Factors Influencing the Retention of Midwives in Rural Areas of Bhutan: A National Cross-sectional Study

Background: The retention of midwives in rural areas is pivotal in achieving sustainable development goals, particularly those concerning maternal and child health. Though the human resource planning policy mandates at least one midwife in every primary healthcare facility (PHCF), Bhutan has not achieved this target. Objective: This study has aimed to explore the factors that influence the retention of midwives in rural areas of Bhutan. Methods: A national cross-sectional study was conducted in 2022 among all 165 midwives working in rural PHCFs across 20 districts in Bhutan. The questionnaire was designed based on the World Health Organization framework that was developed for rural health workforce retention. Data were collected online using a structured closed-ended self-administered questionnaire and were then analysed using descriptive statistics and linear regression. Results: The analysis revealed that the midwives had a high retention intention. Age, monthly income, work experience, personal origins and values, family and community aspects, working and living conditions, career-related opportunities, financial incentives, and mandatory service were positively and statistically significantly correlated with retention. Financial incentives and working and living conditions were the predictors that strongly influenced the retention of midwives in rural areas. Conclusion: This study indicated that the retention of midwives was high and was influenced by multiple factors. Financial incentives and working and living conditions were highly significant factors in attracting and retaining midwives in rural PHCFs.