It elects 5 Members of the European Parliament (MEPs) on the electoral system of proportional representation by means of the single transferable vote.

[1][2] The Irish Times criticised the wide geographic spread of the constituency, calling it "a heterogeneous mish-mash of counties with little historic or cultural connection to each other".

[3] For the 2019 European Parliament election, a reapportionment following Brexit and the loss of 73 MEPs from the United Kingdom gave two additional seats to Ireland.

This gives the new constituency a population of 1,831,741, as of the 2022 census[7][8] The constituency comprises the counties of Cavan, Donegal, Galway, Kildare, Laois, Leitrim, Longford, Louth, Mayo, Meath, Monaghan, Offaly, Roscommon, Sligo and Westmeath; and the city of Galway.

[9] The main urban areas of Midlands–North-West (by population size) are Galway, Drogheda, Dundalk, Navan, Newbridge, Naas, Portlaoise, Athlone, Mullingar, Letterkenny, Celbridge, Sligo, Maynooth, Leixlip, Ashbourne and Tullamore.