Grossesses non planifiées et avortements à Kinshasa (République Démocratique du Congo) : Défis et progrès

Lince-Deroche, Naomi; Kayembé, Patrick; Blades, Nakeisha; Williams, Patrice; London, Susan; Mabika, Crispin; Philbin, Jesse; Bankole, Akinrinola

doi:10.1363/2019.30887

Cited by 7 publications

(7 citation statements)

References 24 publications

(31 reference statements)

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“…Les femmes continuent de recourir à des avortements clandestins, à cause notamment de la persistance de la stigmatisation et des sanctions sociales [ 30 , 31 ]. En République démocratique du Congo, des professionnels de la santé préconisent au-delà de l'assouplissement de la loi pour garantir des services sûrs et accessibles en matière d'avortement, le combat de la stigmatisation à travers la mise en œuvre des dispositions du protocole de Maputo et la sensibilisation aussi bien des décideurs politiques, des prestataires de services de santé que des populations [ 32 ]. Il faut noter que la fourniture de services médicalisés d'IVG n'est pas un acquis, surtout dans un environnement de défaillance du système de santé.…”

Section: Discussionunclassified

Opinions de femmes sur la législation relative à l'avortement dans la ville de Yaoundé

Mayack

2022

Pan Afr Med J

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Introduction l'accès à l'interruption volontaire de grossesse (IVG) est restrictif au Cameroun. La législation autorise l'acte dans deux cas: lorsque la grossesse résulte d'un viol ou lorsqu'elle fait courir à la femme enceinte un péril grave pour sa santé. L'avortement pratiqué hors de ce cadre légal est qualifié d'illicite. Cet article identifie et analyse les opinions de femmes vivant dans la capitale Yaoundé, sur les dispositions juridiques nationales relatives à l'IVG. Méthodes trente-cinq (35) entretiens semi-directifs ont été réalisés à Yaoundé auprès de femmes âgées de 19 à 40 ans. Les participantes à l'étude recrutées au sortir de consultations (service de planification familiale ou santé maternelle et infantile) ont contribué à la sélection d'autres enquêtées par la méthode «boule de neige». Les données collectées ont fait l'objet d'une analyse thématique de contenu. Résultats plus de la moitié des enquêtées est défavorable à la dépénalisation de l'avortement. La dimension transgressive associée à cet acte constitue l'argument majeur soutenant le refus d'un éventuel assouplissement de la législation. Le motif de la sécurité sanitaire est avancé dans les opinions encourageant la dépénalisation. La difficulté à se positionner ou le silence de participantes est une illustration du caractère sensible du sujet de l'IVG. Conclusion l'avortement dans son essence est porteur de tensions émanant des interactions entre les logiques institutionnelles, les normes du groupe social et les aspirations individuelles. La polarisation des débats est un frein à l'examen de la question de la dépénalisation sous un prisme multidimensionnel.

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Section: Discussionunclassified

Opinions de femmes sur la législation relative à l'avortement dans la ville de Yaoundé

Mayack

2022

Pan Afr Med J

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“…In the DRC, abortion is legally restricted. As a result, clandestine abortions are common and stigmatized [ 7 , 8 ]. Our team gave strict attention to maintaining local collaboration, which is crucial in building trusting relationships and facilitating trustworthiness, particularly when researching topics that intersect with abortion [ 48 ].…”

Section: Methodsmentioning

confidence: 99%

“…The maternal mortality rate in the Democratic Republic of Congo (DRC) is one of the highest in the world (846:100000) [ 5 ]; deaths due to illicit abortions contribute to at least 7% of all deaths [ 5 , 6 ]. In 2016, 40,090 women and girls obtained post abortion care with 77% requiring treatment for complications in the capital city of Kinshasa alone [ 1 , 7 ]. Mortality rates for post abortion complications are as high as 37.8% (95% CI: 23.8–53.5%) [ 8 , 9 ] owing to critical gaps in community hospitals’ provision of basic delivery services and few referral services for post abortion care [ 6 , 7 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Deaths due to unsafe abortion could be reduced from 22,000 to 9000 [ 7 ] per year globally by meeting the need for post abortion care. Certain countries have endorsed the International Confederation of Midwives (ICM) policy on abortion provision [ 12 , 13 ] by incorporating midwives into abortion-based strategies to reduce maternal mortality [ 14 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

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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

Bourret

Larocque

Hien

et al. 2020

BMC Health Serv Res

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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 gro cup 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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“…Before March 2018, induced abortion was not legal under any circumstance in the DRC. However, an article in the code of medical ethics allowed doctors to perform the service to save a woman’s life [ 24 ]. In 2018, the DRC endorsed the African Charter on Human and People’s Rights on the Rights of Women in Africa (Maputo Protocol), which allowed women to legally access abortion under a broader range of conditions—including in cases of sexual assault, rape, or incest [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Strengthening healthcare providers’ capacity for safe abortion and post-abortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo

et al. 2021

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Background Fragile and crisis-affected countries account for most maternal deaths worldwide, with unsafe abortion being one of its leading causes. This case study aims to describe the Clinical Outreach Refresher Training strategy for sexual and reproductive health (S-CORT) designed to update health providers’ competencies on uterine evacuation using both medications and manual vacuum aspiration. The paper also explores stakeholders’ experiences, recommendations for improvement, and lessons learned. Methods Using mixed methods, we evaluated three training workshops that piloted the uterine evacuation module in 2019 in humanitarian contexts of Uganda, Nigeria, and the Democratic Republic of Congo. Results Results from the workshops converged to suggest that the module contributed to increasing participants’ theoretical knowledge and possibly technical and counseling skills. Equally noteworthy were their confidence building and positive attitudinal changes promoting a rights-based, fearless, non-judgmental, and non-discriminatory approach toward clients. Participants valued the hands-on, humanistic, and competency-based training methodology, although most regretted the short training duration and lack of practice on real clients. Recommendations to improve the capacity development continuum of uterine evacuation included recruiting the appropriate health cadres for the training; sharing printed pre-reading materials to all participants; sustaining the availability of medication and supplies to offer services to clients after the training; and helping staff through supportive supervision visits to accelerate skills transfer from training to clinic settings. Conclusions When the lack of skilled human resources is a barrier to lifesaving uterine evacuation services in humanitarian settings, the S-CORT strategy could offer a rapid hands-on refresher training opportunity for service providers needing an update in knowledge and skills. Such a capacity-building approach could be useful in humanitarian and fragile settings as well as in development settings with limited resources as part of an overall effort to strengthen other building blocks of the health system.

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Grossesses non planifiées et avortements à Kinshasa (République Démocratique du Congo) : Défis et progrès

Cited by 7 publications

References 24 publications

Opinions de femmes sur la législation relative à l'avortement dans la ville de Yaoundé

Opinions de femmes sur la législation relative à l'avortement dans la ville de Yaoundé

Midwives’ integration of post abortion manual vacuum aspiration in the Democratic Republic of Congo: a mixed methods case study & positive deviance assessment

Strengthening healthcare providers’ capacity for safe abortion and post-abortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo

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