“You must first save her life”: community perceptions towards induced abortion and post-abortion care in North and South Kivu, Democratic Republic of the Congo

Abstract Background: Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF.Methods: Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison group and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results: All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.

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Midwives’ Integration of Post-Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

10.21203/rs.3.rs-59473/v1 ◽

2020 ◽

Author(s):

Kirsty Marie Bourret ◽

Sylvie Larocque ◽

Amélie Hien ◽

Carol Hogue ◽

Kalum Muray ◽

...

Keyword(s):

Democratic Republic ◽

Democratic Republic Of Congo ◽

Statistical Significance ◽

Republic Of Congo ◽

Abortion Care ◽

Vacuum Aspiration ◽

Post Abortion Care ◽

Manual Vacuum Aspiration ◽

Post Abortion

Abstract Background: This collaborative research with the Professional Association of Congolese midwives (SCOSAF) in the province of Kinshasa, Democratic Republic of Congo sought to understand how midwives have integrated manual vacuum aspiration (MVA) for post abortion care. Methods: A positive deviant approach to Creswell’s mixed method comparative case study design was used to identify midwives who have integrated MVA post training and to explore enabling factors. Case group comparisons of positive and non-positive deviant midwives provided further interpretations. Results: All 102 midwives invited to be surveyed were recruited. They included 34% who reported practicing MVA post training. No statistical significance was found between the two groups’ demographics and facility type. Overall, groups had positive attitudes regarding midwifery, MVA, and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for its overall impact on the diffusion of midwifery led MVA to improve access to safe respectful reproductive care.

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“Provide care for everyone please”: engaging community leaders as sexual and reproductive health advocates in North and South Kivu, Democratic Republic of the Congo

Reproductive Health ◽

10.1186/s12978-019-0764-z ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 1

Author(s):

Victoria J. Steven ◽

Julianne Deitch ◽

Erin Files Dumas ◽

Meghan C. Gallagher ◽

Jimmy Nzau ◽

...

Keyword(s):

Reproductive Health ◽

Sexual And Reproductive Health ◽

Democratic Republic ◽

Community Leaders ◽

Republic Of The Congo ◽

South Kivu ◽

North And South

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Factors Associated with Unsafe Induced Abortion among Women who attended Fitche Hospital, Oromia, Ethiopia: Cross-sectional study

10.21203/rs.2.10385/v1 ◽

2019 ◽

Author(s):

Abebe Feyissa Amhare ◽

Dereje Gobena Alemayehu ◽

Alemtsehay Adam Bogale

Keyword(s):

Care Service ◽

Traditional Birth Attendant ◽

Multivariate Logistic Regression Analysis ◽

Cross Sectional Study ◽

Induced Abortion ◽

Sectional Study ◽

Cross Sectional ◽

Abortion Care ◽

Post Abortion Care ◽

Post Abortion

Abstract Background Unsafe induced abortion is one of the most medical and public health problems in developing countries including Ethiopia. Ethiopia has permitted abortion in specific legal circumstances when the conception of the fetus is caused by rape, incest, when continuation of pregnancy endangers the mother’s life. The aim of this study is to assess the magnitude and associated risk factors of unsafe induced abortion among women who received post abortion care service in Fitche Hospital. Methods Institutional based cross-sectional study was carried out among women who received post abortion care service at Fitche hospital from November 30, 2017 up to May 30, 2018. The data was collected using pre tested questionnaire and entered to EpiData version 3.1 software and analyzed using SPSS version 24. Descriptive statistics, multivariate logistic regression analysis and chi-square test were conducted. Results Three hundred and eight respondents (100% response rate) with mean age of 30 ± 9 years were participated in this study. From respondents, 45% had history of unsafe induced abortion and 27% of them reported the abortion was performed in house by traditional birth attendant. Single women were more likely practice unsafe induced abortion than widowed women [OR: 9.71; 95%CI (1.30 – 72.42)]. Women who had low monthly income [OR: 6.72; 95%CI (2.15 - 20.97)] and house wives [OR: 12.29; 95%CI (1.70 - 88.63)] were more likely practice unsafe induced abortion than counterparts. Failure of contraceptive methods, place of interference, method used for interference, a person who induced the abortion, a condition after procedure, and reasons to induce abortion were identified as association factors of unsafe induced abortion at P < 0.001. Conclusion The study assessed the magnitude and reported a significant association between unsafe induced abortion and socio-demographic factors, contraceptive practice, and abortion related items. These findings are positive enough to warrant a large-scale study to better understand the unsafe abortion vulnerability factors in Ethiopia.

