Alignment of Midwifery Education in Nepal With Global Standards and Essential Competencies From the International Confederation of Midwives: A Mixed-Methods Study

Abstract

Introduction: Maternal and neonatal mortality rates in Nepal remain high, reflecting persistent gaps in the quality of maternal and newborn care. To address this issue, a national midwifery education program was initiated in 2016. This study assessed Nepal's preservice midwifery curricula against global standards and competencies defined by the International Confederation of Midwives (ICM). Methods: A mixed-methods study was conducted, comprising a desk review of national standards and curricula against ICM education standards (2021) and competencies (2024), 15 stakeholder interviews, 3 focus group discussions, and site visits to 4 hospitals and one midwifery school. Quantitative data were mapped using a 4-point alignment scale, and qualitative data were coded and thematically analyzed. Results: The Nepal Nursing Council standards for the bachelor's in midwifery program aligned with 72% of the ICM education standards. The standards for the certificate in midwifery program covered 67%, whereas the certificate in midwifery curriculum from the Council for Technical Education and Vocational Training aligned with only 52%. The bachelor's in midwifery curriculum met 89% of the ICM essential competencies, the certificate in midwifery curriculum met 76%, and the certificate in nursing curriculum met 43%. These quantitative gaps were contextualized by qualitative findings, including theory-practice mismatches, shortages of qualified faculty members and training resources, and insufficient supervision. Discussion: Stakeholders confirmed the absence of dedicated midwifery regulations and clear career pathways in the country as an issue. Without targeted reforms to standardize curricula, investment in infrastructure, and legally recognizing midwifery as a distinct profession, Nepal's ability to reduce preventable maternal and neonatal mortality will be compromised.