Open Access

Manuela Raddatz, Lisa Gronemann, Friederike zu Sayn-Wittgenstein-Hohenstein

• Background Research on midwifery care in Germany indicates a partial shortage of midwifery services based on user surveys and service evaluations. However, these assumptions cannot be substantiated and quantified as there is no reliable data on the size of the midwifery workforce and no approach to measure the degree of coverage with midwifery services. An initial approach to this is currently being developed in a research project at Osnabrück University of Applied Sciences and Witten/Herdecke University, Germany. The aim is to provide a target definition using a midwife-to-population ratio representing full coverage with midwifery services. Methods The developed ratios and their potential for assessing the degree of coverage are presented based on study progress data. Results Various midwife-to-population ratios were calculated based on different assumptions regarding workforce characteristics and population’s healthcare needs. Each variant has some potential for bias. In particular, the use of different theoretical definitions of the concept "healthcare need" leads to widely differing ratios. Deciding in favour of one of the definitions thus implies per se the inclusion of a bias. Conclusions The developed midwife-to-population ratios represent the starting point missing so far to enable measuring the degree of coverage with midwifery care in Germany, yet biases seem to be inevitably included. A careful balance between economic and target-orientated approaches to the concept of “healthcare need” can be an initial measure to reduce the potential for bias. A first application, supported by an evaluation, appears useful to allow further adjustments to be made. Simultaneously, an intra- and interprofessional consensus process should be initiated regarding the definition of needs-based midwifery care in the light of health workforce planning.