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| David and Lucille Packard Foundation |
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Despite the country’s law that makes abortion legal only to save the life of the woman, induced abortion is common in Nigeria. Approximately one in 10 Nigerian women has had an abortion in her lifetime and abortion is most common for women younger than 25, according to a 2006 Guttmacher Institute report. Not only is abortion fairly common, unsafe abortion remains a national problem. In spite of the common use of technologies with normally low complications rates, one in four women who undergo a surgical abortion has serious complications which suggest that the procedures are often performed by unskilled practitioners or in unhygienic conditions or both, according to the same report. The tremendous number of unsafe abortions makes lifesaving postabortion care (PAC) to treat complications from unsafe abortion with manual vacuum aspiration or medical abortion particularly important. In many countries such as Nigeria, skilled health providers are scarce and training midlevel providers, who far outnumber physicians and often work in rural, underserved areas, in postabortion care creates greater access to such lifesaving care for women.
One strategy to improve midwives’ capacity to treat postabortion complications is documented this month in the International Journal of Gynecology and Obstetrics. “An evaluation of a national intervention to improve the postabortion care content of midwifery education in Nigeria,” written by Akin Akiode, Tamara Fetters, Ramatu Daroda, Bridget Okeke and Ejike Oji, reports the results of an assessment of a multi-year national intervention to improve postabortion care training in all 70 schools of midwifery in Nigeria.
The three-year evaluation took place between 2003 and 2006 and illustrates significant improvements in the PAC training content and capacity among instructors at all 70 schools of midwifery, among the six national midwifery training centers, and among midwifery graduates from six schools where all graduates were contacted and interviewed six to nine months post-graduation. To date, this is the most comprehensive evaluation of a national midwifery program and one of the few times that post-graduation outcomes among students have been attributed to a change in a national midwifery education program. “The model provides a unique critical examination of a national model for scaling up and improving skills of midwives,” says Tamara Fetters, Ipas senior associate for Research and Evaluation and one of the study’s authors.
This paper contributes to the field of programmatic evaluation, midwifery education, and safe and unsafe abortion, a neglected medical education topic. “Few documented models for improving standards of midwifery education in Southern Hemisphere countries are available in the published literature, so this study makes an important contribution to workforce capacity building,” says Janie Benson, vice president for Research and Evaluation at Ipas.
For more information, contact media@ipas.org