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Return on Investment for Essential Obstetric Care Training in Ghana: Do Trained Public Sector Midwives Deliver Postabortion Care?


  • Kathryn Andersen Clark PhD,

    Corresponding authorSearch for more papers by this author
    • Kathryn Andersen Clark, PhD, is a senior research associate at Ipas, a global, nonprofit reproductive health organization dedicated to reducing deaths and disabilities from unsafe abortion that is located in Chapel Hill, NC.

  • Ellen H. M. Mitchell PhD,

    1. Senior Epidemiologist in the Department of Clinical Epidemiology, Biostatistics and Bioinformatics (KEBB), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.
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  • Patrick Kuma Aboagye MD, MPH3

    1. National Program Coordinator for Reproductive Health with management responsibility for Ghana's postabortion care program, Accra, Ghana.
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Senior Research Associate, Ipas, 300 Market St., Ste. 200, Chapel Hill, NC 27516. E-mail:


Introduction: In Ghana, the provision of postabortion care (PAC) by trained midwives is critical to the efficient and cost-effective reduction of unsafe abortion morbidity and mortality.

Methods: We performed a secondary analysis of provider data from a representative sample of Ghanaian health facilities in order to consider the determinants of PAC provision among both physicians and midwives.

Results: In the previous 5 years, more than 58% of providers had participated in at least one type of essential obstetric training. Overall, 28% of clinicians were offering PAC services (80% of physicians as compared to 20% of midwives). Bivariately, the provision of PAC services was associated with in-service training. After adjusting for select provider and facility characteristics, PAC/MVA training, working in a facility with the National Reproductive Health Standards and Policy available, and not working in a publicly run facility were associated with midwives offering PAC services.

Discussion: Although the provision of PAC by midwives is an efficient and cost-effective strategy for reducing maternal morbidity and mortality, clinical training of midwives leads to a lower yield of PAC providers when compared to physicians. Policy and practice should continue to support PAC expansion by trained midwives in the public sector and by understanding the barriers to provision of services by midwives working in public facilities.

J Midwifery Womens Health 2010;55:153–161 c̊ 2010 by the American College of Nurse-Midwives. Published by Elsevier Inc. All rights reserved.