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Background: There is a dearth of evidence on the scale, scope and quality of midwifery education programs in conflict-affected settings. This study sought to assess the extent to which midwifery pre-service education programs meet national and global standards, and to explore how conflict affects pre-service midwifery education in Yobe State Nigeria and the Benadir and Galgaduud regions of Somalia. Methods: A rapid assessment of midwifery education programs was conducted in the two midwifery education programs in Yobe State, Nigeria and in seven purposively selected programs in Somalia using an adaptation of the Midwifery Education Rapid Assessment Tool. Information was collected through interviews with program leadership, teachers, students, and clinical preceptors during school and clinical practice site visits. Researchers adapted the tool to reflect national and international standards, incorporating supplementary questions to capture considerations specific to conflict-affected contexts. Data were analyzed by program and country using Stata and Excel. Results: In Nigeria, each school met 17 and 18 standards, respectively, out of 22 across assessment domains (77.3%–81.8%). In contrast, in Somalia, schools met between 6 and 10 standards out of the 18 standards for which data were available (33.3%–55.6%). The biggest gaps in Somalia were in leadership, infrastructure and resources. No schools in either setting had sufficient space or clinical practice sites that met International Confederation of Midwives (ICM) criteria, and only two were led by midwives. In Nigeria, all infrastructure, curriculum and student- and regulatory-related standards examined were met, but gaps were identified in program staffing and preceptor capacity, and support for faculty and clinical practice sites. In both countries, none of the programs met the average number of clinical practice experiences stipulated in the ICM guidelines due to a lack of teaching hospitals. Students in both countries felt safe on campus but did not feel safe traveling to and from the schools and clinical practice sites. Conclusions: More investment in midwifery education is needed to ensure international standards for quality education are met. Proactive measures are needed to enhance student safety between school and practice settings in conflict-affected settings. By addressing these gaps, we can strive toward improving midwifery education. [ABSTRACT FROM AUTHOR]

Introduction: Midwives play an important role in maternal and newborn care, yet are in short supply globally. The shortage in midwives is particularly acute in sub-Saharan African countries, many of which are conflict-affected. Midwives face many challenges that impact their workforce participation and retention, and these challenges are often compounded in conflict settings. Somalia ranks among the countries with the highest maternal mortality rate, with an estimated shortage of 20,000 midwives compared to the WHO recommended standard. Yet, limited research has explored the lived experience of midwives in conflict. This qualitative study seeks to explore the experiences, plans, and aspirations of midwifery students and recent graduates from nine midwifery schools in Somalia and to understand how the safety and security situation impacts their educational experience and willingness to join the profession., Methods: This is a sub-study embedded within a broader prospective multi-cohort study of midwifery students and early career midwives conducted in 2023 and which will continue until 2025. We invited graduates and students in their final year from eight schools in Mogadishu and one school in Galgadud to participate in the study. This study draws on findings from five focus group discussions conducted with midwifery students and graduates who were included in the parent cohort study, for a total sample size of 33 students and graduates. We conducted thematic analysis using a combination of inductive and deductive coding., Results: Our data illustrates powerful motivation among midwifery students and graduates to join the profession. Motivation was mostly intrinsic, with participants describing their desire to help the mother-baby dyad and to reduce maternal mortality in their communities as the predominant driving force for joining the profession. Yet, participants cited several barriers to entering the workforce, including harmful gender norms that prioritize women's domestic roles over professional aspirations and societal mistrust toward young midwives. Participants stated that their age and gender undermined them professionally and noted the community's preference for older midwives and traditional birth attendants. Safety and security significantly impacted participants' acceptance of job placement in remote areas and students' ability to attend school regularly. In terms of perceived preparedness, graduates felt well prepared for their role but identified gaps in abortion care, neonatal resuscitation, and usage of basic ultrasound., Conclusion: The challenges faced by midwifery students and newly graduated midwives have direct implications for the health outcomes of mothers and infants in conflict-affected settings. The recurring themes of inadequate training, security risks, and restrictive gender norms require holistic and systematic interventions that address these issues in order to improve motivation and workforce participation among this important health cadre., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2025 Abdullahi, Mohamud, Ahmed, Omar, Dalmar, Tappis and Elnakib.)