title: Return on investment for essential obstetric care training in Ghana: do trained public sector midwives deliver postabortion care?
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Ipas, Chapel Hill, NC 27516, USA. clarkk@ipas.org
authors.forename: Kathryn Andersen
authors.initials: KA
authors.lastname: Clark
authors.forename: Ellen H M
authors.initials: EH
authors.lastname: Mitchell
authors.forename: Patrick Kuma
authors.initials: PK
authors.lastname: Aboagye
mesh_terms: D000028:Abortion, Induced / Q000592:standards; D003362:Cost-Benefit Analysis; D004506:Education, Nursing / Q000458:organization & administration*; D005260:Female; D005869:Ghana; D006801:Humans; D008428:Maternal Mortality; D008880:Midwifery / Q000191:economics / Q000193:education* / Q000592:standards; D009774:Obstetrics / Q000191:economics / Q000193:education* / Q000592:standards; D011182:Postoperative Care / Q000191:economics / Q000592:standards*; D011634:Public Health; D011787:Quality of Health Care; D016387:Women's Health