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Contraceptive situation and Influencing Factors in Guangdong Province: A comparative questionnaire study

10.21203/rs.3.rs-220653/v1 ◽

2021 ◽

Author(s):

FAN JIANG ◽

Yanxia Qu ◽

Peixuan Lin ◽

Li Li ◽

Qingshan Xuan ◽

...

Keyword(s):

Family Planning ◽

Health Care Providers ◽

Contraceptive Use ◽

Induced Abortion ◽

Care Providers ◽

Monthly Income ◽

Abortion Care ◽

Post Abortion Care ◽

Contraceptive Services ◽

Post Abortion

Abstract BackgroundThe aim of our study is to describe the status of induced abortion and contraceptive use in reproductive women and make clear the correlated factors in Guangdong province.MethodA self-administered questionnaire survey was conducted separately in 1839 individuals aged 18–49 and 900 health care providers from Guangdong province. The content of questionnaire was based on status of induced abortion and contraceptive use for the former and problems concerning contraceptive services for the latter. Systematic random sampling was used and data were analyzed using SPSS 19.0. Descriptive statistics and binary logistic regression were used in this study.Results30.61% of participants experienced the induced abortion. The rate of repeated abortion was 19.96% and it was 20.45% in persons under 20 years old. 18.23% of 1839 individuals chose LARC as the main contraceptive method. The females with college degree(Odds ratio, OR = 1.867; 95% confidence intervals 95%CI: 1.175–2.969), technologists(OR = 2.291; 95%CI: 1.063–4.936) and the persons whose monthly income were of between 3000–5000¥(OR = 1.920; 95%CI: 1.204–3.065) were more likely to use LARC. The younger females less than 30 years old and never using PAC services had lower odds of using LARC. The rate of post abortion care performance was merely 12.23%. Age, monthly income, occupation, living conditions and obtaining free contraceptives in time were all strongerly influence factors for the use of post-abortion care(P < 0.01). The satisfaction rate of free contraceptive services was about 57.44%. Variety uniformity, obtaining inconveniently and worrying about the quality were the main reasons. 66.22% of hospitals set up the department of family planning in our study. Highly work intensity(54.67%) and less leadership (40.22%) influenced health care providers to provide family planning services.ConclusionThe abortion rate was high especially in young women. There were many problems affecting contraceptive services which damaged women’reproductive health. Increasing government investment for family planning services, strengthening the construction of the family planning department and performing post abortion care and long-acting reversible contraception by taking relevant steps would be useful measures for improving current contraceptive status.

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Midwives’ Integration of Post Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

10.21203/rs.3.rs-59473/v3 ◽

2020 ◽

Author(s):

Kirsty Marie Bourret ◽

Sylvie Larocque ◽

Amélie Hien ◽

Carol Hogue ◽

Kalum Muray ◽

...

Keyword(s):

Democratic Republic ◽

Democratic Republic Of Congo ◽

Positive Deviance ◽

Republic Of Congo ◽

Abortion Care ◽

Vacuum Aspiration ◽

Post Abortion Care ◽

Manual Vacuum Aspiration ◽

Post Abortion

Abstract Background: Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF.Methods: Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison group and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results: All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.

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