Strengthening midwifery education through clinical experience: Findings from a qualitative study in Indonesia

  • Qorinah Estiningtyas Sakilah Adnani
    Corresponding author at: Jl Pahlawan IX/24, Ketanon, Kedungwaru, Tulungagung, Jawa Timur 66226, Indonesia.
    Department of Midwifery, Faculty of Health and Environmental Sciences, Auckland University of Technology, South Campus, Auckland 2104, New Zealand

    Department of Midwifery, Karya Husada Institute of Health Science, Jl Soekarno Hatta P.O. Box 153, Kediri, East Java 64225, Indonesia
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  • Andrea Gilkison
    Department of Midwifery, Faculty of Health and Environmental Sciences, Auckland University of Technology, North Campus, Auckland 0627, New Zealand
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  • Judith McAra-Couper
    Department of Midwifery, Faculty of Health and Environmental Sciences, Auckland University of Technology, South Campus, Auckland 2104, New Zealand
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      One of the Indonesian Government’s strategies to reduce maternal mortality rates has been to place a midwife in every village to provide midwifery care and facilitate essential primary healthcare services. To increase the numbers of midwives, the Indonesian Government began opening midwifery schools. However, Indonesia’s maternal mortality rates remained high. This raises the question of the quality of midwifery education in Indonesia and how this education could be strengthened so that midwifery plays a key role in reducing maternal mortality rates.

      Aim of the research

      The aim of this study was to identify the barriers and enablers to strengthening midwifery education in Indonesia.


      A qualitative descriptive approach and in-depth interviews was the method used with 37 participants from 12 midwifery schools in eight cities situated in six provinces in Indonesia. Indonesian midwives, midwifery lecturers, midwifery students, newly graduated midwives, and obstetricians were interviewed in Bahasa Indonesia. Interviews were transcribed, translated, and thematically analysed following Braun and Clark (2006).


      This article focuses on findings on “midwifery clinical experience”, a theme which contained four sub-themes: “effective hands-on clinical experience”, “theory-practice gap”, “role of the mentor in practice”, and “the system in the clinical environment”.


      This study highlights barriers to preparing midwifery students for obtaining adequate midwifery knowledge and skills during clinical placement. Quality clinical experience would improve knowledge and skills for better preparedness for students to competently meet their role as midwives, contributing to the strengthening of midwifery education in Indonesia.


