BACKGROUND:
Midwives often struggle to provide an autonomous midwifery model of care. Midwifery centres (MCs) can provide an enabling space, but most countries lack licensure or regulatory systems to assure quality. Accreditation—using international standards and localized through a participatory process—may facilitate MC integration into healthcare systems, strengthen sustainable quality, and fully enable midwifery care.

OBJECTIVES:
This study explored the expectations and experiences of stakeholders involved in a voluntary accreditation process and assessed the provision of care at MCs once accredited.

METHODS:
A rapid ethnographic approach, combining participant observation and semi-structured interviews, was conducted during a Goodbirth Network accreditation process of six midwifery centres in Haiti, Uganda, and South Africa. Convenience sampling was applied, and qualitative data was thematically analyzed using NVivo software. Care provision and health outcome data at centres that completed accreditation were also analyzed.

RESULTS:
Findings suggest the accreditation process fosters a culture of co-production and continuous quality improvement. The participatory approach itself was identified as a self-reflexive tool supporting quality. Four qualitative themes emerged around accreditation: the value of accreditation, identification of enablers and barriers to accreditation, and future expectations of participants. Providing care at an accredited centre resulted in pride, increased confidence in the midwifery model of care, and health outcomes exceeded national averages. However, structural and cultural barriers varied across contexts, potentially influencing stakeholder engagement and implementation.

CONCLUSIONS:
With increasing evidence that MCs provide safe, respectful, and provide evidence-based care, accreditation may serve as a mechanism to bridge quality gaps, provide enabling spaces for midwives, and support positive health outcomes. Further research is needed to explore the short- and long-term benefits of accreditation, as well as enablers and barriers to its adoption

KEY MESSAGE:
A participatory approach to accreditation may facilitate MC implementation, integration, and sustainability in LMICs, contributing to quality care and enabling environments for midwives. Complications - hypertension