Caribbean midwives graduate as trainers in long-acting reversible contraception: a milestone for sexual and reproductive health in the region

collage de fotos capacitación presencial

Montevideo, 28 February 2024. "My experience at the workshop was life changing. I truly gained a lot of insight and knowledge that I can see benefiting my country and my profession for years to come. I gained extensive knowledge on contraception through the course and intensive skills through hands-on training. There was emphasis on knowledge transfer, which is something that I am very passionate about. The team was clearly experienced and placed emphasis on growth and development for our countries. As a nurse midwife, I see how this training can grow the profession to help more women, and I can clearly say that the sky is the limit...", said Taril Bowen, one of the trained midwives.

Universal access to modern and effective contraceptive methods ensures that people, particularly adolescents, avoid the adverse consequences of unintended pregnancies. The use of Long Acting Reversible Contraceptives (LARC) positively impacts health, sexuality and has socio-economic benefits for individuals and societies.

The Pan American Health Organization (PAHO) is working to promote access to these methods and to train health personnel in the medical criteria for eligibility, insertion and removal.

PAHO's Latin American Centre for Perinatology - Women and Reproductive Health (CLP/WR) has implemented a regional training strategy that includes a virtual course and capacity building through the use of simulators and clinical practice supervised by tutors. Those who complete the entire process are certified as trainers in AIPEO (Immediate Post-Event Obstetric Contraception) and thus become promoters and trainers in their own territories.

On February 16, the graduation ceremony was held for the first group of midwives who completed the entire training process as trainers in the Caribbean region. The development of this initiative in the Caribbean was possible thanks to the articulated work of CLP/WR, USAID’s MOMENTUM Country and Global Leadership (MCGL), the Caribbean Regional Midwives Association (CRMA) and the International Planned Parenthood Foundation (IPPF).

During the ceremony, CLP/WR Director Suzanne Serruya referred to the midwives' graduation as a milestone for the organisation. "Universal access to contraception guarantees rights and avoids the negative consequences of unintended pregnancies," she said. In addition, she said that it is necessary to maximise efforts to achieve the targets set out in the Sustainable Development Goals (SDGs), which is why it is necessary to expand comprehensive services at the first level of care. The director referred to the report on the state of access to sexual and reproductive health services, which was presented last year at the 60th Directing Council of PAHO and which includes a series of recommendations that are fundamental for making definitive progress in sexual and reproductive rights.

The regional advisor on Sexual and Reproductive Health, Rodolfo Gómez Ponce de León, gave a presentation in which he outlined the benefits of long-acting contraceptives and stressed that "they are the safest and most effective, they are reversible and they are the most cost-effective methods". Gómez mentioned the resources made available by CLP/WR, among which he highlighted the virtual courses hosted in the Virtual Campus of Public Health (available in 4 languages, and which today have more than 65,000 enrolments within and outside the region), and the simulation centres. The advisor expressed that "CLP works, through technical cooperation with the countries, to guarantee and expand family planning at the first level of care and Immediate Post Obstetric Event Contraception (AIPEO) in the most vulnerable populations in the region, because evidence has shown that it is a fundamental strategy to guarantee sexual and reproductive rights".

Inter-agency articulation as a driver for achieving goals

Mark Hathaway, one of the facilitators and representative of MOMENTUM, highlighted the inter-institutional and country work and pointed out that the success of this initiative was due to the enormous work and commitment of the organisations, countries and participants.

Shirley Curtis, director of CRMA, expressed the same sentiment and also referred to the need to update regulations that favour the expansion of this type of initiative.

During the ceremony, the role of the Ministry of Health, Wellness and Religious Affairs of Grenada was highlighted for its openness to the development of training activities. The Ministry's representative, Carol Telesford-Charles, welcomed the opportunity to be part of the process and reaffirmed their commitment to continue working in coordination to expand the positive impact of this training.

Damian Greaveshas, from Planned Parenthood Association Grenada, also spoke about the opportunity for the Caribbean country and highlighted that this action made it possible for the first time to enter and place implants.   

Other speakers included Eugina Lopez-Uribe, from IPPF, who pointed out the importance of scaling up the project and involving more midwives in the Caribbean; Valeria Bahamondes, consultant, who shared images of the different stages of the training and the testimonies of the women who participated; Anne Pfitzer, from MOMENTUM, who emphasized collaborative work as a success factor; and Solange Kobi Jackson, who participated on behalf of Amalia del Riego, PAHO Representative for Barbados and the Eastern Caribbean, and highlighted the relevance of this type of initiative to achieve the goals set by the region within the framework of the SDGs.

Lynthia Buckmire, one of the midwives who graduated as a trainer, made a special intervention on behalf of all her colleagues and thanked them for the opportunity to have been part of the process and how important it was for her professional career.

Testimony of the protagonists

“...New knowledge of the existing methods we used was learned, new bonds built with our neibourgin Islands and a more genuine appreciation for the work that we do as health care providers was accomplished. It’s a worth wild experience to provide these methods for woman who need them. In moving forward these new skills will be practiced daily when coming in contact with future clients and I am looking forward to sharing what I learned with others so that they too can have a better appreciation of what we do and other clients in areas that we can't reach will have access to the services they need.”
Lynthia Buckmire - Grenada
"...I am excited to utilize this knowledge and these new skills in clinical practice, serving patients from all walks of life. As equally as important however, I look forward to training fellow medical professionals, afterall, "Knowledge shared is knowledge squared".
N'Kosha Fletcher  - Granada
"...Interacting with individuals from diverse backgrounds enriched my learning experience by exposing me to a variety of practices. I am eager to utilize the knowledge gained to serve my community and extend assistance across the island. My goal is to educate fellow health professionals throughout the tri-island state on LARC usage, ensuring accessibility to this vital service for individuals unable to access traditional office visits"
Lewisa Ratoo - Granada
“Participating in the workshop allowed me to sharpen existing skills. The hands-on activities, and the discussions gave me new insights. Collaborating with others fostered a sense of camaraderie turning strangers into allies on a journey of learning. I will be sharing with my colleagues what i have learned as i continue to practice new skills". Lyndale Weaver - Antigua & Barbuda
“... I gained extensive knowledge on contraception through the course and intensive skills through hands-on training. There was emphasis on knowledge transfer, which is something that I am very passionate about. The team was clearly experienced and placed emphasis on growth and development for our countries. As a nurse midwife, I see how this training can grow the profession to help more women, and I can clearly say that the sky is the limit....”. Taril Bowen - Antigua & Barbuda
“...As a public health nurse providing contraceptive service on my island, training in the area of Long Acting Reversible Contraception (LARC's) has adequately enhanced my skills and has provided me with the required  knowledge to offer a more variety of methods to my clients. I have began using my skills and educating persons on the available method.”. Averil Walter - St Kitts & Nevis
“...Presently, in St. Kitts, I am now the only trained nurse who inserts IUDs. In Nevis Nurse Walters is the only nurse who is trained there to do the same. Moreover, in our Federation, we are the first to undergo training in insertion of Implants. Women are no longer limited in their choice of Family Planning methods in St. Kitts and Nevis...” Shirmelle Rabb - St Kitts & Nevis
“...On completion of these skills I plan to implement them into Primary Health Care in my country by conducting educational sessions to adolescence and antenatal clients...”. Laura Lambert - Dominica
“...I plan to give information to the women in my community so that they can make a wise choice of choosing a family planning method of their choice.” Maria Dubois - Dominica
“...It was indeed an opportunity to acquire a new skill set, which empowers me to provide additional information to women who can now make informed decisions regarding contraceptive options...” Alma Dolor - Saint Lucia