The Scope of Midwifery Practice Regulations and the Availability of the Certified Nurse‐Midwifery and Certified Midwifery Workforce, 2012‐2016
Introduction Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital st...
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| Published in | Journal of midwifery & women's health Vol. 65; no. 1; pp. 119 - 130 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Wiley Subscription Services, Inc
01.01.2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1526-9523 1542-2011 1542-2011 |
| DOI | 10.1111/jmwh.13007 |
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| Abstract | Introduction
Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital statistics data at the state and county level.
Methods
Midwifery distribution data came from the Area Health Resources Files, distribution of women of reproductive age came from the US Census, and birth statistics came from US Natality Files from 2012 to 2016. Midwifery regulations were drawn from American College of Nurse‐Midwives Annual Reports. We used bivariate analysis to examine the relationship between state midwifery practice regulations and the number of midwives available in states and counties to potentially meet women's health care needs.
Results
Twenty states and the District of Columbia had autonomous practice regulatory frameworks, whereas 24 states had collaborative practice regulatory frameworks during the years between 2012 and 2016. Six states changed regulations during that period. In 2016, the number of midwife‐attended births per number of midwives in a state was not related to the regulatory framework. However, states with autonomous frameworks had 2.2 times as many midwives per women of reproductive age (P < .0001) and 2.3 times as many midwives per total births when compared with states with collaborative statutory frameworks (P < .0001). At the county level, 70.1% of US counties had no midwife. Of those states with autonomous practice, only 59.7% of counties had no midwives, compared with 74.1% in states with collaborative models (P < .0001).
Discussion
Midwives have the potential to help address the shortage of maternity and reproductive health service providers. Our research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States. |
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| AbstractList | Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital statistics data at the state and county level.INTRODUCTIONStudies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital statistics data at the state and county level.Midwifery distribution data came from the Area Health Resources Files, distribution of women of reproductive age came from the US Census, and birth statistics came from US Natality Files from 2012 to 2016. Midwifery regulations were drawn from American College of Nurse-Midwives Annual Reports. We used bivariate analysis to examine the relationship between state midwifery practice regulations and the number of midwives available in states and counties to potentially meet women's health care needs.METHODSMidwifery distribution data came from the Area Health Resources Files, distribution of women of reproductive age came from the US Census, and birth statistics came from US Natality Files from 2012 to 2016. Midwifery regulations were drawn from American College of Nurse-Midwives Annual Reports. We used bivariate analysis to examine the relationship between state midwifery practice regulations and the number of midwives available in states and counties to potentially meet women's health care needs.Twenty states and the District of Columbia had autonomous practice regulatory frameworks, whereas 24 states had collaborative practice regulatory frameworks during the years between 2012 and 2016. Six states changed regulations during that period. In 2016, the number of midwife-attended births per number of midwives in a state was not related to the regulatory framework. However, states with autonomous frameworks had 2.2 times as many midwives per women of reproductive age (P < .0001) and 2.3 times as many midwives per total births when compared with states with collaborative statutory frameworks (P < .0001). At the county level, 70.1% of US counties had no midwife. Of those states with autonomous practice, only 59.7% of counties had no midwives, compared with 74.1% in states with collaborative models (P < .0001).RESULTSTwenty states and the District of Columbia had autonomous practice regulatory frameworks, whereas 24 states had collaborative practice regulatory frameworks during the years between 2012 and 2016. Six states changed regulations during that period. In 2016, the number of midwife-attended births per number of midwives in a state was not related to the regulatory framework. However, states with autonomous frameworks had 2.2 times as many midwives per women of reproductive age (P < .0001) and 2.3 times as many midwives per total births when compared with states with collaborative statutory frameworks (P < .0001). At the county level, 70.1% of US counties had no midwife. Of those states with autonomous practice, only 59.7% of counties had no midwives, compared with 74.1% in states with collaborative models (P < .0001).Midwives have the potential to help address the shortage of maternity and reproductive health service providers. Our research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States.DISCUSSIONMidwives have the potential to help address the shortage of maternity and reproductive health service providers. Our research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States. Introduction Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital statistics data at the state and county level. Methods Midwifery distribution data came from the Area Health Resources Files, distribution of women of reproductive age came from the US Census, and birth statistics came from US Natality Files from 2012 to 2016. Midwifery regulations were drawn from American College of Nurse‐Midwives Annual Reports. We used bivariate analysis to examine the relationship between state midwifery