Transforming abortion care starts with education

As countries strive to improve access to quality family planning and comprehensive abortion care, competency-based education for key health care providers is emerging as a critical strategy to ensure they are not only knowledgeable, but also practically equipped to deliver respectful, women-centered, rights-based care to everyone, everywhere.

Why competency matters

A recent three-day convening brought together midwives, obstetrician-gynaecologists, civil society representatives, and global health experts from six countries - Bangladesh, the Democratic Republic of Congo, Kenya, Mozambique, Nepal, and Sierra Leone for the first high-level meeting of the Collaborate for Women, Abortion and Contraception Care Together (C4W ACCT) initiative.

Supported by the World Health Organization (WHO) and the UN's Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and jointly led by the International Confederation of Midwives (ICM) and the International Federation of Gynaecology and Obstetrics (FIGO), the initiative, part of the broarder BRIDGES for comprehensive abortion care project, builds on recent cross-regional work seeking to reframe conventional hierarchies in clinical practice by promoting more inclusive, collaborative models of care. These efforts aim to strengthen interprofessional collaboration and advance access to quality family planning and comprehensive abortion care.

The discussions highlighted the limitations of traditional education models that often emphasize theoretical knowledge, leaving graduates underprepared for the realities of clinical practice. In contrast, competency-based education focuses on what learners can do - not just what they know. It defines clear competencies, sets performance benchmarks and aligns education with the actual needs of communities.

The Family planning and comprehensive abortion care toolkit, developed by the World Health Organization (WHO) and the UN's Special Programme in Human Reproduction (HRP), outlines 57 core competencies for the primary healthcare workforce. These competencies cover clinical skills, ethical and legal standards, effective communication, and women-centered care, and service delivery standards - ensuring providers are equipped to deliver quality, rights-based care.

What needs to change

Participants discussed recent needs assessments in their countries, revealing persistent gaps in family planning and comprehensive abortion care education. While some curricula mention these topics, they often lack depth, consistency and structured clinical practice. For example:

• Curricula may include components on family planning, but education on comprehensive abortion care is often limited or entirely absent, especially in regions with restrictive abortion laws.
• Some educators and students alike report that existing curricula do not align with competency-based education principles, citing barriers such as lack of resources, resistance from leadership, and limited educator capacity.

These findings underscore the need for systemic reform - not just curriculum updates, but a shift in how education is designed, delivered and assessed. Participants at the Nairobi meeting also emphasized that interprofessional collaboration must go beyond technical alignment - it must be gender-transformative, rights-based and person-centred. Participants examined how entrenched gender norms, professional hierarchies, stigma and systemic barriers hinder access to care, and how strategic, collaborative leadership can dismantle these obstacles.

Tools for transformation

To support this shift, WHO and HRP have developed a three-volume toolkit:

• Volume 1: Defines the essential competencies for family planning and comprehensive abortion care.
• Volume 2: Offers a curriculum development guide based on a new educational design model.
• Volume 3: Provides a framework for dissemination, implementation, monitoring and evaluation (DIME).

These resources are designed for a wide range of stakeholders - educators, policymakers, regulators, and civil society organizations - who play a role in shaping the health workforce.

Beyond the classroom

Recognizing that education does not stop at graduation, WHO and HRP also launched online, self-paced courses based on WHO's Abortion care guideline to support continuous professional development. The first course, focused on medical abortion, offers modules on assessment, administration, follow-up and service delivery. The second course builds knowledge of how to integrate a human rights-based approach to comprehensive abortion care. Participants receive a WHO Academy Award of Completion, reinforcing the value of lifelong learning.

Toward a competent, respectful workforce

Competency-based education is more than a pedagogical trend-it's a pathway to equity, quality and dignity in reproductive health care. By embedding the approach into national education systems, countries can ensure that midwives, nurses and doctors are prepared not just to provide services, but to do so in ways that honour the rights and realities of the people they serve.

The work and impact described here have been funded by the Government of Canada through the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO).