Barriers and Facilitators to the Implementation of Midwifery Centers in Low- and Middle-Income Countries: A Scoping Study

Facility-based birth is an important strategy for reducing maternal and neonatal mortality, yet institutionalization has also been associated with overmedicalized and disrespectful care. Midwifery centers (MCs) may offer an alternative, but evidence on their implementation in low- and middle-income countries (LMICs) remains limited. This study explored barriers and facilitators to MC implementation and functioning in LMICs. A scoping review conducted in 2020 identified 15 publications. Ten key informants were interviewed in 2020 to complement and contextualize the literature findings. Findings were analyzed thematically and organized within a SWOT framework. A literature update conducted in 2026 identified 13 additional publications, resulting in 28 included publications. Facilitators included enabling environments for midwives, internal standards, sustainable financing, community-centered care, and professional collaboration. Barriers included workforce and education gaps, insufficient professional and regulatory recognition, weak health-system integration, and inadequate maternity care infrastructure. Expert insights complemented the literature by highlighting practical implementation challenges. Successful MC implementation requires context-sensitive approaches supported by adequate health-system infrastructure, professional autonomy, and functional referral networks to enable safe and respectful maternity care.