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BackgroundMidwifery support and care led by midwives is the most appropriate strategy to improve maternal and newborn health. The Government of Ethiopia has recently improved the availability of midwives by scaling up pre-service education. However, the extent to which graduating students acquire core competencies for safe and effective practice is not known. The purpose of this study was to evaluate the quality of midwifery education by assessing the competence of graduating midwifery students.MethodsWe conducted a cross-sectional study to assess the competence of students who completed basic midwifery education in Ethiopia in 2013. We interviewed students to obtain their perceptions of the sufficiency and quality of teachers and educational resources and processes. We assessed achievement of essential midwifery competencies through direct observation, using a 10-station Objective Structured Clinical Examination (OSCE). We calculated average percentage scores of performance for each station and an average summary score for all stations. Chi-square test, independent sample t test, and linear regression analysis were used to assess the statistical significance of differences and associations.ResultsWe assessed 484 graduating students from 25 public training institutions. Majority of students rated the learning environment unfavorably on 8 out of 10 questions. Only 32 % of students managed 20 or more births during training, and just 6 % managed 40 or more births. Students’ overall average competence score was 51.8 %; scores ranged from 32.2 % for manual vacuum aspiration to 69.4 % for active management of the third stage of labor. Male gender, reporting sufficient clinical experience, and managing greater numbers of births during training were significant predictors of higher competence scores.ConclusionsThe quality of pre-service midwifery education needs to be improved, including strengthening of the learning environment and quality assurance systems. In-service training and mentoring to fill competence gaps of new graduates is also essential.

Introduction: To stop violence against women by their spouses we need to understand how the specific society perceives and views such violence. Then and only then can we institute effective and acceptable strategy to tackle the problem. Objective: To assess community perceptions and attitude towards violence against women by their spouses Methods: We conducted a qualitative study using focus group discussions and in-depth interviews with women, family arbitrators, healthcare workers, psychosocial experts, victims and perpetrator of violence, and law enforcement bodies in Gondar town, Northwest Ethiopia. Data were analyzed thematically using the Open Code Software. Results: The normative expectation that conflicts are inevitable in marriage makes it difficult for society to reject violence. Acts of violence against women represent unacceptable behavior according to existing social and gender norms when there is no justification for the act and the act causes severe harm. There is considerable permissiveness of violent acts when the act is not regarded as wrong, there is socially acceptable premise, and the consequences are deemed mild. Marital rape is not understood well and there is less willingness to condemn it. Conclusions: We conclude that there is insufficient understanding of violence against women in its contemporary use and many people hold a non-disapproving stance regarding violence against women by their spouses calling for a culturally sensitive information, education and communication intervention. [Ethiop.

BackgroundCultural competency is now a core requirement for maternal health providers working in multicultural society. However, it has not yet received due attention in Ethiopia. This study aimed to determine the level of cultural competence and its associated factors among maternal health care providers in Bahir Dar City Administration, Northwest Ethiopia.MethodsInstitution based cross-sectional study was carried out using both quantitative and qualitative methods. Maternal health care providers from all health facilities were our study participants. Structured Questionnaire with some modification of Campinha Bacote’s tool was used to collect quantitative data from health workers and semi structured guide line was used for qualitative data among women. While quantitative data analysis was done using SPSS, qualitative data was analyzed using open code software. P-value of less than 0.05 was taken to determine statistical significance. Cronbach’s alpha was used to test internal reliability and a factor loading of 0.3 or greater was the criterion used to retain items.ResultTwo hundred seventy four health workers and seven women were involved in the study. The overall competency level was 57.3 % thought vary in different subscales or stages. Of the cultural competent health workers near to three fourth (73.0 %) were in awareness stage which is the earliest stage of competence in which individuals were aware only their own culture but not the world view of their clients. The voices of mothers in the qualitative assessment also showed discordance in cultural competence with their healthcare providers. Female health workers almost six times [AOR,5.5; 2.71, 11.30] more competent than male providers and those who got in-service training related to maternal care provided services more culturally competent than their counter parts with [AOR,3.5; 1.4, 8.64]. Reliability Cronbach’s α coefficient value of cultural competence subscales showed 0.672,0 .719, 0.658, 0.714, and 0.631 for cultural awareness, knowledge, skill, encounter and desire, respectively.ConclusionsThe overall competence level of health workers was low and the mean competence level falls in awareness stage in the continuum of culturally incompetent, culturally aware, culturally competent, and culturally proficient indicated that the providers were aware of only their own culture but not the world view of their clients. The voices of mothers also showed that they were dissatisfied for the services they got and the interactions they had with health care providers. Hence, we recommend on job training of health workers and incorporation of cultural components in the curriculum of health workers as it would be the key to provide culturally acceptable services.

BackgroundIncreasing access to safe abortion services is the most effective way of preventing the burden of unsafe abortion, which is achieved by increasing safe choices for pregnancy termination. Medical abortion for termination of early abortion is said to safe, effective, and acceptable to women in several countries. In Ethiopia, however, medical methods have, until recently, never been used. For this reason it is important to assess women's preferences and the acceptability of medical abortion and manual vacuum aspiration (MVA) in the early first trimester pregnancy termination and factors affecting acceptability of medical and MVA abortion services.MethodsA prospective study was conducted in two hospitals and two clinics from March 2009 to November 2009. The study population consisted of 414 subjects over the age of 18 with intrauterine pregnancies of up to 63 days' estimated gestation. Of these 251 subjects received mifepristone and misoprostol and 159 subjects received MVA. Questionnaires regarding expectations and experiences were administered before the abortion and at the 2-week follow-up visit.ResultsThe study groups were similar with respect to age, marital status, educational status, religion and ethnicity. Their mean age was about 23, majority in both group completed secondary education and about half were married. Place of residence and duration of pregnancy were associated with method choice. Subjects undergoing medical abortions reported significantly greater satisfaction than those undergoing surgical abortions (91.2% vs 82.4%; P < .001). Of those women who had medical abortion, (83.3%) would choose the method again if needed, and (77.4%) of those who had MVA would also choose the method again. Ninety four percent of women who had medical abortion and 86.8% of those who had MVA would recommend the method to their friends.ConclusionsWomen receiving medical abortion were more satisfied with their method and more likely to choose the same method again than were subjects undergoing surgical abortion. We conclude that medical abortion can be used widely as an alternative method for early pregnancy termination.