Midwives integration of manual vacuum aspiration for postabortion care in the Kinshasa and Kongo central provinces of the Democratic Republic of Congo

Abstract

Illicit abortion in the Democratic Republic of Congo (DRC) results in the deaths of tens of thousands of women each year. There is great humanitarian potential for a return on investment if midwives are properly supported in integrating post-abortion care into their practice. In 2017, over 350 Congolese midwives were trained in the use of manual vacuum aspiration (MVA), an inexpensive and lifesaving post-abortion procedure. Yet, to date there is little understanding of its integration into midwifery practice in the DRC. The overarching aim of this thesis was to conduct collaborative research with the Professional Association of Congolese midwives (SCOSAF) in the provinces of Kinshasa and Kongo Central that would assist Congolese midwives to increase their practice of MVA, while modeling an equitable research partnership based on mutual trust and collaboration. The thesis has three chapters that build on each other and serve to demonstrate the unique substantive, methodological and theoretical contributions of the research. Substantively, the dissertation provides initial insight into those midwives who have integrated MVA post training compared to those who have not, as well as an exploration of those strategies used to successfully incorporate it into practice. Furthermore, the dissertation provides a model for conducting collaborative abortion research with midwifery associations and offers an advocacy tool that the midwifery association of SCOSAF can use to influence their expertise in midwifery led post-abortion care in the DRC. Methodologically, the dissertation introduces a novel combination of a mixed method case group comparison using a positive deviant approach. By applying a positive deviant assessment to the research, the dissertation provides a solution-based approach to uncovering the practical ways in which midwives can be supported in integrating post-abortion care into their practice. Lastly, the dissertation advances understanding of Congolese midwives’ integration of post-abortion care into practice through the proposition of a theoretical model that is aligned with regional knowledge.