwives in Papua New Guinea. A study was undertaken to describe the educational programme, employment, practices and experiences of graduates who studied midwifery in 2012 and 2013 as part of the initiative.
  
  
  OBJECTIVE
  the aim of this paper is to explore the education, employment and practice of newly graduated midwives in Papua New Guinea.
  
  
  METHODS
  a mixed methods descriptive study design was used. Surveys and focus groups were used to gather data. Ethical approval was granted by the relevant Human Research Ethics Committees.
  
  
  METHODS
  all midwifery graduates in 2012 and 2013 from the four midwifery schools in Papua New Guinea were included in the study and almost 80% were contacted.
  
  
  RESULTS
  nearly 90% of graduates were working as midwives, with an additional 3% working as midwifery or nursing educators. This study discovered that graduates exhibited increased skills acquisition and confidence, leadership in maternal and newborn care services and a marked improvement in the provision of respectful care to women. The graduates faced challenges to implement evidence based care with barriers including the lack of appropriate resources and differences of opinion with senior staff.
  
  
  CONCLUSIONS
  factors affecting the quality of midwifery education will need to be addressed if Papua New Guinea is to continue to improve the status of maternal and newborn health. Specifically, the length of the midwifery education, the quality of clinical practice and the exposure to rural and remote area practice need addressing in many contexts like Papua New Guinea.
authors: WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia. Electronic address: Alison.Moores@uts.edu.au.
authors: Alison
authors: A
authors: Moores
authors: Faculty of Health and Behavioural Sciences, University of Goroka, Goroka, EHP, Papua New Guinea.
authors: Paula
authors: P
authors: Puawe
authors: Division of Nursing, School of Medical and Health Sciences, University of Papua New Guinea, NCD, Papua New Guinea.
authors: Nancy
authors: N
authors: Buasi
authors: WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia.
authors: Florence
authors: F
authors: West
authors: National Department of Health, Port Moresby, NCD, Papua New Guinea.
authors: Mary K
authors: MK
authors: Samor
authors: Papua New Guinea Nursing Council, Port Moresby, NCD, Papua New Guinea.
authors: Nina
authors: N
authors: Joseph
authors: WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia.
authors: Michele
authors: M
authors: Rumsey
authors: WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia.
authors: Angela
authors: A
authors: Dawson
authors: WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia.
authors: Caroline S E
authors: CS
authors: Homer
mesh_terms: D004651:Employment / Q000379:methods* / Q000523:psychology / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008880:Midwifery / Q000193:education*; D009721:Nurse Midwives / Q000523:psychology*; D010219:Papua New Guinea; D036301:Qualitative Research; D020377:Self Efficacy; D011795:Surveys and Questionnaires
keywords: Developing countries; Education, midwifery; Midwife attitudes; New graduate role; Students, midwifery: Transitional Programmes