Costing and Cost-Effectiveness Analysis of Midwife-led Care
Costing and Cost-Effectiveness Analysis of Midwife-led Care
Year: June 2025
Collaborators: Fernandez Foundation and Leapfrog 2 Value
Team: Sarang Deo, Subhiksha Shankarraman
Background
Global evidence highlights the benefits of midwife-led care in improving maternal and neonatal health—including significant reduction in Caesarean sections, maternal and neonatal deaths, stillbirths and invasive medical interventions. Midwifery boosts healthcare access and efficiency, particularly in resource-constrained regions. However, the evidence on cost and cost-effectiveness of midwifery-led care model in Low- and Middle-Income countries (LMICs) is scarce. There is a need for a more organized and comprehensive data collection and evidence generation to help policymakers and healthcare authorities assess the feasibility of scaling the midwife-led care model, improving maternal outcomes.
About the Study
The study aims to assess the costs associated with low-risk deliveries in a midwife led model in comparison to the popular obstetrician led care model and a collaborative care model in India. Besides generating cost evidence for the most scalable maternal care model, the insights on cost-effectiveness of the practice also intend to help the healthcare set-ups optimize the use of their resources.
Methodology
The costing study was conducted at Fernandez Hospital, a private facility specializing in maternal care, in Bogulkunta, Hyderabad, Telangana. We identified three distinct patient pathways: midwife-led care (MLC), obstetrician-led care (OLC), and collaborative care (CC), operating within the same birthing unit. Time-Driven Activity-Based Costing (TDABC) method was used to calculate the cost of different services as a summation of rent, salaries, wages, and medical and non-medical equipment. The patient profiles were matched for eligibility for admission to MLC. Data was collected through a combination of observation/ shadowing, surveys and nursing notes. We reviewed and analyzed 109 nursing notes and conducted 96 structured qualitative surveys with both medical and non-medical staff. To account for potential variations, we analysed base cost using the mean of time and frequency data, and the highest and lowest cost estimates using ±2 standard deviations from these mean metrics. The cost effectiveness analysis is ongoing.
Intended Outcome
Through a nuanced costing and cost-effectiveness analysis of midwifery approach this study will provide evidence-based insights to inform policy and strategy decisions for broader adoption of midwife-led model. Furthermore, it intends to generate robust data through comparative analysis of maternal and newborn outcomes under midwife-led care, obstetrics-led care and collaborative care to drive advocacy efforts for fostering a respectful, natural and empowering maternal care environment.