practice regulations and the number of midwives available in states and counties to potentially meet women's health care needs. Results Twenty states and the District of Columbia had autonomous practice regulatory frameworks, whereas 24 states had collaborative practice regulatory frameworks during the years between 2012 and 2016. Six states changed regulations during that period. In 2016, the number of midwife‐attended births per number of midwives in a state was not related to the regulatory framework. However, states with autonomous frameworks had 2.2 times as many midwives per women of reproductive age (P < .0001) and 2.3 times as many midwives per total births when compared with states with collaborative statutory frameworks (P < .0001). At the county level, 70.1% of US counties had no midwife. Of those states with autonomous practice, only 59.7% of counties had no midwives, compared with 74.1% in states with collaborative models (P < .0001). Discussion Midwives have the potential to help address the shortage of maternity and reproductive health service providers. Our research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States. IntroductionStudies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital statistics data at the state and county level.MethodsMidwifery distribution data came from the Area Health Resources Files, distribution of women of reproductive age came from the US Census, and birth statistics came from US Natality Files from 2012 to 2016. Midwifery regulations were drawn from American College of Nurse‐Midwives Annual Reports. We used bivariate analysis to examine the relationship between state midwifery practice regulations and the number of midwives available in states and counties to potentially meet women's health care needs.ResultsTwenty states and the District of Columbia had autonomous practice regulatory frameworks, whereas 24 states had collaborative practice regulatory frameworks during the years between 2012 and 2016. Six states changed regulations during that period. In 2016, the number of midwife‐attended births per number of midwives in a state was not related to the regulatory framework. However, states with autonomous frameworks had 2.2 times as many midwives per women of reproductive age (P < .0001) and 2.3 times as many midwives per total births when compared with states with collaborative statutory frameworks (P < .0001). At the county level, 70.1% of US counties had no midwife. Of those states with autonomous practice, only 59.7% of counties had no midwives, compared with 74.1% in states with collaborative models (P < .0001).DiscussionMidwives have the potential to help address the shortage of maternity and reproductive health service providers. Our research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States. Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital statistics data at the state and county level. Midwifery distribution data came from the Area Health Resources Files, distribution of women of reproductive age came from the US Census, and birth statistics came from US Natality Files from 2012 to 2016. Midwifery regulations were drawn from American College of Nurse-Midwives Annual Reports. We used bivariate analysis to examine the relationship between state midwifery practice regulations and the number of midwives available in states and counties to potentially meet women's health care needs. Twenty states and the District of Columbia had autonomous practice regulatory frameworks, whereas 24 states had collaborative practice regulatory frameworks during the years between 2012 and 2016. Six states changed regulations during that period. In 2016, the number of midwife-attended births per number of midwives in a state was not related to the regulatory framework. However, states with autonomous frameworks had 2.2 times as many midwives per women of reproductive age (P < .0001) and 2.3 times as many midwives per total births when compared with states with collaborative statutory frameworks (P < .0001). At the county level, 70.1% of US counties had no midwife. Of those states with autonomous practice, only 59.7% of counties had no midwives, compared with 74.1% in states with collaborative models (P < .0001). Midwives have the potential to help address the shortage of maternity and reproductive health service providers. Our research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States. |
| Author | Ranchoff, Brittany L. Declercq, Eugene R. |
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| Keywords | certified midwives midwifery workforce health policy certified nurse-midwives access to maternity and reproductive health services midwifery midwifery practice laws midwife-attended births maternal health access to care public health |
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Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for... Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive... IntroductionStudies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for... |
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| SubjectTerms | Access access to care access to maternity and reproductive health services Annual reports Attended births Autonomous practice Availability Births Censuses certified midwives certified nurse‐midwives Collaboration Female health policy Health services Humans Job Description maternal health Maternal Health Services - organization & administration Midwifery Midwifery - legislation & jurisprudence Midwifery - methods midwifery practice laws midwifery workforce midwife‐attended births Midwives Nurse Midwives - legislation & jurisprudence Practice Patterns, Nurses' - legislation & jurisprudence Pregnancy Professional Practice - legislation & jurisprudence Public health Quality of Health Care Regulation Reproductive health United States Women Womens health Workforce Workforce - legislation & jurisprudence |
| Title | The Scope of Midwifery Practice Regulations and the Availability of the Certified Nurse‐Midwifery and Certified Midwifery Workforce, 2012‐2016 |
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