BACKGROUND:
The Government of Pakistan introduced community midwives to provide maternal care services to rural communities. Despite government's huge efforts, evidence from rural regions of Pakistan demonstrates that the utilization of midwifery services is very low and the maternal health indicators have not shown significant improvements.

OBJECTIVES:
The aim of this qualitative study was to explore factors that influence utilization of midwifery services in a large rural district (Thatta) of Pakistan.

METHODS:
Interviews were conducted with officials from the health department, three categories of midwives including i) midwifery students; ii) trained and working community midwives; and iii) trained and non-working community midwives. We also carried out interviews with community-married women. A total of 25 interviews were conducted. The data was collected using the four domains of the community midwifery model. A qualitative thematic analysis approach was used for analysis.

RESULTS:
Based on the data collection, two overarching themes were identified: (I) Social and cultural challenges faced by CMWs including the young age of midwives, and community women’s varied preferences for their delivery and childbirth processes were major challenges for community midwives (II) Support and acceptance including nonacceptance of community midwives’ services by doctors, other healthcare providers, and community women were identified as significant barriers to midwifery services.

CONCLUSIONS:
The study provides key insights to policy makers and program implementers to empower community midwives and work on their capacity building to help achieve the aim of increasing skilled birth attendants in rural regions of Pakistan.

KEY MESSAGE:
Policy makers and government health officials in Pakistan must work on interventions to address challenges faced by community midwives in their communities. Poster session 4 (Group B)