Midwives’ knowledge, attitude, practices, and experiences toward trauma-informed abortion care in urban district hospitals in Rwanda

In Rwanda, many abortion services are not currently providing trauma-informed abortion care (TIAC) due to laws that restrict service provision and the incorporation of potentially traumatizing procedures with little attention to the woman's experience and support needs. Midwives working in abortion services often lack adequate training to effectively support clients with trauma. The authors aim to evaluate midwives' knowledge, attitudes, practices, and experiences toward TIAC. A mixed-method design was used. In quantitative, all midwives were invited to participate. In qualitative, purposive sampling was applied, and four focus group discussions with eight participants each were conducted. Of the 167 midwives who participated in this study, 86.2% demonstrated sufficient knowledge of TIAC, 83.8% had thorough experience of TIAC, and 62.3% reported a negative attitude toward TIAC. Respondents with an advanced diploma were more likely to have satisfactory knowledge than those with a bachelor's degree, and the workplace institution influenced TIAC practice. Males had a more positive attitude compared to their female counterparts. Moreover, respondents with more knowledge of and positive attitudes toward TIAC were significantly more likely to have good practice. Four themes were identified: a) conceptualization and practice of TIAC; b) TIAC as an essential practice in quality care; c) physical environment as a hindrance of TIAC; and d) dynamics of caring leading to secondary trauma. Providing TIAC training to midwives is essential for shifting negative attitudes. Hospitals need to enhance their infrastructure and offer resources to address the challenges of abortion services, including mitigating secondary trauma among healthcare workers.