Kirsty M Bourret , Marie Chantal Kankolongo , Nadia Lobo , Désiré Banga , Elisa Maffioli , Marie Klingberg-Allvin
{"title":"\"意外怀孕后，我们希望附近的助产士能告诉我们该怎么做\"。刚果民主共和国金沙萨省利益相关者对助产士主导的以妇女为中心的综合人工流产护理的看法：定性描述研究。","authors":"Kirsty M Bourret , Marie Chantal Kankolongo , Nadia Lobo , Désiré Banga , Elisa Maffioli , Marie Klingberg-Allvin","doi":"10.1016/j.midw.2024.104238","DOIUrl":null,"url":null,"abstract":"<div><h3>Problem</h3><div>Midwives are an essential yet underutilised health human resource for improving unsafe abortion outcomes and increasing abortion access and contraceptive care.</div></div><div><h3>Background</h3><div>In Democratic Republic of Congo (DRC), morbidity and mortality resulting from unsafe abortions are alarmingly high. The recent ratification of the Maputo Protocol in 2018 has made safe abortion accessible. National implementation strategies recognise midwives as providers of comprehensive abortion care (CAC), yet there is little understanding of their current role in its provision.</div></div><div><h3>Aim</h3><div>To understand the obstacles and facilitators in integrating the midwifery model of CAC in DRC's health system.</div></div><div><h3>Methods</h3><div>A qualitative descriptive design was used to explore health system stakeholders' perceptions regarding the midwifery model of CAC in Kinshasa, DRC. Data sources included <em>n</em> = 43 key informant interviews and <em>n</em> = 2 FGDs. Results were member-checked with DRC Midwives’ Association (SCOSAF) members.</div></div><div><h3>Findings</h3><div>Findings highlight midwives provided all aspects of CAC, with attention to the psycho-social well-being of their clients and acted as health service navigators in the community. Appropriate midwifery legislation, scope of practice that includes CAC, administrative support and remuneration, and better access to continuing education are facilitating health system factors for the midwifery model of CAC. Finally, SCOSAF, the Midwives’ Association, played an influential role in the implementation, positively supporting CAC integration by midwives.</div></div><div><h3>Discussion</h3><div>Understanding health system levers and the involvement of Midwives’ Associations are important considerations when integrating and sustaining the midwifery model of CAC. Gender transformative approaches are appropriate given systemic gender inequities inherent in midwifery.</div></div><div><h3>Conclusion</h3><div>Further research is needed to understand the impact of the midwifery model of CAC in DRC.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"140 ","pages":"Article 104238"},"PeriodicalIF":2.6000,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"“With an unwanted pregnancy, we are looking for midwives in the neighbourhood to show us what to do.” Stakeholder perceptions of midwife-led woman-centred comprehensive abortion care in the province of Kinshasa, Democratic Republic of Congo: a qualitative descriptive study\",\"authors\":\"Kirsty M Bourret , Marie Chantal Kankolongo , Nadia Lobo , Désiré Banga , Elisa Maffioli , Marie Klingberg-Allvin\",\"doi\":\"10.1016/j.midw.2024.104238\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Problem</h3><div>Midwives are an essential yet underutilised health human resource for improving unsafe abortion outcomes and increasing abortion access and contraceptive care.</div></div><div><h3>Background</h3><div>In Democratic Republic of Congo (DRC), morbidity and mortality resulting from unsafe abortions are alarmingly high. The recent ratification of the Maputo Protocol in 2018 has made safe abortion accessible. National implementation strategies recognise midwives as providers of comprehensive abortion care (CAC), yet there is little understanding of their current role in its provision.</div></div><div><h3>Aim</h3><div>To understand the obstacles and facilitators in integrating the midwifery model of CAC in DRC's health system.</div></div><div><h3>Methods</h3><div>A qualitative descriptive design was used to explore health system stakeholders' perceptions regarding the midwifery model of CAC in Kinshasa, DRC. Data sources included <em>n</em> = 43 key informant interviews and <em>n</em> = 2 FGDs. Results were member-checked with DRC Midwives’ Association (SCOSAF) members.</div></div><div><h3>Findings</h3><div>Findings highlight midwives provided all aspects of CAC, with attention to the psycho-social well-being of their clients and acted as health service navigators in the community. Appropriate midwifery legislation, scope of practice that includes CAC, administrative support and remuneration, and better access to continuing education are facilitating health system factors for the midwifery model of CAC. Finally, SCOSAF, the Midwives’ Association, played an influential role in the implementation, positively supporting CAC integration by midwives.</div></div><div><h3>Discussion</h3><div>Understanding health system levers and the involvement of Midwives’ Associations are important considerations when integrating and sustaining the midwifery model of CAC. Gender transformative approaches are appropriate given systemic gender inequities inherent in midwifery.</div></div><div><h3>Conclusion</h3><div>Further research is needed to understand the impact of the midwifery model of CAC in DRC.</div></div>\",\"PeriodicalId\":18495,\"journal\":{\"name\":\"Midwifery\",\"volume\":\"140 \",\"pages\":\"Article 104238\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-11-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Midwifery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0266613824003218\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Midwifery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0266613824003218","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
“With an unwanted pregnancy, we are looking for midwives in the neighbourhood to show us what to do.” Stakeholder perceptions of midwife-led woman-centred comprehensive abortion care in the province of Kinshasa, Democratic Republic of Congo: a qualitative descriptive study
Problem
Midwives are an essential yet underutilised health human resource for improving unsafe abortion outcomes and increasing abortion access and contraceptive care.
Background
In Democratic Republic of Congo (DRC), morbidity and mortality resulting from unsafe abortions are alarmingly high. The recent ratification of the Maputo Protocol in 2018 has made safe abortion accessible. National implementation strategies recognise midwives as providers of comprehensive abortion care (CAC), yet there is little understanding of their current role in its provision.
Aim
To understand the obstacles and facilitators in integrating the midwifery model of CAC in DRC's health system.
Methods
A qualitative descriptive design was used to explore health system stakeholders' perceptions regarding the midwifery model of CAC in Kinshasa, DRC. Data sources included n = 43 key informant interviews and n = 2 FGDs. Results were member-checked with DRC Midwives’ Association (SCOSAF) members.
Findings
Findings highlight midwives provided all aspects of CAC, with attention to the psycho-social well-being of their clients and acted as health service navigators in the community. Appropriate midwifery legislation, scope of practice that includes CAC, administrative support and remuneration, and better access to continuing education are facilitating health system factors for the midwifery model of CAC. Finally, SCOSAF, the Midwives’ Association, played an influential role in the implementation, positively supporting CAC integration by midwives.
Discussion
Understanding health system levers and the involvement of Midwives’ Associations are important considerations when integrating and sustaining the midwifery model of CAC. Gender transformative approaches are appropriate given systemic gender inequities inherent in midwifery.
Conclusion
Further research is needed to understand the impact of the midwifery model of CAC in DRC.
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