A health systems approach to evaluating the impact of midwifery-led person-centered comprehensive abortion care in the Democratic Republic of Congo: A mixed method and quasi experimental evaluation

Poor access to contraceptives, unintended pregnancies and subsequent unsafe induced abortion in Democratic Republic of Congo (DRC) result in the deaths of tens of thousands of women annually.

The midwifery model prioritizes a person-centered and equitable approach to care that can improve maternal outcomes related to unsafe abortion and reduce unwanted pregnancies.

Yet, globally, evidence warns that scaling-up interventions for midwives are ineffective because they fail to address the profession’s unique status and needs within health systems.

In DRC, there is great humanitarian potential for a return on investment if midwives are properly supported in the health system to provide person-centered care.

This project will explore how to sustainably support midwives to provide Person Centered Comprehensive Abortion Care (PCCAC) in DRC and evaluate its impact on women’s access to and experiences of quality care and reproductive autonomy. It will build on the applicant’s previous research and established local partnerships.

A multi-disciplinary research team at the Karolinska Institutet, McMaster University, University of Michigan, Swedish Embassy (Kinshasa) and research consortium in DRC will support the applicant to conduct this innovative research using two interconnected studies.

First, we will use an embedded case study to explore the roles of midwives within the DRC health system in order to design a context appropriate intervention to support the scale up of midwife led PCCAC.

Second, we will conduct a quasi-experimental evaluation to measure the impact and cost-effectiveness of midwife-led PCCAC on the quality of women’s experiences, and contraceptive uptake. This will include an embedded process evaluation to inform outcomes.

The intervention will be implemented by IPAS DRC, taking advantage of a unique window of opportunity as they concurrently conduct activities to support the implementation of new guidelines for Comprehensive Abortion Care in the country.