Group level changes and differences in midwives’ organisational and psychological work environment in Sweden - a nation-wide ecological prospective study

Background National statistics indicate that nearly one-quarter of Swedish midwives are employed outside the healthcare sector, highlighting persistent challenges in recruitment and retention. Although the demanding work conditions faced by midwives within the healthcare sector are documented, there is limited research on how these conditions evolve over time. Aim To identify group level changes and differences over time in how midwives assess their organisational and psychosocial work environment and to compare the assessments with Swedish benchmarks Methods This study is part of the longitudinal Swedish nation-wide GoodWEM project, using group level survey data from midwives in 2020 (n = 1677) and 2023 (n = 1836). Organisational and psychosocial work environments were assessed with Copenhagen Psychosocial Questionnaire III and compared with national benchmarks. Mean scores were analysed using linear regression and practical significance was evaluated using a predefined Minimal Important score Difference. Findings Between 2020 and 2023, Swedish midwives reported modest improvements in organisational and psychosocial work conditions, however, none of these changes met the ±5 point threshold for minimal important score difference, indicating limited clinical relevance. The proportion of midwives engaged in full-time work decreased from 52 % to 47 %. In 2023, midwives reported higher emotional and quantitative demands, role conflicts, and burnout than Swedish benchmarks, alongside more limited influence and poorer self-rated health, indicating persistent systemic challenges within the profession. Discussion and conclusion These findings underscore the need for long-term, systemic reforms to support midwives’ professional sustainability. Addressing structural, organisational, and contextual factors will be essential for improving retention, wellbeing, and care quality across diverse practice settings.