Evidence-informed framework for gender transformative continuing education interventions for midwives and midwifery associations

INTRODUCTION

Continuing education for midwives is an important investment area to improve the quality of sexual and reproductive health services. Interventions must take into account and provide solutions for the systemic barriers and gender inequities faced by midwives. Our objective was to generate concepts and a theoretical framework of the range of factors and gender transformative considerations for the development of continuing education interventions for midwives.

METHODS

A critical interpretive synthesis complemented by key informant interviews, focus groups, observations and document review was applied. Three electronic bibliographic databases (CINAHL, EMBASE and MEDLINE) were searched from July 2019 to September 2020 and were again updated in June 2021. A coding structure was created to guide the synthesis across the five sources of evidence.

RESULTS

A total of 4519 records were retrieved through electronic searches and 103 documents were included in the critical interpretive synthesis. Additional evidence totalled 31 key informant interviews, 5 focus groups (Democratic Republic of Congo and Tanzania), 24 programme documents and field observations in the form of notes. The resulting theoretical framework outlines the key considerations including gender, the role of the midwifery association, political and health systems and external forces along with key enabling elements for the design, implementation and evaluation of gender transformative continuing education interventions.

CONCLUSION

Investments in gender transformative continuing education for midwives, led by midwifery associations, can lead to the improvement of midwifery across all United Nations' target areas including governance, health workforce, health system arrangements and education.

Delivery room logbook - fact or fiction?

The delivery room logbook entries of Gimbie Adventist Hospital for a period of one month were monitored and compared with the actual number of births recorded on a separate worksheet for that period. The implications of the missing data were reviewed. This data was compared to a previous audit of the same design. Eighty per cent of births were recorded during this one month period which reflected an improvement from 72% reported in a previous study. Underreporting resulted in discrepencies when calculating the number of births and signal functions such as caesarean section rates, blood transfusion, administration of parenteral anticonvulsants and removal of retained products. In turn, these discrepencies impact the calculation of process indicators of safe motherhood projects. The reliability of the delivery room logbook as the sole source of information to create health policy and to monitor and evaluate health programs is questionable.

A community-based long-term follow up of women undergoing obstetric fistula repair in rural Ethiopia

OBJECTIVES

To assess urinary and reproductive health and quality of life following surgical repair of obstetric fistula.

DESIGN

Follow-up study.

SETTING

A newly established fistula clinic (2004) at Gimbie Adventist Hospital, a 71-bedded district general hospital in West Wollega Zone, in rural Western Ethiopia.

POPULATION

Thirty-eight women (86%) of 44 who had undergone fistula repair were identified in their community.

METHODS

Community-based structured interviews 14-28 months following fistula repair, using a customised questionnaire addressing urinary health, reproductive health and quality of life.

MAIN OUTCOME MEASURES

Urinary health at follow up was assessed as completely dry, stress or urge incontinence, or fistula. King's Health Questionnaire was modified and used for the quality-of-life assessment.

RESULTS

At follow up, 21 women (57%) were completely dry, 13 (35%) suffered from stress or urge incontinence and three (8%) had a persistent fistula. Surgery improved quality of life and facilitated social reintegration to a level comparable to that experienced before fistula development for both women who were dry and those with residual incontinence (P = 0.001). For women still suffering from fistula no change was seen (P = 0.1). Four women became pregnant following their surgery, among which there was one maternal death, three stillbirths and one re-occurrence of fistula.

CONCLUSION

Community-based, long-term follow up after fistula repair succeeded in Western rural Ethiopia. Despite one-third still suffering stress or urge incontinence, the women reported improved quality of life and social reintegration after fistula closure.