Strengthening midwifery and nursing interventions to reduce child mortality in South Asia: a policy and practice review

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Abstract
Child mortality continues to pose a major public health challenge in South Asia, where under-five and neonatal mortality remain high, especially in Afghanistan, Pakistan, and parts of India. Here, we synthesised evidence from 38 studies published between 2012 and 2024, examining predictors of mortality, barriers to effective nursing and midwifery interventions, and strategies to strengthen these roles. We identified four barrier domains: inadequate education and professional development, socio-cultural and gender constraints, infrastructure and resource shortages, and systemic policy challenges. Across several countries, over half of midwives lacked adequate pre-service training, more than 60% of facilities reported critical equipment shortages, and restrictive policies limited midwives' autonomy. Despite these challenges, community-based interventions and targeted policy reforms demonstrated measurable improvements, including up to 49% increases in institutional deliveries and reductions in neonatal mortality by 2-3 per 1000 live births. Strengthening midwifery and nursing capacity through competency-based education, investment in rural health systems, and culturally sensitive community engagement - guided by World Health Organization and International Confederation of Midwives frameworks - represents a feasible pathway for reducing preventable child deaths and advancing progress toward Sustainable Development Goal 3 in South Asia.

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