The role, scope and impact of Chief Midwives — Findings from a global study

BACKGROUND: Strengthening midwifery leadership is a global priority for improving maternal and newborn health outcomes. While dedicated Chief Midwife roles are increasingly recommended as a means to achieve this, little evidence exists on how these positions are structured, enacted, and whether they influence policy, practice, and the profession at the national level. AIM: To explore the role, scope, and impact of Chief Midwives across diverse health system contexts. METHODS: A qualitative study was conducted. Ten individual semi-structured interviews were conducted online in 2025 with Chief Midwives from seven countries. Data were collected in English and Spanish and analysed using narrative analysis to examine how participants understood and enacted their leadership roles. RESULTS: Chief Midwives described broad and multi-layered roles spanning policy leadership, workforce and service oversight, education and regulation, and cross-sector collaboration. Despite variation in formal structures, Chief Midwives reported consistent responsibilities, particularly acting as the senior advocate for midwifery and women within national decision-making spaces. The role was characterised as relational and political, requiring trust-building, negotiation, and boundary-spanning across professional and institutional domains. Impacts included shaping national policy, strengthening workforce and leadership pipelines, improving models of care, and enhancing professional visibility and morale. Effectiveness was shaped by structural positioning, political access, clarity of the Chief Midwife mandate, adequate resourcing and professional collaborations. CONCLUSIONS: Chief Midwives are pivotal system-level leaders who influence policy, practice, and professional recognition. However, their impact is contingent on clear mandates, senior positioning, adequate resourcing, and sustained institutional and political support.