gms | German Medical Science

Background: In Germany, women have a legal right to midwife care and medical services around the time of birth (§24d, SGB V). However, they have to find a midwife themselves and this is often difficult. The health system does not systematically organise and provide comprehensive midwifery care. It is not known exactly how many midwives there are in Germany, to what extent they participate in the provision of care and with what range of services, and what regional and socio-economic differences influence the provision of care.

The aim is to present a freely available, interactive midwifery compass to potential users, which should help to close the information gaps mentioned above. The presentation includes background information on the data basis, an explanation of how the tool works and the presentation of selected results, so that it becomes clear how the compass can be used and which limitations have to be taken into account.

Methods: Midwives participating in the provision of care were recorded using the LEO contract partner database of the Association of Health Insurance Companies (vdek) for freelance midwifes and data from the Employment Agency for employed midwives. The regional analyses are based on the INKAR database of the Federal Institute for Research on Building, Urban Affairs and Spatial Development. The analysis of the services provided was carried out from the BARMER billing data with extrapolation to all SHI-insured persons.

Results: The midwife compass allows a regional, population density-related and deprivation-related representation of the midwife distribution as well as the services provided by freelance midwives for SHI-insured persons according to the midwife assistance contract. It shows that on average there is one midwife for every 40 births, with slight regional variations. The most striking result is that in areas with strong deprivation (social hotspots) there are twice as many births per midwife. These regions are mainly located in large cities. This corresponds with the results of the analysis of midwifery services in pregnancy and postpartum: Both in pregnancy and in postpartum care, about 30 percent of socioeconomically disadvantaged women have no contact with a midwife (no billed midwifery service).

Relevance and conclusions: The Midwives’ Compass enables an interactive representation of midwifery care in Germany that has not been available before, which brings together data from different sources and enables individual own analyses according to region, population density and socio-economic situation. The freely available tool can support students and researchers as well as others interested in the supply situation in their research. The data can be used to directly produce results relevant to health care provision. For example, care gaps can be identified and information relevant to care planning can be obtained.

Ethics and conflicts of interest: A vote on ethics was not necessary. The research was financed by own resources. There are no conflicts of interest.