Search

Evidence-based quality care is essential for reducing the high burden of maternal and newborn mortality and morbidity in sub-Saharan Africa. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers. We assessed midwifery care providers’ childbirth and immediate newborn competencies as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) project in Benin, Malawi, Tanzania, and Uganda. We used a self-administered questionnaire assessing knowledge, and skills drills observations assessing skills and behaviours in the 16 ALERT maternity wards. A total of 302 participants took part in the knowledge assessment and 113 skills drills were conducted. The assessments revealed knowledge gaps in frequency of fetal heart rate monitoring and timing of umbilical cord clamping. More than half of the participants scored poorly on aspects related to routine admission tasks, clinical history-taking and rapid and initial assessment of the newborn in the skills drills assessment, while higher scores were achieved in active management of the third stage of labour. The assessment also suggested a lack of involvement of women in decision-making, illustrated by the failure to encourage women to ask questions and failing to report clinical findings back to them. Participants furthermore indicated a lack of support from their managers, supervision and access to education and training resources. Inadequate competency level of the midwifery care providers may be due to gaps in pre-service training but possibly furthermore related to the structural and operational facility characteristics including continuing professional development. Investment and actioning on these findings are needed when developing and designing pre-service and in-service training to ensure women, newborns and families have access to evidence-based and quality midwifery care when needed.Trial registrationPACTR202006793783148—June 17th, 2020.

ObjectivesThe study aimed to assess the determinants of modern contraceptive method use among young women in Benin.DesignA mixed-methods design.Setting and participantsWe used the Benin 2017-18 Demographic and Health Survey datasets for quantitative analysis. Data collection was conducted using multiple-cluster sampling method and through household survey. Qualitative part was conducted in the city of Allada, one of the Fon cultural capitals. The participants were purposively selected.OutcomesContraceptive prevalence rate, unmet need for modern method, and percentage of demand satisfied by a modern method for currently married and sexually active unmarried women were measured in the quantitative part. Access barriers and utilization of modern methods were assessed in the qualitative part.ResultsOverall, 8.5% (95%CI: 7.7-9.5%) among young women ages 15 to 24 were using modern contraceptives and 13% (95%CI: 12.1-14.0%) among women ages 25 or more. Women 15-24 had a higher unmet need, and a lower demand satisfied by modern contraceptive methods compared to women aged 25 or more. 60.8% (56.9-64.7%) of all unmarried young women had unmet need for modern contraceptives. Young women were more likely to use male condoms which they obtain mainly from for-profit outlets, pharmacies, and relatives. The factors associated with demand satisfied by a modern method were literacy, being unmarried, knowing a greater number of modern contraceptive methods, and experiencing barriers in access to health services. On the other hand, the qualitative study found that barriers to using modern methods include community norms about pre-marital sexual intercourse, perceptions about young women’s fertility, spousal consent, and the use of non-modern contraceptives.ConclusionContraceptive use is low among young women in Benin. The use of modern contraceptives is influenced by socio-demographic factors and social norms. Appropriate interventions might promote comprehensive sexuality education, increase community engagement, provide youth-friendly services, and address gender inequalities.Strengths and limitations of this studyThis study used a nationally representative survey data which allows generalizability at the national level.We used a mixed methods design which enables us to compare and discuss the large-scale quantitative data with qualitative information from the ground.The quantitative information could have been affected by recall errors and biases.