BACKGROUND:
Midwives are crucial for improving maternal and newborn health (MNH), yet policy and regulatory barriers often limit their practice. This study conducted by Burnet Institute, ICM, and UNFPA in 2024, examines these barriers and identifies enablers to optimize midwifery practice globally.

OBJECTIVES:
To identify policy and regulatory frameworks hindering or supporting midwives' full scope of practice and to provide evidence-based recommendations for policy reform.

METHODS:
This mixed-methods study included desk reviews of national scope of practice policies from 25 countries across all WHO regions, focus group discussions with 48 midwives from 33 countries, and an online survey with 568 midwives from 87 countries. Data, collected in 5 languages, were analyzed to identify key barriers, enablers, and regional variations influencing midwifery practice.

RESULTS:
Key barriers include outdated regulations and definitions of midwifery in national policies, leading to a lack of clarity in midwives’ scope of practice, especially in emergency care. Unclear distinctions between nursing and midwifery, and discrepancies between policy and practice further compound the issue. For example, despite national policies authorizing midwives to perform emergency obstetric and newborn procedures, midwives were frequently restricted from providing this care in practice. In many rural and humanitarian settings, midwives often provided emergency care without legal backing. Enablers include aligned national policies with global standards, clear regulatory frameworks, extended roles, supportive workplaces, education/training reforms, and leadership/mentorship programs.

CONCLUSIONS:
Addressing policy gaps and leveraging enablers are essential to empower midwives and improve maternal and newborn health outcomes. Recommendations include aligning national policies with ICM essential competencies for midwifery practice, aligning education with ICM global standards for midwifery education' and implementation of the Professional Framework for Midwifery, strengthening midwives understanding of regulation, and ensuring midwifery representation in regulatory bodies.

KEY MESSAGE:
Strengthening policy and regulatory frameworks to support midwives' full scope of practice is crucial for achieving equitable, high-quality MNH care worldwide. Regulation - framework