Competency-based midwifery training linked to less observed mistreatment in Ethiopian maternity care

Graduates of an Ethiopian midwifery programme trained under a competency-based curriculum showed measurably less mistreatment of women during labour and childbirth than peers trained under the country’s conventional curriculum, according to a comparative cross-sectional study published in BMC Medical Education. Researchers directly observed the care provided by 68 BSc midwifery graduates from third-generation Ethiopian universities, 32 of whom had completed a competency-based curriculum and 36 of whom had trained under a conventional one. Using a validated observation tool, the team scored instances of mistreatment during real childbirth care and compared the mean mistreatment scores between the two groups.

The overall mean mistreatment score across all observed graduates was 34.6%. Conventional-curriculum graduates scored higher, at 38.1%, while competency-based graduates scored 30.8%. The 7.3-percentage-point difference was statistically significant, with t(66) = −3.75 and p < .001, and a large standardized effect size of Cohen’s d = −0.91 favouring the competency-based group. The researchers visualised the between-group difference using a Gardner–Altman plot, an approach that displays the raw mean difference alongside the data distribution rather than relying solely on summary statistics.

Two domains drove much of the gap. Poor-rapport scores were 36.7% in the competency-based group versus 46.5% in the conventional group, and non-response to medical requests was 15.6% versus 30.5%. Both figures were descriptively lower among competency-based graduates, suggesting that the interpersonal and responsiveness dimensions of care differed most clearly between the curricula. The competency-based curriculum at Debre Tabor University was adopted in 2013 specifically to address a recognised weakness in Ethiopian midwifery education, which has emphasised theory over practice and limited clinical competence, including professional behaviours.

Despite the advantage for competency-based graduates, the study documented deficiencies in both groups. Recorded problems included failures in obtaining consent, gaps in supportive care, breaches of privacy, and instances of verbal abuse. The authors are explicit that these shared shortcomings warrant further attention, and that lower mistreatment scores do not demonstrate comprehensive respectful maternity care. In other words, even the better-performing group fell short of the full standard of respectful care across all observed domains.

The study’s design also constrains what can be concluded. Because it was cross-sectional and comparative rather than experimental, the association between curriculum background and lower observed mistreatment does not establish a causal curriculum effect. Graduates from the two curricula may differ in ways unrelated to their training, and workplace conditions after graduation could shape observed behaviour independently of preservice education. The authors call for longitudinal and multilevel research to disentangle the contributions of preservice education and workplace conditions to respectful maternity care.

Subject of Research: Respectful maternity care among midwifery graduates trained under competency-based versus conventional curricula in Ethiopia: a comparative cross-sectional study

Article Title: Respectful maternity care among midwifery graduates trained under competency-based versus conventional curricula in Ethiopia: a comparative cross-sectional study

Article References: Wondie, A. G., Siebeck, M., Sendekie, T. Y., Fischer, M. R., & Berndt, M. (2026). Respectful maternity care among midwifery graduates trained under competency-based versus conventional curricula in Ethiopia: a comparative cross-sectional study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10661-5

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10661-5

Keywords: Respectful, maternity, care, midwifery, graduates, trained, under, competency-based, versus, conventional, curricula, Ethiopia