Shaping the midwifery profession in Nepal - Uncovering actors' connections using a Complex Adaptive Systems framework.

OBJECTIVES: 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.

CONCLUSION: 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.