Exploring the experiences of midwives in rural and remote regions in South Asia: a scoping review

Early Abstract:

Background: South Asia continues to face significant challenges in maternal and neonatal health, particularly in rural and remote regions where healthcare access is limited. While governments and organisations have increasingly recognised the importance of deploying professionally trained midwives to address these disparities, the documented experiences of midwives working in these challenging environments remain limited. This scoping review aimed to explore the existing literature on the experiences of midwives practicing in rural and remote areas of South Asia, with the goal of identifying key themes, gaps and opportunities for future policy and practice.
Methods: A scoping review was carried out using the Scopus, CINAHL, Web of Science and PubMed databases. A search was conducted using keywords for articles published between 2000 and May 2025. Abstracts were screened based on eligibility criteria and common themes were identified and categorised for analysis. Data was assessed using the Mixed Methods Appraisal Tool.
Results: A total 21 studies met the inclusion criteria including case study (n = 1) quantitative (n = 9), qualitative (n = 8) and mixed method studies (n = 3). The included studies spanned seven South Asian countries of Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka. Six themes were identified across published literature including clinical care, scope of practice, education, resources and workforce, technology, society and culture and environment and weather. Midwives face challenges in providing care, including limited resources, sociocultural barriers related to gender roles and adverse weather conditions. The integration of technology, enabling midwives to practice to their full scope, enhancing education and fostering community acceptance could enhance midwifery practice in limited resource settings.
Discussion: Available literature documents resilience and dedication of midwives in rural South Asia, while also highlighting the systemic barriers they face. The findings suggest that strengthening midwifery education, improving working conditions and promoting community engagement are essential for allowing midwives to provide effective and culturally appropriate care. Moreover, greater investment in infrastructure, workforce planning and technology integration is needed to address ongoing gaps. As countries in South Asia continue to build midwifery capacity, context-specific strategies that account for social, cultural and environmental realities will be critical.
Conclusion: This review contributes valuable insight to the limited body of literature on rural midwifery in South Asia and offers a foundation for future research, policy development and program implementation aimed at improving maternal and neonatal health outcomes in these underserved regions.
Keywords: midwifery, maternal, neonatal, remote, rural, South Asia.