Regional and Socioeconomic Inequalities in Access to Midwifery Care: Comparing Germany and New Zealand
1
Institute of Midwifery, Charité Universitätsmedizin Berlin, Berlin, Germany
2
Institute for Applied Photogrammetry and Geoinformatics, Jade University of Applied Sciences Wilhelmshaven/Oldenburg/Elsfleth, Oldenburg, Germany
3
School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Equitable access to midwifery care is essential for maternal and newborn health and aligns with SDG 3 and SDG 10¹. Many countries lack systematic workforce planning to achieve this goal. In Germany, the absence of a central registry or demand-oriented planning tool has led to regional and social inequities²,³. In contrast, Aotearoa New Zealand maintains a nationwide registry and monitoring system, offering a useful reference for equity-oriented planning.
METHODS:
A cross-sectional spatial analysis used national workforce data, population statistics, and socioeconomic indices. The german demand planning guideline was adapted to midwifery. Coverage was calculated using national provider-to-population benchmarks (Germany: 960 women per midwife; New Zealand: 382 women per midwife) and adjusted for deprivation (GISD; NZDep2018). Accessibility was assessed with travel-time analysis.
RESULTS:
In Germany, 17,792 practising midwives served 17.1 million women of reproductive age. Coverage ranged from 0% to 259%, with nearly one quarter of districts undersupplied. Coverage correlated negatively with deprivation (r ≈ –0.30, p < 0.001). Median travel time was 9.6 minutes, but exceeded 30 minutes in several rural districts. In New Zealand, 3214 practising midwives served 1.4 million women. Coverage ranged from 0% to 317%; 29% of territorial authorities were undersupplied. No significant association with deprivation was observed (r ≈ 0.05, p = 0.72). Median travel time was 15.7 minutes, with extremes in remote island regions (up to 118.5 minutes).
CONCLUSIONS:
Systematic workforce planning offers a clear pathway to reduce inequalities in maternity care. Germany needs a national midwifery registry and an equity-sensitive planning framework to ensure fair access. Evidence from New Zealand shows that coordinated data systems and structured care models can be implemented effectively and strengthen both midwifery access equity and maternal health equity.
Equitable access to midwifery care is essential for maternal and newborn health and aligns with SDG 3 and SDG 10¹. Many countries lack systematic workforce planning to achieve this goal. In Germany, the absence of a central registry or demand-oriented planning tool has led to regional and social inequities²,³. In contrast, Aotearoa New Zealand maintains a nationwide registry and monitoring system, offering a useful reference for equity-oriented planning.
METHODS:
A cross-sectional spatial analysis used national workforce data, population statistics, and socioeconomic indices. The german demand planning guideline was adapted to midwifery. Coverage was calculated using national provider-to-population benchmarks (Germany: 960 women per midwife; New Zealand: 382 women per midwife) and adjusted for deprivation (GISD; NZDep2018). Accessibility was assessed with travel-time analysis.
RESULTS:
In Germany, 17,792 practising midwives served 17.1 million women of reproductive age. Coverage ranged from 0% to 259%, with nearly one quarter of districts undersupplied. Coverage correlated negatively with deprivation (r ≈ –0.30, p < 0.001). Median travel time was 9.6 minutes, but exceeded 30 minutes in several rural districts. In New Zealand, 3214 practising midwives served 1.4 million women. Coverage ranged from 0% to 317%; 29% of territorial authorities were undersupplied. No significant association with deprivation was observed (r ≈ 0.05, p = 0.72). Median travel time was 15.7 minutes, with extremes in remote island regions (up to 118.5 minutes).
CONCLUSIONS:
Systematic workforce planning offers a clear pathway to reduce inequalities in maternity care. Germany needs a national midwifery registry and an equity-sensitive planning framework to ensure fair access. Evidence from New Zealand shows that coordinated data systems and structured care models can be implemented effectively and strengthen both midwifery access equity and maternal health equity.
| eISSN: | 2654-1459 |
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