title: Shaping the midwifery profession in Nepal - Uncovering actors' connections using a Complex Adaptive Systems framework.
abstract: OBJECTIVE
  To explore how actors connect in a system aiming at promoting the establishment of a midwifery profession in Nepal.
  
  
  METHODS
  A qualitative explorative study based on the framework of Complex Adaptive Systems. Semi-structured interviews were conducted with 17 key people representing eight different organisations (actors) promoting the development of the midwifery profession.
  
  
  RESULTS
  The actors' connections can be described with a complex set of facilitators for and barriers to promoting the establishment of a midwifery profession. The identified facilitators for this establishment in Nepal are (1) a common goal and (2) a desire to collaborate, whilst the barriers are (1) different political interests and priorities, (2) competing interests of the nursing profession and societal views, (3) divergent academic opinions on a midwifery profession, and (4) insufficient communication. The results also showed that Nepalese society cannot distinguish between nursing and midwifery and that the public support for a midwifery profession was hence minimal.
  
  
  CONCLUSIONS
  The move of midwifery from an occupation to a profession in Nepal is an on-going, challenging process. The study indicates the importance of understanding the motivations of, and barriers perceived by, actors that can promote or obstruct the establishment of the midwifery profession. It also points to the importance of informing the wider public about the role and responsibility of an autonomous midwifery profession.
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: bogrenupper@gmail.com.
authors.forename: Malin Upper
authors.initials: MU
authors.lastname: Bogren
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Berg
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Edgren
authors.affiliation: Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, UK.
authors.forename: Edwin
authors.initials: E
authors.lastname: van Teijlingen
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Wigert
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D007587:Job Description; D000068101:Maternal-Child Health Services / Q000458:organization & administration; D008880:Midwifery / Q000592:standards*; D009390:Nepal; D024802:Nurse's Role; D036301:Qualitative Research
keywords: Complex Adaptive System; Higher education; Midwife; Midwifery profession; Professionalisation; South Asia