A Qualitative Study to Assess Experiences of Auxiliary Nurse Midwives Working in Sub Center of Pune District

Abstract

Auxiliary Nurse Midwives (ANMs) are the frontline health workers forming the backbone of India's primary healthcare delivery system. Operating from sub-centers the most peripheral unit of the health system ANMs in rural and semi-urban Pune district serve as the first point of contact between the community and health services. Despite their critical role, their lived experiences, challenges, and professional needs remain underexplored. To explore and describe the lived experiences of ANMs working at sub-centers in Pune district, including their roles, challenges, motivating factors, support systems, and perceived gaps in resources and training. A descriptive qualitative research design was employed. Purposive sampling was used to select ANMs from sub-centers across rural and semi-urban areas of Pune district, Maharashtra. Data were collected through in-depth interviews using a semi-structured interview guide. Thematic analysis was conducted following Braun and Clarke's framework to identify recurring patterns and themes from the transcribed narratives. ANMs described their roles as multifaceted, encompassing maternal and child health, immunization, family planning, health education, and disease surveillance. Key challenges included inadequate infrastructure, irregular supply of medicines and equipment, high documentation burden, and limited supervisory support. Despite these barriers, participants expressed strong commitment to their communities. Training gaps particularly in emergency obstetric care and digital health tools were widely reported. Community relationships emerged as a significant source of professional motivation and resilience. ANMs in Pune district sub-centers demonstrate remarkable dedication under challenging conditions. Addressing systemic gaps in infrastructure, supervision, workload management, and continuing education is essential to strengthen their effectiveness and well-being. Findings underscore the need for policy-level interventions to support frontline health workers in achieving Universal Health Coverage goals.