MACRO—National/Federal Government	Operationalize human rights and respectful care for all childbearing families Make human rights and RMC training mandatory for midwives, educators, and other health professionals who work alongside midwives. Require leaders at all facilities and midwifery-led units to engage with the OCHRC RMC Reflection Guides. Establish incentives mechanisms for accountability, redress, and remediation person-centred care and respectful communication at the facility level. Build strong monitoring, data capturing and learning mechanisms Track maternal and newborn outcomes related to midwifery care, including person-centred quality metrics for—respect, autonomy and mistreatment. Map and analyse links between different models of midwifery integration and perinatal outcomes across jurisdictions. Collect data at point of service on patient experience using validated person-centred measures of autonomy, respect and mistreatment. Commit to midwifery leadership and governance Establish a Division of Midwifery and a Director of Midwifery, at the highest level of the GOI—Health Affairs Unit, as well as within each state health office. This distributive leadership approach will allow for national directives to be seamlessly communicated to state departments of health and create a bidirectional flow of information, best practice, and accountability. Build the national and state infrastructure to grow midwifery leadership within the workforce. Include midwifery leadership at all levels of government and governance ensuring that decisions cannot be made about midwives or midwifery care, without midwives present. Frequently engage and consult with practicing midwives ensuring representation at all levels of organization of care.
MESO—Regional/State Regulation	Reinforce midwifery education programs at global standard Require minimum of 18 months of additional education in midwifery after nursing to qualify as a midwife and at least 3 years for direct entry candidates. Establish ongoing partnerships between global and local midwifery educators and clinician leaders to provide ongoing virtual and in person support for midwifery educators in India. Provide mentors or supervisors for early career midwives. Mentors/supervisors should not be in a position of power over or directly work with early career midwives. Prioritize a full-scope relationship-based model of care for NPMs Build midwifery regulation that facilitates continuity of care from preconception to early parenting. Include expanded capacity for midwives to deliver essential family planning, gynecologic, and infant care. Establish midwives as autonomous health care providers and support them in working to their full scope in a variety of settings. Set protocols and policies that enable midwives to participate in the care of all childbearing families. Establish a triage network where midwives serve as primary care providers, providing first line antepartum and intrapartum services, receiving referrals from community health workers, and initiating referrals or collaborative care plans with obstetric specialists as necessary. Focus on community engagement and public information Integrate community voices and women’s empowerment groups to define and redesign maternity care services that are respectful and responsive. Center the needs of the most marginalized women and communities to achieve equity. If all women and families thrive, the country can thrive. Invest in public education and cross disciplinary information sharing on the role, value, and benefits of midwifery care.
MICRO—Local/Facility Environments	Create a positive work culture and environment for NPMs Ensure fair and meaningful payment structures including parity in terms of compensation, opportunities and avenues for professional growth. Recruit enough midwives to manage work load and flow. Enable role flexibility for midwives including clinical, policy, administrative, and teaching positions Expand organizational awareness and resources to respond to occupational/traumatic stress. Create enabling environments for interprofessional practice Educate all clinical staff on core principles of interprofessional collaboration, including leadership models that are not hierarchical—and are respectful of different evidence streams Promote a respectful work environment across the health professions and mandate training on positive communication and collaboration. Embed content on midwifery role and scope into all health professional educational programs including medicine and nursing. Support midwives to care for people with complex medical and social needs Provide additional support and incentives to midwives who work in rural and remote settings, or who care for clients with complex care needs. Provide additional cultural congruence training to midwives who work with historically marginalized and at-risk populations. Provide in-service training to community health workers and obstetric consultants on the competencies and role of midwives in caring for special populations.