Why are women still aborting outside designated facilities in metropolitan South Africa?

Abstract

Objective To explore why South African women still abort outside designated services where there is substantial legal service provision. Design Descriptive study. Setting Three hospitals in Gauteng Province in South Africa. Sample Forty‐six women attending hospital with incomplete abortion who had abortions induced outside of designated facilities. Methods An interviewer‐administered questionnaire with open and closed questions was completed. Induction status was determined from answers to a set of closed questions. Open‐ended questions explored the circumstances of induction. Main focus of interviews Methods of induction used, barriers to legal service use. Results Nearly two‐thirds of women (n= 38) had self‐induced or had consulted a traditional healer. A minority of these women (n= 11) indicated that they did this because they experienced barriers to legal service use. For others it was presented as a ‘natural’ response to a health problem (unwanted pregnancy). Several women (n= 10) were given misoprostol by a doctor, nurse, or pharmacist. Fifty‐four percent of the women had not used legal services because they did not know about the law, while 15% knew of their legal rights, but did not know of a legal facility. Others did know where to access legal services but feared rude staff (17%) or breaches of confidentiality (6.5%). Others (6.5%) had been unable to get a legal abortion early enough in pregnancy to comply with the law. Conclusions Lack of information on abortion rights under the Act and perceived poor quality of designated facilities were the most important barriers to access and should be addressed by policymakers and health service management. The willingness of women to self‐medicate and visit traditional healers in these circumstances may influence the overall ability of the new legislation to reduce abortion morbidity.

Every death counts: use of mortality audit data for decision making to save the lives of mothers, babies, and children in South Africa

“…41 Another study noted that women even in metropolitan areas still self-medicated and sought traditional healers, mainly because of little information about abortion rights and perceived poor quality of designated facilities. 42 Coverage of antenatal care is very high, with 94% of women attending at least one antenatal visit. However, the timing, number, and content of these visits are not optimum for all women.…”

‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces

“…In South Africa, studies conducted since the implementation of CTOPA have reported on the progress made in providing TOP services, notably the increase in the number of designated facilities and staff capacity-building, as well as the ongoing challenges of negative provider attitudes [9,25,26]. However, there has been insufficient scholarly focus on the psychosocial issues faced by health care providers of abortion services [27].…”

Characteristics of private abortion services in Mexico City after legalization

“…However, their reasons may also include expectation of a better quality of care in the private system, absence of bureaucratic hurdles and conscientious objectors, lack of awareness of the new law and privacy concerns. 5,15,21 Studies of clandestine services pre-legalization generally focus on issues related to access and women's perspectives. 5,13,[19][20][21] More recently, much attention has been paid to evaluate Mexico City's public facilities, where efforts have been successfully focused on improving quality of care, methods used and providers' attitudes.…”

“…14 Experience from South Africa, where abortion was legalized in the 1990s and introduced in public sector abortion services, suggests that women may avoid public services for fear of staff attitudes, ignorance about the law, lack of information on where to access services, and fear of breaches in confidentiality. 15 Furthermore, adolescents may seek private abortion services hoping to avoid burdensome requirements, e.g. parental consent, in public facilities.…”