Why Midwifery Schools in Poorer Countries Struggle to Build Research Cultures

Midwifery schools in low- and middle-income countries sit at one of the most consequential intersections in global health. They train the practitioners who will care for pregnant women and newborns in settings where maternal and neonatal mortality remain stubbornly high, and they are expected to do so using the best available evidence. Yet a new scoping review published in Discover Education suggests that the institutions charged with this task are themselves often unable to generate, sustain, or even participate in the research that evidence-based care depends on. The review, led by Qorinah Estiningtyas Sakilah Adnani of Universitas Padjadjaran in Indonesia with colleagues spanning Sub-Saharan Africa, South and Southeast Asia, and Australia, maps the barriers and enablers shaping research culture in midwifery education across the developing world, and its findings paint a picture of motivated educators working inside systems that rarely make scholarship feasible.

The research team followed the PRISMA-ScR framework, the recognized reporting standard for scoping reviews, searching Scopus, PubMed, and ScienceDirect on 12 January 2026 for English-language publications from January 2014 to December 2025. They supplemented the database searches with a targeted sweep of organizational websites, including those of the World Health Organization and the International Confederation of Midwives, because many normative documents governing midwifery education are never indexed in bibliographic databases. From 1,051 records identified, the team screened 1,046 titles and abstracts, assessed 22 full-text reports, and ultimately included 17 sources: empirical studies, reviews, conceptual analyses, and two policy frameworks drawn from Rwanda, Ethiopia, Lesotho, Bangladesh, Malawi, and multi-country LMIC networks. The heterogeneity of the corpus forced the authors to make an important analytical distinction between direct evidence, meaning studies that explicitly examined research-related conditions within midwifery education settings, and contextual evidence, meaning sources that illuminated broader structural or policy conditions without studying institutional research culture itself. Ten sources qualified as direct evidence and seven as contextual, a split that shaped how cautiously the findings could be interpreted.

At the heart of the review lies a conceptual clarification that matters for anyone designing interventions. The authors separate three related but distinct ideas: research culture, the institutional norms, values, and practices that determine whether research is recognized and sustained; research capacity, the knowledge, skills, resources, and infrastructure needed to actually conduct studies; and research engagement, the observable participation of educators in scholarly writing, collaboration, supervision, and publication. This taxonomy matters because the included sources varied widely in what they measured. Some examined individual competence, others institutional support, and still others the policy environment. By keeping the categories distinct, the review shows that a failure at one level cannot be fixed at another. Training an educator in research methods accomplishes little if her institution provides no protected time, no mentorship, and no recognition for scholarly work.

The barriers the review identifies are strikingly consistent across geographies. Educators in Rwanda, Ethiopia, Bangladesh, and the Asia-Pacific region reported limited preparation in research methods, scientific writing, and publication processes, even when they expressed strong interest in developing these skills. Institutional conditions compounded the problem: high teaching and clinical workloads, minimal protected time for scholarship, under-resourced learning environments, weak research infrastructure, and few incentives or rewards for publication. In some settings, restricted institutional autonomy and fragmented oversight further limited opportunities to embed research within faculty roles. The review is explicit that these constraints shift attention away from deficit-based accounts of individual educators and toward the organizational environments in which they work. The problem is not that midwifery lecturers lack ambition; it is that their institutions rarely create realistic conditions under which scholarship can occur.

Against this backdrop, mentorship emerges as the single most consistent enabler in the literature. Studies of faculty development partnerships and longitudinal mentorship programs, including work from Malawi and Rwanda, suggest that educators build confidence and sustain scholarly activity when they receive structured guidance over time rather than one-off technical instruction. Mentorship, the review argues, functions not merely as a mechanism for skill transfer but as a relational pathway through which academic expectations, confidence, and professional identity are reinforced. Critically, however, the evidence indicates that mentorship works best when it is embedded within institutional systems rather than dependent on short-term external projects. Where mentorship was linked to local leadership, continuity, and ownership, the reported gains appeared more durable; where it arrived as a donor-funded workshop, the benefits tended to evaporate when the funding did.

