Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy




Yolanda Babenko-Mould

2nd Supervisor

Marilyn Evans



High maternal mortality remains a global health issue. In 2017, approximately 295,000 women worldwide died from complications related to pregnancy or childbirth, and 94% of these maternal deaths occurred in low-income countries. Evidence shows that family planning (FP) improves maternal health outcomes and significantly contributes to the reduction of maternal mortality. Low FP uptake is partly attributed to inadequate education of health care providers to provide FP services. The purpose of this study was to describe nurse/midwife educators' understanding and enactment of teaching FP methods with nursing/midwifery students in educational programs. More precisely, the aim of this study was to generate a substantive theory that explains how nurse/midwife educators introduce FP methods into their teaching practice to facilitate learning among nurse/midwifery students. This study was conducted following the constructivist grounded theory methodology as articulated by Dr. Kathy Charmaz. The primary source of data was individual semi-structured interviews with 25 nurse/midwife educators recruited from all the schools/faculties/departments of nursing and midwifery in Rwanda, augmented with written documents related to FP education in nursing/midwifery pre-service programs. The substantive theory that emerged from the data analysis indicated that the process of teaching FP in pre-service nursing/midwifery education has three phases: preparing, facilitating and evaluating. This theory also identified the influential factors that impact that process and the actions that nurse/midwife educators engage in to address the challenges related to those influential factors. These study findings generated valuable knowledge that can guide the improvement of teaching FP in pre-service nursing/midwifery programs in Rwanda and other limited-resource countries and contexts.

Summary for Lay Audience

Family Planning (FP) helps individuals and couples to attain the desired number of children at a desired and planned time. Individuals and couples have a fundamental human right to decide freely and responsibly the spacing and number of their children. Therefore, they have the right to adequate education and information related to FP methods. Nurses and midwives are the cornerstones of the health care system, and they are in good positions to provide FP services that focus on FP methods. However, some scholars in the field of FP have noted that a considerable number of nurses and midwives have limited knowledge and skills to provide education about FP methods. Studies about FP in undergraduate nursing/midwifery education have focused on gaps in the curriculum and in students' competencies. To date, no study has been conducted in Rwanda to explore how nurse/midwife educators experience teaching FP methods in pre-service nursing/midwifery education.

A qualitative study using constructivist grounded theory methodology was conducted with all the schools/departments of nursing and midwifery in Rwanda. This study aimed to describe nurse/midwife educators' understanding and enactment of teaching FP methods in educational programs. Twenty-five nurse/midwife educators involved in teaching FP methods in nursing/midwifery programs participated in individual interviews.

The findings of this study identified the factors that influence nurse/midwife educators' ability to teach FP to nursing/midwifery students and the actions they engaged in to overcome the challenges encountered during the process of teaching FP. The recommendations for this study involve addressing the factors that limit nurses’/midwives' ability to effectively teach FP to nursing/midwifery students, where such knowledge would better equip students to apply to practice upon graduation.

Available for download on Sunday, December 24, 2023