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        • World Health Organization
        Maternal Mortality.
        2019 (. (Accessed 2 January 2021))
        • Ministry of Health Republic of Indonesia
        Indonesia Health Profile Jakarta.
        Ministry of Health Republic of Indonesia, Indonesia2018
        • Alkema L.
        • Chou D.
        • Hogan D.
        • et al.
        Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group.
        Lancet. 2016; 387: 462-474
        • World Health Organization
        • UNICEF
        • UNFPA
        • The World Bank
        Trends in Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.
        • United Nations
        Global Indicator Framework for the Sustainable Development Goals and Targets of the 2030 Agenda for Sustainable Development.
        2020 (. (Accessed 17 January 2020))
        • Kassebaum N.J.
        • Barber R.M.
        • Bhutta Z.A.
        • et al.
        Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.
        Lancet. 2016; 388: 1775-1812
        • UNFPA
        • International Confederation of Midwives
        • World Health Organization
        The State of the World’s Midwifery 2014. A Universal Pathway a Woman’s Right to Health.
        • Van Lerberghe W.
        • Matthews Z.
        • Achadi E.
        • et al.
        Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality.
        Lancet. 2014; 384: 1215-1225
        • World Health Organization
        Midwives Voices, Midwives Realities. Findings from a Global Consultation on Providing Quality Midwifery Care.
        World Health Organization, Geneva, Switzerland2016
        • Shankar A.
        • Sebayang S.
        • Guarenti L.
        • et al.
        The village-based midwife programme in Indonesia.
        Lancet. 2008; 371: 1226-1229
        • Hesselink L.
        Healers on the Colonial Market Native Doctors and Midwives in the Dutch East Indies.
        KITLV Press Royal Netherlands Institute of Southeast Asian and Caribbean Studies, Leiden, The Netherlands2011
        • Anderson I.
        • Meliala A.
        • Marzoeki P.
        • Pambudi E.
        The Production, Distribution, and Performance of Physicians, Nurses, and Midwives in Indonesia: An Update.
        The World Bank, Washington, DC2014
        • Middleton J.J.
        Midwifery Consultancy Report: Ikatan Bidan Indonesia.
        UNFPA, Bakti Husada2014
        • National Research Council
        • Indonesian Academy of Sciences
        Reducing Maternal and Neonatal Mortality in Indonesia: Saving Lives, Saving the Future.
        National Academies Press, Washington, DC2013
        • Irawaty D.
        Indonesia accreditation agency for higher education in health (IAAHEH) support of the inter-professional clinical practice.
        in: The Annual International Conference of the Asia-Pacific Quality Network (APQN): Capacity Building for Next Generation Quality Assurance in Higher Education, Nagpur, India; March 22–252018: 56-64
        • International Confederation of Midwives
        Model Curriculum Outlines for Professional Midwifery Education.
        • Ristekdikti
        Registrasi Online Uji Kompetensi D3 Kebidanan.
        2018 (. (Accessed 26 October 2018))
        • Guba EG
        The Paradigm Dialog.
        Sage Publications, Thousands Oaks, CA1990
        • Sandelowski M.
        Focus on research methods — whatever happened to qualitative description?.
        Res. Nurs. Health. 2000; 23: 334-340
        • Sandelowski M.
        What’s in a name? Qualitative description revisited.
        Res. Nurs. Health. 2010; 33: 77-84
        • Merriam S.B.
        Qualitative Research: A Guide to Design and Implementation.
        Jossey-Bass, San Francisco, CA2009
        • Turkmani S.
        • Currie S.
        • Mungia J.
        • et al.
        ‘Midwives are the backbone of our health system’: lessons from Afghanistan to guide expansion of midwifery in challenging settings.
        Midwifery. 2013; 29: 1166-1172
        • Braun V.
        • Clarke V.
        (Mis)conceptualising themes, thematic analysis, and other problems with Fugard and Potts’ (2015) sample-size tool for thematic analysis.
        Int. J. Soc. Res. Methodol. 2016; 19: 739-743
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual. Res. Psychol. 2006; 3: 77-101
        • Lincoln Y.S.
        • Guba E.G.
        Naturalistic Inquiry.
        Sage Publications, Newbury Park, CA1985
        • Adnani Q.E.S.
        How Can Midwifery Education in Indonesia Be Strengthened? [PhD Thesis].
        Auckland University of Technology, Auckland, New Zealand2020
        • Bradfield Z.
        • Hauck Y.
        • Duggan R.
        • Kelly M.
        Midwives’ experiences of learning and teaching being ‘with woman’: a descriptive phenomenological study.
        Nurse Educ. Pract. 2020; 43102699
        • Kuliukas L.
        • Bradfield Z.
        • Costins P.
        • et al.
        Midwifery students’: developing an understanding of being ‘with woman’–– a qualitative study.
        Midwifery. 2020; 84102658
        • Ahmadi G.
        • Shahriari M.
        • Kohan S.
        • Keyvanara M.
        Fear, an unpleasant experience among undergraduate midwifery students: a qualitative study.
        Nurse Educ. Pract. 2018; 29: 110-115
        • Bäck L.
        • Sharma B.
        • Karlström A.
        • Tunon K.
        • Hildingsson I.
        Professional confidence among Swedish final year midwifery students — a cross-sectional study.
        Sex. Reprod. Healthc. 2017; 14: 69-78
        • Bäck L.
        • Hildingsson I.
        • Sjöqvist C.
        • Karlström A.
        Developing competence and confidence in midwifery-focus groups with Swedish midwives.
        Women Birth. 2017; 30: e32-e38
        • Lakhani A.
        • Jan R.
        • Baig M.
        • et al.
        Experiences of the graduates of the first baccalaureate midwifery programme in Pakistan: a descriptive exploratory study.
        Midwifery. 2018; 59: 94-99
        • Dawson A.
        • Kililo M.
        • Geita L.
        • et al.
        Midwifery capacity building in Papua New Guinea: key achievements and ways forward.
        Women Birth. 2016; 29: 180-188
        • Sharma B.
        • Hildingsson I.
        • Johansson E.
        • Prakasamma M.
        • Ramani K.V.
        • Christensson K.
        Do the pre-service education programmes for midwives in India prepare confident ‘registered midwives’? A survey from India.
        Glob. Health Action. 2015; 8: 1-9
        • Yigzaw T.
        • Ayalew F.
        • Kim Y.M.
        • et al.
        How well does pre-service education prepare midwives for practice: competence assessment of midwifery students at the point of graduation in Ethiopia.
        BMC Med. Educ. 2015; 15: 1-10
        • Midwifery Council of New Zealand
        Midwifery Council.
        2018 (. (Accessed 8 October 2018))
        • Yanti Y.
        • Claramita M.
        • Emilia O.
        • Hakimi M.
        Students’ understanding of “women-centred care philosophy” in midwifery care through Continuity of Care (CoC) learning model: a quasi-experimental study.
        BMC Nurs. 2015; 14: 1-7
        • Erlandsson K.
        • Doraiswamy S.
        • Wallin L.
        • Bogren M.
        Capacity building of midwifery faculty to implement a 3-years midwifery diploma curriculum in Bangladesh: a process evaluation of a mentorship programme.
        Nurse Educ. Pract. 2018; 29: 212-218
        • Lukasse M.
        • Lilleengen A.M.
        • Fylkesnes A.M.
        • Henriksen L.
        Norwegian midwives’ opinion of their midwifery education—a mixed methods study.
        BMC Med. Educ. 2017; 17: 1-12
        • Kibwana S.
        • Haws R.
        • Kols A.
        • et al.
        Trainers’ perception of the learning environment and student competency: a qualitative investigation of midwifery and anesthesia training programs in Ethiopia.
        Nurse Educ. Today. 2017; 55: 5-10

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