GCG

RÉSEAU D’AFRIQUE CENTRALE POUR

LA SANTÉ REPRODUCTIVE DES FEMMES

Gabon, Cameroun, Guinée Équatoriale

B.P. 1134 Libreville, GABON

ReseauGCG.gmail.com

Final report to the European Society of Contraception & Reproductive Health

Expert Group on Abortion

Project title:

Gabon-France training program for midwife leaders in Central Africa

September 15, 2015 - January 15, 2016

INTRODUCTION

This project aimed to give Gabonese midwives with preliminary training in post-abortion care exposure to abortion and contraception practice in a context where abortion is legal and integrated in medical establishments. We were able to engage several abortion clinic directors in France to organize training for the midwives in their clinical service. Those trainings would include observation, exchange with French practitioners and experience with medical abortion, surgical abortion (observation only), ultrasound, IUD insertion, post-abortion care with misoprostol and/or aspiration and counselling. In additional to such direct experience, we hoped to facilitate sustainable cooperation between networks of medical practitioners in France and Gabon.

We were able to accomplish our fixed goals beyond our hopes. The present report is a summary of reports written in French by the two midwives in training as well as of evaluation sessions, also in French, conducted with the midwives, other members of the Central African Network, and directors of the abortion clinics in Paris where the trainings took place. The report also details three conferences attended by the midwives (two as presenters) that greatly enhanced the experience.

TRAININGS IN ABORTION CENTERS

Justine Ella Mekui, midwife practitioner at the Public Hospital in Libreville, and Virginie Mengue Abessolo, midwife practitioner in the rural north of Gabon, spent 10 intensive days in three abortion/family planning clinics observing, dialoguing and studying methods with doctors, nurses, midwives and counselors: CHU Bicêtre, Hôpital Trousseau Les Bleuetes, and Hôpital Louis Mourier à Colombe.

Specifically, they focused on pre- and post-abortion interviews, medical abortion including dosage of drugs and interviews with women, practice and dosing for local anesthesia, and different contraception techniques. They stressed the importance of hearing (and, then, discussing) interviews of practitioners with women in a respectful context characterized by trust and open communication. Both midwives said this experience radically transformed their notion of good medical care.

CONFERENCES

1. The midwives participated in the congress of the National Association of Abortion and Contraception (ANCIC) held in Bordeaux. Since we were unable to get financial support for attending this event, GCG co-directors, Gail Pheterson and Aimée Patricia Ndembi Ndembi, donated their honorarium for travel and lodging expenses of the two Gabon midwives. The experience was extremely important for the African context where abortion is illegal. Congress participants spoke about the struggle against stigma and other obstacles to safe abortion care, also in a legal context such as France. For the Gabon midwives, this conference was a political consciousness-raiser and opportunity to meet midwives in France eager to cooperate with their African colleagues. Informal as well as formal exchange set a base, and contact was renewed in Paris with concrete plans for future collaboration. Topics of exchange of particular interest included hospital reception of women after rape or other aggression, female excision, abortion under local versus general anesthesia, adolescent pregnancies and the role of midwives in abortion services.

2. One of the visiting midwives, Justine Mekui, was able to stay additional days due to the kind offer of lodging by an ally in France. This extended stay allowed her to participate in an international conference in Paris sponsored by the French National Institute for Demographic Studies (INED), the Center for Population and Development (CEPED) and the University of Geneva. The conference was titled: Comment progresse l’accès à l’avortement dans des contextes restrictifs? Perspectives historiques et internationales. Justine presented with other members of GCG's team, including a doctoral student, the co-directors and GCG medical trainer, Dr. Marijke Alblas, who came to Paris from Capetown especially for the event. I include here the presentation co-presented at the conference. It is in French, but the photos and short titles should permit also English speakers to follow the general line of the presentation.Our Central Africa network used the opportunity to organize a meeting the day after the major event. At this meeting, we made contact with Doctors without Borders, Women on Waves, individual researchers on abortion and a network of abortion clinics in the Netherlands. These exchanges facilitated the mobilization of funds to extend trainings in Gabon to the rural south.

3. The President of the French Association for Contraception, Dr. Elizabeth Aubény, impressed with the leadership and clinical skills of midwife Justine Mekui, mobilized funds to invite her back to Paris a few months after the training to present a keynote speech at the Association's national meeting. There were over 200 practitioners present. Justine Mekui spoke for 20 minutes about midwife practice related to abortion and contraception in rural Gabon. The reception was enthusiastic, and led to appointments for discussing possible future collaborations, namely a solidarity network in France for sending needed materials and for mobilizing activities during visits of African midwife trainees in France.

CONCLUSION

The Central Africa Network for Women's Reproductive Health (GCG) is convinced of the value of short-term training opportunities for African midwives in France. In addition to the vital learning from clinical integration in an abortion and family planning center, midwives were able participate in international professional activities and to gain strong support from European partners. The experience proved to be extremely enriching for our African network and, according to the feedback received, also enriching to the international community of practitioners, activists and scientists dedicated to safe quality services in the most underserved regions of the world.

It is for all the above reasons that we are reapplying for another year of trainings, this time for two other committed African midwives.

Report prepared by Gail Pheterson

Co-director of the Central African Network for Women's Reproductive Health

April, 2016

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