Does Curriculum Reform Improve Clinical Practice? Comparing the Quality of Labor and Delivery Care Provided by Midwives in Ethiopia

Abstract

Purpose: Maternal and neonatal health remains a major challenge in Ethiopia. Despite midwives’ potential to prevent over 80% of related deaths, shortages and competence gaps persist due to theory-focused preservice curricula. In 2013, Debre Tabor University introduced a competency-based midwifery curriculum. This study evaluated whether this curriculum reform improved the quality of labor and delivery care provided by midwives. Methods: A comparative cross-sectional study was conducted among 68 BSc midwifery graduates from ten third-generation Ethiopian universities (32 trained under a competency-based curriculum; thirty-six under a conventional curriculum). Labor and delivery care quality was assessed through direct observation using a validated checklist. Additional data on birth outcomes were collected through record reviews, and facility inventories were used to evaluate the availability of essential supplies. Mean percentage scores were compared using independent t -tests and effect sizes (Cohen’s d ) were visualized with Gardner–Altman plots. Results: On average, midwives performed 75.3% of the tasks required for quality labor and delivery care, with competency-based curriculum graduates (CBCGs) scoring higher (83.3%) than conventional curriculum graduates (CCGs) (68.2%), which was consistent across all components of labor and delivery care. This difference was statistically significant ( t (61.77) = 5.29, p < .001), with a large effect size (Cohen’s d = 1.26; Δ = 15%). During the initial client assessment, CBCGs more frequently inquired about vaginal bleeding and practiced hand hygiene. CBCGs also demonstrated higher performance in delivery preparation, neonatal resuscitation readiness, administering uterotonics, early breastfeeding support, and skin-to-skin contact. Conclusion: Midwives trained under a competency-based curriculum provided higher quality labor and delivery care than the conventionally trained control group, with a large effect size, suggesting clinical relevance. However, the overall performance revealed persistent gaps, highlighting the need for further research to examine long-term outcomes to inform curriculum development and policy. Keywords: education, competency, quality, labor and delivery, Ethiopia