Understanding midwifery workforce recruitment and retention: a realist review protocol for synthesising international evidence to inform UK workforce strategy

Abstract

Abstract Introduction Midwives play an essential role in improving maternal and newborn outcomes, yet workforce shortages continue to challenge the sustainability of maternity services internationally and within the UK. An earlier scoping review by the authors identified multiple barriers, enablers and workforce strategies associated with recruitment and retention. However, considerable variation in findings suggested that factors influencing recruitment and retention may operate differently according to context. Existing evidence offers limited explanatory understanding regarding how, why, for whom and under what circumstances factors shaping recruitment and retention of midwives influence workforce sustainability. This protocol outlines a realist review designed to develop programme theory explaining the contextual and causal factors that may influence entry into the midwifery profession and retention of midwives. Methods and analysis The review will commence in mid-2026 and be completed by early 2027. It will take a realist approach following Pawson’s six iterative stages of realist synthesis. Candidate theories, an initial programme theory, and the realist research question are informed by our earlier international scoping review and engagement with expert advisors across two panels comprising midwifery staff and workforce stakeholders. Searching will proceed iteratively and include database searching, citation tracking, targeted concept searching and grey literature. Evidence will be appraised according to relevance, richness and rigour and data extraction and synthesis will follow a realist logic of analysis. Ethics and dissemination The review will involve analysis of existing published and publicly available data and therefore does not require formal ethical approval. Experts contributing to theory development will be involved as advisors rather than research participants. Findings will be disseminated through peer reviewed publication, conference presentation and stakeholder-focused outputs. The review will generate evidence-informed programme theory to support future midwifery workforce policy and practice. PROSPERO registration details CRD420261398706.