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Background: Although abortion is a fundamental right for every woman, it is one of the most controversial rights worldwide. Access to safe and legal abortion is an essential indicator of maternal health. In the DRC, the penal code bans abortion altogether. The recently ratified Maputo Protocol expands abortion access in the country, but the stigma has not decreased. However, qualified providers deliver safe abortion care within the health public system.

Aim: This study explores the comprehensive abortion “CAC" providers' perception of confidence and competence development in a restrictive setting.

Method: A qualitative study was conducted using in-depth interviews targeting 20 selected CAC providers. The data were analyzed using the thematic analysis method and interpreted according to the socio-ecological model.

Results: Developing competence and confidence in providing abortion care in restrictive settings is a long process with plenty of obstacles at individual, interpersonal, organizational, community, and policy levels. The study identified several factors influencing competence and confidence development. These include the respondents' previous experience (academic and professional) on abortion, self-motivation, shared understanding of the existing law, training on CAC, quality improvement activities, workplace environment, and social norms.

Conclusion: A comprehensive and user-centered training approach and multisectoral support would enhance CAC provider confidence and competence development.