The review also situates midwifery education within a wider structural landscape that generic research-capacity frameworks often ignore. Contextual sources highlighted the influence of gendered workplace hierarchies, the comparatively low professional status of midwifery, and the frequent embedding of midwifery within nursing structures, all of which can reduce the visibility and authority of midwives as academic contributors. Education pathways themselves are extraordinarily heterogeneous: across LMICs, entry-level midwifery programs range from certificates and diplomas to bachelor’s degrees, delivered in universities, colleges, and hospital-based training institutions. Global standards envisage that faculty hold qualifications above the level at which they teach, increasingly at master’s or doctoral level, yet many educators in LMIC settings have never had the opportunity to undertake postgraduate or research training. Because the capacity to teach, supervise, and conduct research depends heavily on an educator’s own prior exposure to higher-degree research, this variation in preparation directly shapes what kind of research culture an institution can realistically build.

Two global policy frameworks provide the normative backdrop against which these institutional realities appear especially stark. The International Confederation of Midwifery’s Global Standards for Midwifery Education and the World Health Organization’s Framework for Strengthening Quality Midwifery Education both position research, innovation, and evidence use as core components of educational quality. The review treats these documents as policy context rather than empirical evidence, but their significance is clear: the expectation that midwifery education be research-informed is now written into global standards, even as the empirical literature shows that implementation remains uneven and frequently unsupported. This gap between normative ambition and institutional capacity is perhaps the review’s most important finding, because it suggests that policy endorsement alone, without resourcing and structural change, will have limited effect on everyday academic practice.

The authors are careful about the limits of their synthesis, and their transparency strengthens rather than weakens the conclusions. The evidence base is small and heterogeneous; not all included sources directly examined research culture within midwifery education institutions; the search was restricted to English-language publications, likely reducing representation from Latin America, the Pacific, and francophone Africa; no formal critical appraisal was undertaken, consistent with scoping review methodology; and the team did not conduct a formal stakeholder consultation stage, relying instead on the embedded professional experience of its members across LMIC midwifery and health workforce contexts. The findings should therefore be read as mapping recurring patterns and plausible enabling conditions rather than establishing definitive causal claims about what strengthens research culture in every setting.

Even with those caveats, the practical implications are pointed. The review argues that sustainable progress is most likely where educator development, mentorship, leadership, and institutional support are aligned within enabling policy environments, and that research culture should be approached as a long-term institutional and system-level process rather than a stand-alone training activity. Concrete priorities include integrating research mentoring into faculty development systems, creating protected time and formal recognition for scholarly activity, and aligning accreditation and quality assurance mechanisms with expectations for evidence use. Because contexts vary so substantially, implementation must be locally adapted rather than assumed to be universally transferable. The authors also call for longitudinal, mixed-methods, and comparative studies examining how institutional investments such as protected time, mentorship systems, and regulatory reform influence research participation over time, with greater attention to under-represented regions. What emerges from this synthesis is a deceptively simple reframing: the question is not how to motivate midwifery educators to do research, but how to build institutions in which doing research becomes possible.

Subject of Research: Barriers and enablers of research culture in midwifery education in low- and middle-income countries

Article Title: A scoping review of barriers and enablers shaping research culture in midwifery education in low- and middle-income countries

Article References: Adnani, Q. E. S., Argaheni, N. B., Rahmatina, A. N., Melani, M., Susanti, A. I., Adepoju, V. A., Osborne, A., & McKenna, L. (2026). A scoping review of barriers and enablers shaping research culture in midwifery education in low- and middle-income countries. Discover Education, 5(1), Article 1160. https://doi.org/10.1007/s44217-026-02081-w

Image Credits: AI Generated

DOI: 10.1007/s44217-026-02081-w

Keywords: midwifery education, research culture, low- and middle-income countries, scoping review, mentorship, faculty development, research capacity, institutional support, maternal health, WHO, International Confederation of Midwives, evidence-based practice