In March 2020 together with the Ethiopian Midwives Association we started the program entitled “Midwife students as advocates to empower female graduates and adolescents by promoting SRHR and gender equality to support access and retention in the educational system using blended e-learning” funded by the Institutional Collaboration Projects Orange Knowledge Programme of Nuffic.
After one year of launching the SRHR[e]Education course in Ethiopia a study was conducted to report on the impact and progress that this project has had on the first groups of students participating in this project.
Results from a digital survey and phone interviews show that this project has positively influenced the young minds of midwifery students across Ethiopia, while also indirectly reaching members in the community thanks to these students, specifically adolescents.
In Ethiopia, adolescents represent approximately 28% of the population and SRHR problems in this age group are prominent, especially issues such as gender-based violence, risky sexual practice, unintended pregnancies, unsafe abortion and STIs. Midwives, midwifery students specifically, have a unique position to promote and teach SRHR and gender equality in their work, clinical practice, and with their fellow students and adolescents they encounter. However, pre-service education insufficiently provides them with the knowledge and skills to teach and enforce these crucial topics.
In addition, gender disparity is an issue for (student) midwives themselves, which influences school dropout and employability. There is a need to enhance and provide students access to SRHR education, which will empower adolescents entering a very sensitive age, and will also promote women to persevere and improve the gender disparities in the healthcare system, especially among midwives. The SRHR[e]Education course is aimed to strengthen four Ethiopian universities’ SRHR curriculum and support the educational system to deliver competent and gender-sensitive education to midwifery graduates since March 2020. Today these graduates, in turn, will have learnt about these issues and communicated them effectively with their fellow students and adolescents in the community, further strengthening gender equality among the universities and, overall, in the communities in Ethiopia.
In this article, we will look at the impact this project has had on the midwifery students who participated from Addis Ababa, Debre Birhan, Kotebe Metropolitan and Gondar University during the first year that this project was run. Specifically, we will evaluate what the impact of this course was on their studies and their community, giving us an insight into the future of the SRHR[e]Education in Ethiopia.
After one year since this project was launched, a study was performed by students residing in the Netherlands and Ethiopia to evaluate the quality and experience of the midwifery students who have been participating in the SRHR[e]Education program by implementing a questionnaire and developing an interview for the course participants to take. Of the 243 midwifery students who participated, a total of 78 students (32%) responded to the questionnaire and 19 (8%) volunteered and attended interviews. The demographics of the midwifery students who participated are available in Table 1. Additionally, test results before and after each module were used to analyze the knowledge acquisition of the participants.
We discovered that, in fact, 95% of the survey respondents perceived this course as valuable and complementary to their studies. Many students saw it as a program where they could learn about topics that are considered “taboo” in the community and aren’t accessible in their classes; are more focused on the social sciences, complementing their more natural sciences curriculums; and involve reaching out to their patients in a more personalized manner. Students reported learning new and challenging topics such as gender based violence and introduction to entrepreneurship, but they also mentioned that what was most helpful was learning about communication skills, family planning services, and how to reach out to adolescents and women. Test results showed that indeed the highest knowledge gain was both GBV and entrepreneurship, but the most valuable topics, as claimed by students in the interviews, were, in fact, finding ways to provide quality care to their patients through better communication, GBV awareness, and delivering proper family planning services. Also, due to the offline characteristics of this program, students living in remote areas of Ethiopia, where internet access is little to none, were addressed and helped in order for them to learn about SRHR issues, which are comparatively higher than in the bigger cities Addis and Gondar. Furthermore, 82% of students found the blended learning strategy the preferred method of learning, seeing as they could progress through the course at their own pace and in any place, allowing many students to access this course in the remote areas they live in and helping them develop self-learning skills, as some students reported in the interviews.
“This form of learning method is able to reach students easily without boundaries. It also increases the self-initiative of students to learn.”
– SA (M), student at Gondar University
A total of 12% of students who participated in the survey started working in a health facility after graduating. Many reasons for not starting to work there ranged from not having yet received their license exam grade, not finding job openings in their region, or finding a different type of job, which offered them better working conditions. Although most students did not work in the healthcare system, all of the students mentioned that they apply their knowledge and skills from this project either at work, with family or friends, and/or at the university/during their clinical practice. Some midwifery students have mentioned that their own perspectives on gender equality and women’s rights have changed positively due to the awareness and information shared in this program, and that because of this, they are trying to do the same with the people they come in contact with. Of the 12% working in a health facility, 3% are females. Although this number is low, we hope that women are more empowered and motivated to continue persevering through the job market and use their gender based knowledge in other fields of work as well. Many midwifery students, especially females, mentioned during the interviews, starting jobs at the universities they studied, or beginning volunteer services in the health field. Additionally, now that the scores are published for the license exam, we expect the number of midwifery students in health facilities to increase, both female and male.
“During my studies I did my internship at the university hospital and there I gave services to women. Mainly I advised them on sexual crimes, gender based violence and domestic violence (things I learnt in the course), topics of which they didn’t feel comfortable talking about before. I advised them to speak about their GBV privately and I gave them knowledge about the different methods of family planning, which they should discuss later with their husbands. I was able to change the minds of some of them, especially about the family planning methods and domestic violence.”
– EY (F), student at Gondar University
Moreover, students participated in the Team Training Program (TTP), which is offered in their university’s curriculum to apply their knowledge and skills with the community. In these activities, students would reach out to members of the community living near health facilities such as schools, prisons and/or charities to promote and expand health education. All students reported applying their SRHR knowledge in these activities, teaching adolescents in schools about family planning, STIs and condom use during high risk sex, as well as educating prisoners about their health. In total, an estimate of adolescents and fellow students reached with SRHR knowledge and information from the SRHR[e]Education program, as reported by the survey respondents only, was 1,365 and 1,220, respectively.
“This course creates awareness on gender equality, and increases women’s self-confidence, also changing the attitudes of men towards women’s rights.”
– EM (M), student at Addis Ababa University
Although this study gave us valuable insights, we must keep in mind that the survey was an online activity, therefore students without internet connectivity did not complete the survey which may have biased the results. However, thanks to the students working locally in Ethiopia, we were able to interview many students that were located both in the big cities as well as rural areas in the country, thus providing us with significant quantitative results.
Overall, this blended learning program has been useful for midwifery students and community members in the big cities as well as in the remote areas in Ethiopia, where internet connectivity and availability of resources are lacking. It was also helpful to promote gender equality, and to change the mindsets of midwifery students, especially female midwives, who often encounter community members facing gender differences as well as with gender inequalities in the field of work itself. This course has already had a huge impact on these university students and those family, friends, fellow students, colleagues and patients around them, so it is important to consider what more it can do in the future, especially as Health[e]Foundation’s and Ethiopian Midwives Association’s development and implementation of this program expands and improves.