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In-clinic follow-up to assess completion of medical abortion is no longer a requirement according to World Health Organization guidance, provided adequate counselling is given. However, timely recognition of ongoing pregnancy, complications or incomplete abortion, which require treatment, is important. As part of a larger trial, this study aimed to establish whether women having a medical abortion could self-assess whether their abortion was complete using an automated, interactive questionnaire on their mobile phones. All 469 participants received standard abortion care and all returnees filled in a self-assessment on paper at clinic follow-up 2–3 weeks later. The 234 women allocated to receive the phone messages were also asked to do a mobile phone assessment at home ten days post-misoprostol. Completion of the mobile assessment was tracked by computer and all completed assessments, paper and mobile, were compared to providers’ assessments at clinic follow-up. Of the 226 women able to access the mobile phone assessment, 176 (78%) completed it; 161 of them (93%) reported it was easy to do so. Neither mobile nor paper self-assessments predicted all cases needing additional treatment at follow-up. Prediction of complete procedures was good; 71% of mobile assessments and 91% of paper assessments were accurate. We conclude that an interactive questionnaire assessing completion of medical abortion on mobile phones is feasible in the South African setting; however, it should be done later than day 10 and combined with an appropriate pregnancy test to accurately detect incomplete procedures. [ABSTRACT FROM AUTHOR]

In-clinic follow-up to assess completion of medical abortion is no longer a requirement according to World Health Organization guidance, provided adequate counselling is given. However, timely recognition of ongoing pregnancy, complications or incomplete abortion, which require treatment, is important. As part of a larger trial, this study aimed to establish whether women having a medical abortion could self-assess whether their abortion was complete using an automated, interactive questionnaire on their mobile phones. All 469 participants received standard abortion care and all returnees filled in a self-assessment on paper at clinic follow-up 2–3 weeks later. The 234 women allocated to receive the phone messages were also asked to do a mobile phone assessment at home ten days post-misoprostol. Completion of the mobile assessment was tracked by computer and all completed assessments, paper and mobile, were compared to providers’ assessments at clinic follow-up. Of the 226 women able to access the mobile phone assessment, 176 (78%) completed it; 161 of them (93%) reported it was easy to do so. Neither mobile nor paper self-assessments predicted all cases needing additional treatment at follow-up. Prediction of complete procedures was good; 71% of mobile assessments and 91% of paper assessments were accurate. We conclude that an interactive questionnaire assessing completion of medical abortion on mobile phones is feasible in the South African setting; however, it should be done later than day 10 and combined with an appropriate pregnancy test to accurately detect incomplete procedures. RésuméSelon les directives de l’Organisation mondiale de la santé, le suivi dans le centre de santé pour s’assurer que l’avortement médicamenteux est complet n’est plus nécessaire, pourvu que des conseils adaptés soient prodigués. Néanmoins, il est important de déceler rapidement une poursuite de la grossesse, des complications ou un avortement incomplet, qui exigent un traitement. Dans le cadre d’un essai plus large, cette étude visait à déterminer si femmes ayant eu un avortement médicamenteux pouvaient évaluer elles-mêmes si leur avortement était complet, à l’aide d’un questionnaire interactif automatisé sur leur téléphone portable. Toutes les 469 participantes ont reçu des soins types liés à l’avortement et toutes les patientes revenues au centre ont rempli une autoévaluation sur papier lors du suivi dans ce centre, deux ou trois semaines plus tard. Les 234 femmes sélectionnées pour recevoir les messages téléphoniques ont aussi été invitées à faire une évaluation sur téléphone portable chez elles dix jours après la prise de misoprostol. L’achèvement de l’évaluation sur le portable a été contrôlé par ordinateur et toutes les évaluations complétées, sur papier et téléphone, ont été comparées à l’évaluation des praticiens lors du suivi dans le centre. Des 226 femmes ayant eu accès à l’évaluation sur portable, 176 (78%) l’ont complétée ; 161 d’entre elles (93%) ont indiqué que cela avait été facile. Les autoévaluations, que ce soit sur portable ou sur papier, n’ont pas prévu tous les cas nécessitant un traitement complémentaire lors du suivi. Les prédictions de la complétude de la procédure étaient bonnes : 71% des évaluations sur portable et 91% sur papier étaient exactes. Nous avons conclu qu’un questionnaire interactif évaluant la complétude de l’avortement médicamenteux sur le téléphone portable est faisable dans le contexte sud-africain ; néanmoins, il devrait être soumis plus tard que le dixième jour et associé à un test de grossesse approprié pour détecter rigoureusement les procédures incomplètes. ResumenEl seguimiento en la unidad de salud para determinar si la mujer tuvo un aborto con medicamentos completo ya no es un requisito, según la guía de la Organización Mundial de la Salud, siempre y cuando se brinde consejería adecuada. Sin embargo, es importante reconocer con prontitud la continuación del embarazo, complicaciones o aborto incompleto, que requiere tratamiento. Como parte de un ensayo clínico más extenso, este estudio tuvo como objetivo establecer si mujeres en proceso de aborto con medicamentos podrían determinar por sí mismas si tuvieron un aborto completo, utilizando un cuestionario interactivo automatizado en su teléfono móvil. Todas las 469 participantes recibieron servicios estándares de aborto y todas las que regresaron llenaron un formulario de autoevaluación durante el seguimiento en la unidad de salud 2 o 3 semanas después. A las 234 mujeres asignadas para recibir los mensajes por teléfono también se les pidió que hicieran una evaluación domiciliaria por teléfono móvil diez días post-misoprostol. La conclusión de la evaluación móvil fue seguida por computadora y todas las evaluaciones terminadas, en versión impresa y móvil, fueron comparadas con las evaluaciones de los prestadores de servicios durante el seguimiento en la unidad de salud. De las 226 mujeres que tenían acceso a su evaluación por teléfono móvil, 176 (78%) la concluyeron; 161 de ellas (93%) informaron que fue fácil de hacer. Ni la autoevaluación móvil ni la impresa previeron todos los casos que necesitaban tratamiento adicional en el seguimiento. La predicción de procedimientos completos fue buena; el 71% de las evaluaciones móviles y el 91% de las evaluaciones impresas fueron precisas. Concluimos que un cuestionario interactivo que evalúa la finalización del aborto con medicamentos por teléfono móvil es factible en Sudáfrica; sin embargo, debe hacerse después del décimo día y combinarse con una prueba de embarazo apropiada para detectar con precisión los procedimientos incompletos. [ABSTRACT FROM PUBLISHER]

