“With an unwanted pregnancy, we are looking for midwives in the neighbourhood to show us what to do.” Stakeholder perceptions of midwife-led woman-centred comprehensive abortion care in the province of Kinshasa, Democratic Republic of Congo: a qualitative descriptive study

What is already known:•Deaths and injuries due to unsafe abortion in Democratic Republic of Congo (DRC) are high. The ratification of the Maputo Protocol in 2018 now permits abortion under specific conditions.•Globally, midwives can safely and effectively provide comprehensive abortion care (CAC).What this paper adds:•Midwives in DRC are competent CAC providers according to National and International standards of care. Midwives organically integrate aspects of the midwifery model of care with abortion services including the client's psychological needs and community outreach and education.•Continuing education for midwives, including mentorship, supports the midwifery model of CAC, yet low access to resources, dated midwifery legislation and inappropriate pay negatively influence feasible integration.•The Midwives’ Association (SCOSAF) supports the integration of the midwifery model of CAC and plays a critical role in sustaining integration. Midwives are an essential yet underutilised health human resource for improving unsafe abortion outcomes and increasing abortion access and contraceptive care. In Democratic Republic of Congo (DRC), morbidity and mortality resulting from unsafe abortions are alarmingly high. The recent ratification of the Maputo Protocol in 2018 has made safe abortion accessible. National implementation strategies recognise midwives as providers of comprehensive abortion care (CAC), yet there is little understanding of their current role in its provision. To understand the obstacles and facilitators in integrating the midwifery model of CAC in DRC's health system. A qualitative descriptive design was used to explore health system stakeholders' perceptions regarding the midwifery model of CAC in Kinshasa, DRC. Data sources included n = 43 key informant interviews and n = 2 FGDs. Results were member-checked with DRC Midwives’ Association (SCOSAF) members. Findings highlight midwives provided all aspects of CAC, with attention to the psycho-social well-being of their clients and acted as health service navigators in the community. Appropriate midwifery legislation, scope of practice that includes CAC, administrative support and remuneration, and better access to continuing education are facilitating health system factors for the midwifery model of CAC. Finally, SCOSAF, the Midwives’ Association, played an influential role in the implementation, positively supporting CAC integration by midwives. Understanding health system levers and the i