Hearing the voices of midwives through reflective writing journals: Qualitative research on an educational intervention for Respectful Maternity Care in Zimbabwe.

Women attending public and private sector health facilities in Africa have reported abuse and neglect during childbirth, which carries a risk of poor health outcomes. We explored from the midwives' perspective the influence of an educational intervention in changing the attitudes, behaviour and practices of a group of midwives in Zimbabwe, using transformative learning theory as the conceptual framework. The twelve-week educational intervention motivating for Respectful Maternity Care consisted of a two-day workshop and five follow-up sessions every two weeks. Thematic analysis was conducted on eighteen reflective journals written by the midwives with member-checking during follow-up discussions and a further one-day participative workshop a year later. The midwives reported being more women-centred, with involvement of birth companions and use of different labour positions, stronger professional pride and agency, collaborative decision-making and less hierarchical relationships which persisted over the year. Their journal narratives included examples of treating birthing women with more compassion. Some categories aligned with the phases of transformative learning theory (self-examination of prior experience, building of competence and self-confidence into new roles and relationships). Others related to improving communications and effective teamwork, providing role-models of good behaviour, use of scientific knowledge to inform practice and demonstrating competence in management of complex cases. This study shows that innovative educational initiatives have the potential to change the way midwives work together, even in challenging physical environments, leading to a shared vision for the quality of service they want to provide, to improve health outcomes and to develop life-long learning skills.

The role of women in promoting voluntary medical male circumcision uptake: Literature review.

Voluntary medical male circumcision (VMMC) is a global strategy for reducing female-to-male sexual transmission of HIV. Women whose partners are circumcised benefit from a reduced risk of contracting other sexually transmitted diseases; making their role in VMMC critical. The objective of our study was to identify and synthesize existing evidence related to women's role in promoting VMMC from a regional perspective. The review and selection process were guided by the Problem; Intervention; Comparison and Outcome (PICO) model, which facilitated the exclusion of irrelevant studies. The search strategy search terms for the PICO components with synonyms, related terms and specialist terms were harvested from the Medical Subject Headings (MeSH)© and Embase©. The inclusion criteria were published studies in English and relevant to women's role in VMMC for the prevention of HIV between 2007 and 2020. Four key categories emerged from the literature as follows: role of women, VMMC uptake, barriers and facilitators of VMMC. The majority of the studies concur on the importance of involving women in VMMC uptake as they have the power to negotiate with their male partners through communication and can persuade men to be circumcised, making it a joint decision. The benefits of VMMC in improving sexual pleasure and attractiveness of the penis seemed to positively convince women to influence and educate men to improve the uptake of VMMC. Women are motivated to convince men to undergo male circumcision (MC) because of the benefits associated with them such as reduction of HIV transmission and cervical cancer. There are, however, limited studies focusing on women's involvement in VMMC; hence, more research to explore this area is recommended. Contribution: This review revealed the important role played by women in influencing men to undergo MC but highlight the need for more studies on women's involvement in VMMC.

The role of women in promoting voluntary medical male circumcision uptake: Literature review

Voluntary medical male circumcision (VMMC) is a global strategy for reducing female-to-male sexual transmission of HIV. Women whose partners are circumcised benefit from a reduced risk of contracting other sexually transmitted diseases; making their role in VMMC critical. The objective of our study was to identify and synthesize existing evidence related to women's role in promoting VMMC from a regional perspective. The review and selection process were guided by the Problem; Intervention; Comparison and Outcome (PICO) model, which facilitated the exclusion of irrelevant studies. The search strategy search terms for the PICO components with synonyms, related terms and specialist terms were harvested from the Medical Subject Headings (MeSH)© and Embase©. The inclusion criteria were published studies in English and relevant to women's role in VMMC for the prevention of HIV between 2007 and 2020. Four key categories emerged from the literature as follows: role of women, VMMC uptake, barriers and facilitators of VMMC. The majority of the studies concur on the importance of involving women in VMMC uptake as they have the power to negotiate with their male partners through communication and can persuade men to be circumcised, making it a joint decision. The benefits of VMMC in improving sexual pleasure and attractiveness of the penis seemed to positively convince women to influence and educate men to improve the uptake of VMMC. Women are motivated to convince men to undergo male circumcision (MC) because of the benefits associated with them such as reduction of HIV transmission and cervical cancer. There are, however, limited studies focusing on women's involvement in VMMC; hence, more research to explore this area is recommended.

