Improving the quality of nurse-midwives in Bangladesh: Addressing barriers of midwifery course in diploma in nursing and midwifery training.

The Government of Bangladesh has initiated various strategies to achieve the MDG5 targets one of which is increasing skilled attendance at birth to 50% and reducing the maternal mortality ratio to 143 per 100000 live births by 2015. Apart from medical graduates five categories of health professionals are considered as skilled birth attendants in Bangladesh. Among them the 4-year trained diploma nurses are the key caregivers in maternal and neonatal health (MNH). The final year of nursing training course is devoted entirely to midwifery training. But very little is known about the quality of midwifery training and the enabling environment to provide MNH services in public sector hospitals in Bangladesh. The objective of this study was to explore the existing practices of nurses in MNH services to understand the enabling environment for working in the obstetric wards and the barriers students face during the midwifery course in the final year of the Diploma in Nursing and Midwifery training in Bangladesh. Qualitative data were collected during 2007-2008 from six public sector primary to tertiary level hospitals in Bangladesh from both a high performing district (Khulna) and a low performing district (Sylhet). (Excerpts)