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

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.

[The vulnerability of women Francophone parent at risk of homelessness in a community in Northern Ontario]. / La vulnérabilité de femmes monoparentales francophones à risque de sans-abrisme dans une communauté du Nord de l'Ontario.

OBJECTIVE: This study aimed to examine the vulnerability of Francophone single mothers at risk of homelessness in Northern Ontario. The project also endeavoured to document the quest for autonomy of these women in a minority context. METHOD: Employing a qualitative approach, eleven life stories were obtained from five women. Although none were homeless at the time of the interviews, in terms of living on the street, two were living with friends and the others were at risk of becoming homeless. All of the participants were between 20 and 59 years old and had completed their secondary education. RESULTS: Taking into account their economic and social situation, as well as the participants' health and cultural resources, vulnerabilities throughout the life course were analyzed. CONCLUSION: The life trajectory of these women showed us that their significant vulnerabilities are relative to the amount of autonomy they are able to secure through the services provided by supporting agencies, particularly in a linguistic minority context. In addition, the triple stigmatization (economic, linguistic and gender relations) requires a broader understanding of the resilience of these women in their journey from poverty (economic) to social (and linguistic) exclusion, and vulnerability. Despite these challenges, each of the individuals interviewed in this study, for whom the quest for autonomy is a continual struggle, demonstrated resilience.