BACKGROUND:
Women from Sub-Saharan Africa still accounted for 70% of all maternal deaths in 2023. Poor quality maternity care now surpasses lack of access to care as a primary barrier to reducing maternal mortality rates. However, Ethiopia continues to achieve improved maternal outcomes, with a 46% reduction in maternal mortality between 2016-2023. As declining official development assistance threatens quality care, Ethiopian midwifery offers critical insights into community-level maternal health solutions that bridge gender divides, particularly in rural contexts.

OBJECTIVES:
This study explores culturally relevant empowerment in Ethiopian midwifery practice. It addresses three core objectives: to identify how Ethiopian midwives conceptualise empowerment, how empowerment is integrated into their practice, and what challenges they face in doing so.

METHODS:
A qualitative approach captured rich narratives from midwives in Hamlin Fistula Ethiopia and the Ethiopian Midwives Association (N=26 female, 25 male) and rural women attending midwifery clinics (N=107). Mixed methods included semi-structured interviews (N=55), focus groups (N=13), and participant observation. Fieldwork proceeded as initial inquiry in 2022. Data were analysed inductively using NVivo before being presented to participants for feedback during a 2024 confirmation phase. Responses were further analysed thematically.

RESULTS:
Both female and male midwives foster empowerment through familial-style relationships, mentoring, role modelling, and mobilising women peer-to-peer. Women-centered care is grounded in ‘compassionate respectful care’ and ‘Mikirke’, a two-way model of dialogue and sharing. Contraceptive supply shortages erode trust. Collaboration with community leaders, other health professionals, and professional advocacy overcome significant institutional restraints.

CONCLUSIONS:
Sustainable midwifery systems must be locally led and relationally embedded in communities, supported by institutional advocacy and resourcing. Empowering midwifery relationships span genders and institutions—linking communities, midwives, mentors, local authorities, educators, associations and ministries.

KEY MESSAGE:
Sustainable change arises through interdependent relationships between individual agency, cultural transformation, and system-wide support. Ethiopia’s midwifery system demonstrates that empowered midwives empower women, who in turn empower communities. Cultural safety