African midwifery students' self-assessed confidence in postnatal and newborn care: A multi-country survey.

BACKGROUND: Majority of maternal and new-born deaths occur within 28 hours and one week after birth. These can be prevented by well-educated midwives. Confidence in postnatal and newborn care skills depend on the quality of midwifery education. OBJECTIVE: To assess confidence and its associated factors for basic postnatal and new-born care skills of final year midwifery students , from seven African countries. METHODS: A multi-country cross-sectional study where final year midwifery students answered a questionnaire consisting of basic skills of postnatal and newborn care listed by the International Confederation of Midwives. The postnatal care area had 16 and newborn care area had 19 skill statements. The 16 skills of postnatal care were grouped into three domains through principle component analysis (PCA); Basic postnatal care; postnatal complications and educating parents and documentation. The 19 skills under the newborn care area were grouped into three domains; Basic care and care for newborn complications; Support parents for newborn care; and Care for newborns of HIV positive mothers and documentation. RESULTS: In total 1408 midwifery students from seven Sub-Saharan countries participated in the study namely; Kenya, Malawi, Tanzania, Uganda, Zambia, Zimbabwe, and Somaliland Overall high confidence for all domains under Post Natal Care ranged from 30%-50% and for Newborn care from 39-55%. High confidence for postnatal skills was not found to be associated with any background variables (Age, sex, type and level of educational programme). High confidence for newborn care was associated with being female students, those aged 26-35 years, students from the direct entry programmes and those enrolled in diploma programmes. CONCLUSIONS: Almost half of the study participants expressed lack of confidence for skills under postnatal and newborn care. No association was found between high confidence for domains of postnatal care and background variables. High confidence was associated with being a female, between 26-35 years of age, from direct entry or diploma programmes for newborn care area. The results of the study indicate gaps in midwifery education. Countries could use the ICM list of competencies to develop country specific standards for midwifery education. However, actual competence remains to be measured.

African midwifery students' self-assessed confidence in antenatal care: a multi-country study.

Background: Evidence-based antenatal care is one cornerstone in Safe Motherhood and educated and confident midwives remain to be optimal caregivers in Africa. Confidence in antenatal midwifery skills is important and could differ depending on the provision of education among the training institutions across Africa.Objective: The aim of the study was to describe and compare midwifery students' confidence in basic antenatal skills, in relation to age, sex, program type and level of program.Methods: A survey in seven sub-Saharan African countries was conducted. Enrolled midwifery students from selected midwifery institutions in each country presented selfreported data on confidence to provide antenatal care. Data were collected using a selfadministered questionnaire. The questionnaire consisted of 22 antenatal skills based on the competency framework from the International Confederation of Midwives. The skills were grouped into three domains; Identify fetal and maternal risk factors and educate parents; Manage and document emergent complications and Physical assessment and nutrition.Results: In total, 1407 midwifery students from seven Sub-Saharan countries responded. Almost one third (25-32%) of the students reported high levels of confidence in all three domains. Direct entry programs were associated with higher levels of confidence in all three domains, compared to post-nursing and double degree programs. Students enrolled at education with diploma level presented with high levels of confidence in two out of three domains.Conclusions: A significant proportion of student midwives rated themselves low on confidence to provide ANC. Midwifery students enrolled in direct entry programs reported higher levels of confidence in all domains. It is important that local governments develop education standards, based on recommendations from the International Confederation of midwives. Further research is needed for the evaluation of actual competence.

Conducting international research in midwifery: a workshop held at the ICM Congress, Vienna, April 2002.

A workshop on international research in midwifery was held at the triennial International Confederation of Midwives (ICM) Congress in Vienna, April 2002. Thirty-five participants from 12 countries took part. The participants themselves defined the agenda, and subsequent discussion addressed the following issues: international research relationships and collaboration; ethical conduct in international research in midwifery; the role of the ICM in international research; and identifying topics for an international midwifery research agenda. Recommendations arising from this workshop were: that guidelines and a code of ethics for the conduct of international research in midwifery be developed; that the ICM and national midwifery organisations continue to actively support research, and further develop that support; that the ICM support education and capacity building for research at basic and continuing education levels; and that the priorities identified for collaborative international studies be updated on a regular basis.