Improving access to Comprehensive Abortion Care Services among internally displaced women in humanitarian setting through midwifery-led person-centered care: A mixed-method study in Northern Ethiopia

Purpose

A health systems approach will be used to evaluate the implementation of midwifery-led person-centered Comprehensive Abortion Care (CAC) using quantitative and qualitative data collection methods. The project incorporates three studies focusing on induced abortion and contraceptive counselling as part of CAC:  

1. An in-depth qualitative study will explore the perceived needs and preferences of internally displaced women (IDW) related to sexual and reproductive health and rights (SRHR) services.
2. A prospective cross-sectional study will be implemented to evaluate the impact of midwifery-led CAC on the experiences and autonomy, clinical outcomes for induced abortion (medical and/or surgical), contraceptive uptake, and the health care system costs associated with midwifery-led person-centered CAC.
3. An explorative qualitative study will further explore the challenges and opportunities of implementing midwifery-led CAC services in humanitarian settings. 

Expected Outcomes

Based on the preferences and needs of women, the analysis will explore how midwives can be actors in strengthening the access to and quality of CAC programs in humanitarian contexts, which is explained through the theory of change: 

• Evidence from exploration of the SRHR needs and preferences of IDW will inform the design of interventions to facilitate midwife-led CAC programming. 
• Involving midwives in delivering CAC services will improve access to CAC services in humanitarian contexts and lead to improved person-centered clinical outcomes and reproductive autonomy, and enhance the resilience of the health system to provide CAC. 
• Ensuring high quality midwifery-led CAC services will also increase post-abortion contraceptive use, reducing unsafe abortions and associated adverse health outcomes. 
• The research evidence generated by exploring the challenges midwives face in delivering midwife-led CAC services will inform national policy decisions for future investments in the midwifery workforce.  
• Identifying the facilitators and challenges of implementing CAC from a client- and provider-centred perspective will also provide evidence for future program expansion in similar settings.