Setting and participants

Bangladesh is a lower middle-income country [21] where poverty and income inequalities is a persistent challenge [22]. Despite interventions as provision of family planning and education of girls, gender inequalities impact on the socio-economic development, particular of women from the rural areas [23]. With approximately 3.1 million live births each year [24], 47 % of deliveries take place in a health facility, which contributes to the overall low ratio of skilled attendance at birth of 50% and a high maternal mortality ratio (MMR) of approximately 196 maternal deaths for every 100,000 live births [19].

Since its inception, the midwifery diploma programme has been embedded in nursing institutes/colleges in Bangladesh, and is currently being offered at 38 public institutes/colleges, which are geographically distributed across the country [10]. The focus group discussions took place at 14 of these public nursing institutes/colleges. A nursing college is a government institution affiliated with a tertiary-level hospital with a high level of referrals from primary level, whilst nursing institutes are situated at district level, and affiliated with general hospitals where midwifery students are placed for their practical learning placements. The yearly intake of midwifery students, all female, is 25–50 places at each institution. The educational institutions are residential, and students come from both rural and urban areas.

Sixty-seven third-year diploma midwifery students were purposively [25] selected to participate in the focus group discussions, based on their willingness and availability. The age of the participants ranged from 19 years to 23 years, all were female, unmarried without own children.