Abortion attitudes among South Africans: findings from the 2013 social attitudes survey

Abstract

Abortion is legal in South Africa, but over half of abortions remain unsafe there. Evidence suggests women who are (Black) African, of lower socioeconomic status, living with HIV, or residents of Gauteng, KwaZulu-Natal, or Limpopo provinces are disproportionately vulnerable to morbidity or mortality from unsafe abortion. Negative attitudes toward abortion have been documented in purposively sampled studies, yet it remains unclear what attitudes exist nationally or whether they differ across sociodemographic groups, with implications for inequities in service accessibility and health. In the current study, we analysed nationally representative data from 2013 to estimate the prevalence of negative abortion attitudes in South Africa and to identify racial, socioeconomic and geographic differences. More respondents felt abortion was ‘always wrong’ in the case of family poverty (75.4%) as compared to foetal anomaly (55%), and over half of respondents felt abortion was ‘always wrong’ in both cases (52.5%). Using binary logistic regression models, we found significantly higher odds of negative abortion attitudes among non-Xhosa African and Coloured respondents (compared to Xhosa respondents), those with primary education or less, and residents of Gauteng and Limpopo (compared to Western Cape). We contextualise and discuss these findings using a human rights-based approach to health.

Vulnerabilidade racial e barreiras individuais de mulheres em busca do primeiro atendimento pós-aborto

“…For black women in South Africa, abortion's social stigma and racial discrimination in health services are also determinants for postponing use of services, one of the factors resulting in the high rate of unsafe abortion and in the search for abortion services at later stages in the pregnancy 23,24 , corroborating our study's results. In the United States, black and Latina women suffer discrimination and stigma in health services even during spontaneous abortion, jeopardizing their search for care 39 .…”

“…International studies, primarily in the United States and South Africa, show a similar situation for black women in the search for abortion services, although their jurisdictions allow abortion. Namely, transportation logistics and financial resources for reaching and having the procedure performed are also factors that limit access in the U.S. and South Africa 20,21,22,23,31 . In Brazil, universal coverage by the Brazilian Unified National Health System (SUS) means that the financial factor is limited essentially to access to urban transportation, mainly by spatial segregation, where poor people live in the more peripheral urban areas that lack public services, including healthcare services.…”

“…These are the most common barriers reported in U.S. studies, especially for young black women, low-income women, and rural women 20,21,22 . In South Africa as well, black women and those living with HIV, with low socioeconomic status, and living in remote areas are disproportionally more vulnerable to unsafe abortion, since these barriers mean that access to legal abortion services is more limted 23,24 . In Latin America, despite important research output on unsafe abortion 25,26 , there is still a gap in studies on racial differences in access to post-abortion care.…”

Differences in abortion attitudes by policy context and between men and women in the World Values Survey

“…We found that for each category of increased education, respondent abortion attitudes are, on average, more favorable, for example, with a nearly a one-point increase (B=0.831) in abortion attitudes among university educated respondents to those with no formal education. Others have reported more accepting abortion attitudes with higher levels of education (Mosley et al 2017). Additionally, religiosity and abortion attitudes has been widely studied (Adamczyk and Valdimarsdóttir 2018;Patel and Johns 2009;Barkan 2014;Begun et al 2016).…”

A Pregnancy Decision-Making Model: Psychological, Relational, and Cultural Factors Affecting Unintended Pregnancy

“…For example, factors that may affect a person’s belief in the permissibility of abortion include fetal age/development, risk to the pregnant person, whether the pregnant person’s partner or family agrees with the termination, and pregnancy from rape or incest (Hans & Kimberly, 2014; Jozkowski et al, 2018). Conservative and traditional Christian religious beliefs, strong beliefs about gender role traditionality, and benevolent sexism have all been found to be highly related to negative abortion attitudes (Huang et al, 2016; Mosley et al, 2017). The intersections of a person’s identities may also create complex values surrounding abortion; for instance, a person who belongs to a conservative religious group and also identifies as feminist may experience conflict stemming from their ideological backgrounds.…”