Sara E. Casey, Guma Patrick Isa, Abdou Sebushishe, Preethika Sundararaj, Megan Piccirillo, Javed Ali, Shiromi M. Perera
South Sudan has extremely high maternal mortality, driven in part by an underfunded health system and a shortage of trained health workers. Skilled birth attendants are essential to reducing maternal mortality. International Medical Corps supports competency-based midwifery education in three schools in South Sudan, offering a 2.5-year certificate and a 3-year diploma aligned with international standards for midwifery practice. A mixed methods evaluation was conducted to assess the strengths and challenges of the midwifery education program to inform program improvement. This manuscript presents data on midwife graduates' perspectives on the training and their work as midwives. A survey was conducted with 314 graduates, complemented by in-depth interviews (n = 15) and daily task diaries (n = 21). Most graduates (76.4%) were currently working as midwives, with nearly half (47.5%) based in rural areas. They reported high satisfaction with their training, felt largely prepared for their roles, and expressed pride in their profession. Graduates felt most competent in providing antenatal care, safe childbirth services and short-acting contraceptives, and least competent providing prevention of mother-to-child transmission of HIV and long-acting reversible contraceptives. Commonly reported challenges included inadequate infrastructure and insecurity. Given the limited evidence on midwifery graduates' experiences in conflict-affected settings, these findings offer valuable insights for strengthening midwifery education and workforce support. Graduates work throughout the country, including in rural areas, supporting women through safe and healthy pregnancies. Strong partnerships between ministries of health and partners are essential to address challenges, support midwives and strengthen health systems, while upholding women's rights to good quality, respectful care.