South African law provides that children under 18 years old can self-consent to medical treatments and terminations of pregnancy. An article published by van Heerden et al. in the South African Journal of Child Health in 2020 found that children 12 years and older were able to give informed consent to medical procedures because they were able to make a treatment choice, comprehend information, weigh options and provide reasons for their decision. However, only children older than 14 years possessed actual understanding of more abstract concepts. This paper considers whether the law is consistent with empirical data on child capacity. It does so by examining the evolution of laws regarding child capacity, interrogating current legal standards on capacity and ultimately evaluating whether the law reflects current empirical knowledge. We conclude that the law on medical treatment is not in conflict with the findings of van Heerden et al. However, there is less synergy between law and empirical data regarding terminations of pregnancy for children under 14 years old. Parliament placed an emphasis on access to health services and did not want age or parental consent to act as a barrier to adolescents getting medical assistance; however, data show that children younger than 14 years old struggle with more complex and abstract medical choices. We suggest that the recommendations in the Choice Act for counselling in terminations of pregnancy by children under the age of 14 years need to be more fully operationalised through the issuing of regulations or a national policy. [ABSTRACT FROM AUTHOR]

Background: In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider's knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels. Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020. Results: Registration of abortion medicines—misoprostol or a combination of mifepristone and misoprostol—was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone—countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula—no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option. Conclusion: Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access. Plain Language Summary: Unsafe abortion is a leading cause of death and disability among women of reproductive age. Medical management of abortion with mifepristone and misoprostol pills, or just misoprostol, is a safe and effective way to end a pregnancy. Owing to an increase in the number of medical abortion products that have entered country health systems, we examined access to these medicines from supply to demand in selected countries. The overarching goal of the national landscape assessments was to produce evidence to support advocacy efforts and policymaking for improved access to quality medical abortion products that is appropriate to the needs of the country. This paper aims to describe key findings across eight country settings on the availability of medical abortion medicines and identify key opportunities to improve access to them across countries. [ABSTRACT FROM AUTHOR]

Background: Studies exploring the sexual and reproductive health (SRH) of refugee women have focused primarily on first generation refugees in humanitarian and crisis settings. There is a paucity of research exploring the reproductive health of girls and young women who are born to refugee parents in a host country or who have migrated with their parents at a very young age and who have since reached sexual maturity. We conducted a qualitative study which aimed to explore the reproductive health and rights' needs and challenges amongst young refugee women in South Africa. Methods: The study was carried out in the city of eThekwini (Durban) in South Africa in 2021 and 2022. A total of 35 semi-structured, in person interviews were conducted amongst young refugee women between the ages of 18 and 24 years living in the city centre. Results: Twenty-five participants were 17 years or younger on arriving in South Africa, one of whom was born in South Africa. Eleven of these women had experienced one or more pregnancies while living in South Africa and all of these women had experienced at least one unintended pregnancy. Participants had poor reproductive health knowledge of the role of menstruation and how conception occurs. Economic, social, and legal insecurities intersected in complex ways as determinants of poor reproductive health outcomes. Despite availability, contraceptive use was poor and linked to lack of knowledge, myths and unwanted side effects. There were negative economic and social impacts for young refugee women experiencing early pregnancies irrespective of whether they were intended or not. Being unable to conceive or experiencing an unintended pregnancy negatively impacted sexual relationships which were entered primarily for material support. Desire for confidentiality shaped lack of access to legal termination of pregnancy in the public health sector. Conclusion: Participants experienced specific vulnerabilities resulting from their position as refugees despite length of stay in South Africa. It is important to better understand these specificities in the design of programmes and policies aimed at ensuring positive health outcomes for these young women. Peer education amongst refugee communities may be an important tool in the provision of culturally acceptable SRH education. [ABSTRACT FROM AUTHOR]

