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In May, Shirley Owino, manager of Ipas’s Africa regional program, and Eleanor Howe, an associate in Ipas’s development unit, traveled to Ghana to work with the Ipas Ghana staff on plans to expand access to comprehensive abortion care in the country. While there, they visited a local health center to observe Ipas training efforts in practice; this is Eleanor’s report.

The small room was hot and muggy, crowded with equipment and people. The one working fan was no defense against the temperature and humidity, both inching higher as the afternoon sun slipped through the open window. The midwife’s once-crisp uniform was drenched with sweat, but whether from the heat or the intensity of the moment, it was difficult to know.

Crowding around her as she carefully laid out sterile instruments on a tray were five other midwives who, like herself, had recently been trained to perform abortions with the manual vacuum aspirator (MVA): an experienced midwife/training mentor, two Ipas trainers, Shirley and myself. We were at Dansoman Health Centre on the outskirts of Ghana’s capital, Accra, for a training exercise known as a “swap visit,” where newly trained abortion providers demonstrate – and receive feedback on – the process of providing comprehensive abortion care. (Comprehensive abortion care is a woman-centered approach to abortion, including pre-abortion counseling and post-abortion family planning counseling).

The sounds of busy city life floated through the window: Tro-tro (small public buses) horns honked incessantly, and passers-by called to each other on the dusty street. Within the center’s compound, the hard benches in the open-air waiting area were crowded with patients. However, inside the procedure room, as the heat continued to mount, the patient seemed oblivious to her surroundings.

She told the midwife who conducted the intake interview she was 40, five weeks pregnant and a trader at the local market. She already had five children and did not want another. For several years she had used injectable birth control but then decided to try another approach that failed. She did not feel she could carry the baby to term and place it for adoption, she said. She had thought carefully about her options, and when she learned that the health center provided legal and safe abortion care, her mind was made up. She had left her tomato stand in the care of a friend and come to the health center for the “one touch,” as some women in Ghana call the MVA procedure, and an intrauterine device (IUD). When the intake nurse asked if she would like to participate in the swap visit, she didn’t blink an eye. And so it was that 10 of us gathered around her as the procedure began.

Ipas’s Mentor Provider Network training model identifies, supports and builds a network of highly skilled abortion providers and mentors. Swap visits, although costly because they require a large time commitment from trainers, are key to building a successful program. Approximately three to six months after receiving training, three new providers from one facility visit another facility and observe the new providers there as they demonstrate how they deliver abortion care  from start (intake) to finish (when the patient leaves with a birth control method) under the supervision of a mentor. Following a checklist, the visiting providers review the facility, including the reception area, client flow and privacy, availability of information materials, infection prevention and contraceptives, and the 54 detailed steps for a successful procedure. They discuss the procedure, asking questions and making suggestions. Then, approximately a week or two later, the providers reverse roles and repeat the visit at the other facility.

In Dansoman that day, the MVA procedure was over 20 minutes after it began. The IUD was in place, and the client was resting before rushing back to her market stand. The midwives sat around a table in the next room and talked about why getting trained to provide abortion care was important to them. “I worked in a gynecology ward where most of the abortion cases were incomplete. I saw a lot of young girls with complications, and some had to have intensive treatments,” Christina Addo, the mentor trainer explained. “With the training, wherever I may be – even when I retire – I can provide services to help save women’s lives.”  

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For more information, contact media@ipas.org