Voices from the field: Auxiliary nurse-midwives of Nepal

The purpose of this study is to explore how auxiliary nurse-midwives (ANM) in government service in Nepal articulate the mediation of the multiple roles their lives encompass. ANMs are pivotal to the government\u27s ability to increase access to health care for pregnant and parenting women and their children in the rural areas of Nepal. Nepal has one of the highest rates of maternal and infant morbidity and mortality in the region. ANMs in the rural health clinics not only provide direct care but also provide supervision and training to a variety of community based health workers who also serve women of child-bearing age. Most studies on women\u27s health in Nepal focus on service delivery with few reports focusing on the experience of women health professionals. The ANM program was developed to achieve two goals: to increase access to health care for rural women and to increase the status of women by increasing access to professional training and a profession. Girls who reach the minimum educational requirements to enter ANM training are often young, unmarried, from urban centers, and protected by the family structure. By virtue of the position, they are put into roles that contradict societal and family norms. Retention and the provision of quality services by ANMs have been raised as major concerns by the government. The main method of research was the use of open-ended and guided interviews with auxiliary nurse-midwives. Document review and meetings with health development workers in Nepal was also carried out. Four themes were focused on to help guide the research: the profession, the role of education, family and other supports, and being a woman. The cornerstone of the study is the women\u27s narratives. The narratives demonstrate the uniqueness of each woman\u27s experience, yet all speak to the dynamics of their own power, agency, resistance and resiliency. It is hoped that this document will add to the discourse on gender, education and health development. The study concluded with recommendations about the ANM program in Nepal and about the roles professionals and institutions play in international health development or social change