Provision of continuity of midwifery care in Australia: An analysis of structural and contextual factors

Problem Continuity of midwifery care (CoMC) is associated with significantly improved outcomes for mothers and babies yet is not universally accessible to Australian women. Globally, implementation of this model has been slow and variable. Background In Australia, the proportion of maternity services providing CoMC models in the public sector varies across jurisdictions. Aim To explore the structural and contextual factors contributing to the provision of public CoMC models in Australia. Methods The Policy Triangle framework was adapted to analyse publicly available data from three Australian states that report use of CoMC: Victoria, Western Australia and Queensland. Structural and contextual factors impacting provision of CoMC were compared: 1) types of pre-registration midwifery education, 2) proportion of endorsed midwives, 3) industrial arrangements, 4) professional association membership, 5) midwifery leadership, and 6) State policy. Findings In 2023, 19.7% of women in Queensland received CoMC, compared with 9.6% in Western Australia and 5.3% in Victoria. Compared to Victoria, Queensland and Western Australia had more endorsed midwives as a proportion of births, higher annual leave loading for midwives working in CoMC models, and a higher proportion of professional association membership. Victoria offered predominantly combined nursing/midwifery pre-registration degrees. Only Queensland had a clear, direct policy statement. There was limited data in relation to midwifery leadership. Conclusions This narrative review provides insights into the socio-political, policy, cultural and industrial ecosystem impacting provision of CoMC. Comprehensive, multilevel strategic interventions are needed to address these barriers to advance women’s access to publicly funded CoMC models.