BACKGROUND:
Midwives are the backbone of maternal and newborn health (MNH) care, yet persistent gender inequalities systematically undermine their leadership, autonomy and ability to provide respectful, high-quality care. Evidence on this issue remains scarce in low- and middle-income countries.

OBJECTIVES:
This study explored how gender inequality shapes midwives’ professional experiences and capacity to deliver quality MNH care using evidence from six countries; Benin, Côte d’Ivoire, Ethiopia, Namibia, Senegal and Zambia.

METHODS:
Using a convergent mixed-methods design, the study combined an online survey with 1,579 midwives and qualitative data from 502 stakeholders, including 46 focus group discussions, 34 “river-of-life” sessions, and 74 key informant interviews. Quantitative data were analysed with descriptive statistics and chi-square tests; qualitative data underwent thematic content analysis. Findings were integrated using a gender-transformative framework spanning four levels: policy, institutional, community/interpersonal, and individual. The study explored midwives’ perceptions and experiences of gender inequality and its impacts.

RESULTS:
At the policy level, midwifery remains undervalued and underfunded relative to male-dominated professions, with 76% reporting being underpaid in comparison. Institutionally, most experienced high workload (80%), under-resourced workplaces (67%), harassment (59%) and weak implementation of gender-responsive policies. At the community/interpersonal level, social norms restrict mobility and reinforce gendered expectations, such as the "double burden" of domestic and professional roles. At the individual level, these pressures drive stress, burnout, and internalised bias, particularly among women. Collectively, these barriers limit leadership opportunities, autonomy, and respectful care. Results varied by country and sex.

CONCLUSIONS:
Gender inequality in midwifery is a deeply rooted structural barrier to respectful, high-quality care. Addressing it requires systemic, gender-transformative reforms—bringing midwives to the policy making space, establishing leadership pathways, equitable remuneration, ensuring safe, supportive and accountable workplaces, and supportive community norms.

KEY MESSAGE:
Empowering midwives through gender-responsive policies and workplaces is essential to achieve high-quality, respectful MNH care for every woman and newborn. Poster session 4 (Group B)