Department of Women and Children's Health, Karolinska Institutet, Stockholm 17177, Sweden.
La Société Congolaise de la Pratique Sage-Femme, Kinshasa General Hospital, Kinshasa, Democratic Republic of the Congo.
Midwifery. 2025 Jan;140:104238. doi: 10.1016/j.midw.2024.104238. Epub 2024 Nov 12.
Midwives are an essential yet underutilised health human resource for improving unsafe abortion outcomes and increasing abortion access and contraceptive care.
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.
To understand the obstacles and facilitators in integrating the midwifery model of CAC in DRC's health system.
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 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.
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.
Further research is needed to understand the impact of the midwifery model of CAC in DRC.
助产士是改善不安全堕胎结局和增加堕胎机会以及避孕护理的重要但未充分利用的卫生人力资源。
在刚果民主共和国（DRC），不安全堕胎导致的发病率和死亡率高得惊人。最近，2018 年批准了《马普托议定书》，使安全堕胎变得可行。国家实施战略承认助产士是全面堕胎护理（CAC）的提供者，但对他们在提供护理方面的作用了解甚少。
了解在刚果民主共和国卫生系统中整合助产士模式的全面堕胎护理的障碍和促进因素。
采用定性描述设计，探讨金沙萨卫生系统利益攸关方对助产士模式的全面堕胎护理的看法。数据来源包括 n = 43 名关键知情人访谈和 n = 2 次小组讨论。结果与刚果民主共和国助产士协会（SCOSAF）成员进行了成员检查。
研究结果强调助产士提供了全面堕胎护理的各个方面，关注客户的心理社会福祉，并在社区中充当卫生服务导航员。适当的助产士立法、包括 CAC 的实践范围、行政支持和报酬，以及更好地获得继续教育，都是有利于全面堕胎护理助产士模式的卫生系统因素。最后，助产士协会 SCOSAF 在实施过程中发挥了重要作用，积极支持助产士整合全面堕胎护理。
了解卫生系统杠杆和助产士协会的参与对于整合和维持全面堕胎护理的助产士模式是重要的考虑因素。鉴于助产士中存在系统的性别不平等，性别转换方法是合适的。
需要进一步研究了解刚果民主共和国全面堕胎护理助产士模式的影响。
