Application of the birthrate plus (BR+) methodology to identify midwifery workforce shortages in China: a retrospective multisite study

Abstract Objective: The goal of this study is to apply Birthrate Plus (BR+) methodology in Chinese midwifery settings to assess the midwifery workforce status and to calculate the potential demand for more midwives. Methods: This was a retrospective multisite study using 12,443 maternal medical records from 49 midwifery settings in Zhejiang Province, China. Data needed in the BR+ , including the types of childbearing women and the number of midwifery service hours, were extracted and then calculated to assess the estimated demand and shortage of midwives. Results: The study included 599 midwives across 49 settings, with a range of 1–35 full-time equivalent midwives per setting, totaling 465 full-time equivalent midwives. Using BR+ methodology, the analysis revealed a shortage of midwives in 61.2% of the surveyed settings and a surplus in 22.4%. The shortage varied significantly across different levels of settings (H=6.505, P <0.05). Conclusions: Overall, the midwifery services provided were significantly insufficient in the surveyed regions, and workforce allocation was unbalanced among different areas.