Abstract
Introduction
The International Confederation of Midwives (ICM) represents 132 midwifery associations in 113 countries. The ICM disseminates the Essential Competencies for Basic Midwifery Practice (EC) that describes the global scope of midwifery practice. The basic (core) and expanded (additional or optional) role of midwives in providing abortion-related care services was first described in 2010. A literature review about three items that are particularly critical to access to abortion services was conducted. Findings that emerged in the recent 2016–2017 update study about these three items are presented.
Methods
A modified Delphi study was administered via the Internet in a series of three rounds. Thirty-seven statements of abortion-related knowledge and skill were presented.
Results
A total of 895 individuals participated. The total of respondents across all three rounds represented 90 of the 105 member countries at the time of the study. The role of midwives in providing comprehensive abortion care, including referral for abortion and provision of postabortion family planning, achieved the necessary 85% agreement to be designated as essential (basic) knowledge or skill for the global scope of midwifery practice. The provision of medication abortion and performance of manual vacuum aspiration abortion were designated as optional for midwives who wished to provide these services. Endorsement of these latter practices was highest in both Francophone and Anglophone regions of Africa, Asian Pacific countries, and countries at a lower state of economic development.
Conclusion
The role of midwives in provision of abortion-related care services was reaffirmed in the recent Delphi study to inform the update to the EC. The role of midwives as direct providers of medical and vacuum aspiration abortions was reaffirmed for those individual midwives who wish to obtain the requisite competency to provide those services, in jurisdictions where these services are legally authorized.
Acknowledgments
The research team was supported at all stages of the study by a Core Working Group and a Task Force. The Core Working Group comprised representatives of the ICM’s Education Standing Committees’ Competencies and Standards Section, the ICM Board, and midwifery educators from ICM regions. The Task Force comprised representatives from the North American Registry of Midwives and the Midwives Alliance of North America, the European Midwifery Association, and ICM-affiliated organizations including the Global Health Workforce Alliance, the World Health Organization Maternal and Child Health Committee, Jhpiego, the Fédération Internationale de Gynécologie et d’Obstétrique Safe Motherhood Committee, and Save the Children. Core ICM staff also supported the study through conducting translations and serving as primary contact with membership organizations.
The authors thank the midwifery faculty at the University of British Columbia and particularly thank midwifery student Caitlin Frame, who provided support for the evidence reviews.
This study was funded by the International Confederation of Midwives (ICM). ICM played no role in the analysis of these data or in the writing of this paper. The funder has granted full rights to researchers to publish accounts of the research.
Disclosure
The authors report no conflicts of interest in this work.