The study findings identified weaknesses in the current model of English instruction taught in public midwifery programs. Without a standard curriculum or use of digital tools to expose students to native English-speaking voices, students’ are exclusively exposed to instructional content created and delivered by adjunct English instructors, most of whom have neither training in teaching English, nor mastery of the language themselves. English being a barrier to accessing global higher education opportunities also hinders midwifery faculty in teaching course curricula and bringing up-to-date, evidence-based content into their classrooms.
This is not a unique situation. Globally, many healthcare faculty and students in low resource settings are faced with delivering and acquiring knowledge in a language they have not sufficiently mastered. As a significant barrier to knowledge and skill acquisition for evidence-based care, this requires more attention from global midwifery educators.
Ultimately, the challenge is to determine the best way of balancing the real benefits of English competency against the realities of limited language mastery in a low resource setting. ESP is one option available in Bangladesh for midwifery education. The ESP approach teaches English for application in a specific discipline. It does this by using vocabulary, examples, demonstrations, scenarios and practice activities that are directly related to the context and professions those studying English live and work (or are preparing to work) in. One way ESP has been described, attributed to Hutchinson and Waters (1987), is, “ESP should properly be seen not as any particular language product but as an approach to language teaching in which all decisions as to content and method are based on the learner's reason for learning”. It is proposed as a viable model for strengthening language mastery and subject matter comprehension in EMI university contexts.
Native language instruction is another useful option. Research has long shown that students learn better–more thoroughly and more efficiently–in their native language. Said otherwise, learning in a language that is not one’s mother tongue (whether a 2nd, 3rd, or 4th language) fosters slower and less complete learning12. This has led some to question the utility of EMI for diploma midwifery programs and whether education quality and outcomes would improve if Bangla were the medium of instruction. Significant programming focused on translation of learning resources would certainly be needed. This appears to be a practical solution particularly given the language challenges experienced by faculty, and that midwives’ deployment posts rarely require English. However, it may continue to disadvantage student and faculty access to current global resources that report and teach on evidence-based practice due their proliferation and that new information and updates are continually produced.
A middle ground between these two options–EMI or native language instruction–is multilingualism. Kirkpatrick, a leading scholar of EMI in Asia, suggests that multilingualism be formally integrated into EMI university settings. This would entail recognizing native languages as complementary rather than a deficiency, and using them in the classroom through verbal instruction and course materials. There is evidence showing that the amount of native language support needed is inversely proportional to their degree of English proficiency. While this appears to be a happy medium, it does not address the need for adequate English competence within the midwifery profession in Bangladesh. Ultimately, investing in strengthening English competencies through an ESP model and investing in translating technical content on midwifery into relevant mother tongues are major undertakings. The options for translation will likely be better and more available over time.
There remains, though, the fundamental need for access to up-to-date educational content on evidence-based midwifery care within the midwifery profession. Perhaps a tiered system of requirements for English competencies that are tied to diploma, Bachelor’s, Master’s and PhD midwifery programs could build bridges for some students (who may later become faculty and leaders within the profession) to access global resources. Higher levels might emphasize English more heavily, while the diploma level would follow a multilingualism approach, teach using an ESP curriculum, and have complementary emphasis on the mother tongue. Ideally, scores on a standard English competency exam would be used to assess students’ language competencies prior to entrance in English-based programs.
Methodological considerations
One of the limitations of this study is that it relied on self-reports and observation, rather than tested language and subject matter competencies. Its strengths though are in the relatively large number of education institutes that participated in the study, and the breadth of knowledge about faculty and student subject matter expertise among study co-authors. It was recognized that the lead researcher might be biased toward pre-determined perceptions of English competencies being a barrier to teaching and learning held by the lead institution (UNFPA). It was also recognized that due to the inherent power imbalance between researcher and participants, the manner of gathering data and engaging with stakeholders may contribute to confirmation bias, with respondents primarily sharing what they anticipated the researcher wished to hear (e.g., that English needed strengthening and the lead agency should take action to support the strengthening). The researcher thus engaged with participants independently of UNFPA and employed reflexivity by designing and carrying out the surveys to remotely collect standard data from institutes, and casting a wide net across institutes to increase broad representation. In addition, while institutes were informed that the surveys were gathering information about the English instruction within the institutes, no information was shared about potential new support to institutes. Finally, the researcher validated and gathered further details on the relevant information identified in the surveys through key informant interviews, which were held with stakeholders independent of UNFPA.