Theoretical refinement of the concept of reproductive justice has been called for. In this paper, I propose the use of a supportability reparative justice approach. Drawing on intra-categorical intersectionality, the supportability aspect starts from the event of a pregnancy to unravel the interwoven embodied and social realities implicated in women experiencing pregnancy as personally supportable/unsupportable, and socially supported/unsupported. The reparative justice aspect highlights the need for social repair in the case of unsupportable pregnancies and relies on Ernesto Verdeja's critical theory of reparative justice in which he outlines four reparative dimensions. Using abortion within the South African context, I show how this framework may be put to use: (1) the facilitation of autonomous decision-making (individual material dimension) requires understanding women within context, and less emphasis on individual-driven 'choice'; (2) the provision of legal, safe state-sponsored healthcare resources (collective material dimension) demands political will and abortion service provision to be regarded as a moral as well as a healthcare priority; (3) overcoming stigma and the spoiled identities (collective symbolic dimension) requires significant feminist action to deconstruct negative discourses and to foreground positive narratives; and (4) understanding individual lived experiences (individual symbolic dimension) means deep listening within the social dynamics of particular contexts. [ABSTRACT FROM AUTHOR]

Pre‐abortion counselling may play a key role in abortion seekers' understanding of their decision to terminate a pregnancy and the subsequent emotions that they feel. In this paper, we report on a study conducted in the Eastern Cape province of South Africa concerning womxn's experiences of the pre‐abortion counselling offered as part of the implementation of the Choice of Termination Act that governs the provision of legal abortion in the country. Using a narrative‐discursive lens, the analysis revealed four micro‐narratives in which participants appreciated non‐directive and empathic counselling, as well as being provided with information. They also indicated that the counselling was upsetting and hurtful, particularly when providers drew on the awfulisation of abortion discourse to suggest that abortion leads to terrible consequences, and foetal personhood discourse to intimate that terminating the pregnancy is wrong and other alternatives (adoption, parenting) are better. The connection between these broadly positive and negative responses may lie in the dominance of anti‐abortion discourses coupled with the powerful positioning of healthcare providers as experts. The attendant disempowerment of clients within the health clinic setting may constrain pregnant people's ability to question such 'expert' information. The implications for feminist client‐centred pre‐abortion counselling are discussed. [ABSTRACT FROM AUTHOR]

There is global recognition that competent and willing health care providers remain the most important determinant of safe abortion or termination of pregnancy services. The psychosocial well-being of providers is critical to the provision of responsive termination of pregnancy services. In light of the dearth of scholarly attention on termination of pregnancy providers' coping strategies in low- and middle-income countries, this paper explores coping strategies among these providers in the urban Gauteng and the mixed rural-urban North West provinces of South Africa. During 2015, in-depth interviews were conducted with 30 termination of pregnancy providers working at abortion facilities in these provinces. Questions focused on providers' lived experiences of abortion service provision, the meanings they attached to their work and their reported coping strategies. Interpretative phenomenological analysis was used to analyse the interviews. Interviewees' mean age was 45.8 years, all were professional nurses and the majority were female (82%), working for an average of 3.6 years in abortion services. Four overlapping themes emerged in relation to reported coping strategies: silence and concealing emotions; seeking support; detachment or disengagement; and belief systems. Study findings point to the need for effective, sustainable employee wellness programmes, within an overall context of positive practice environments. [ABSTRACT FROM AUTHOR]

This paper details the responses of a group of African Primary Health Care Nurses (PHCNs), practising in Soweto clinics, to the issue of abortion. The majority of nurses interviewed — 70 per cent of a sample of 27 — unequivocally and unambiguously rejected abortion. The central concern of this paper is to explore why the responses of this ‘rejecting group’ to women who face the predicament of an unwanted pregnancy were cast in such judgemental terms. I argue that this is best understood by unpacking and exploring their identities as African nurses, mothers and wives. In their discourse, abortion symbolises a denial of women's true calling. To them, when a woman has an abortion she is ending not only her pregnancy but also her opportunity to be a mother and even her womanhood. The issue of abortion also provided the opportunity to explore the complex and contradictory ways in which this group of women understands and responds to patriarchal relationships. [ABSTRACT FROM AUTHOR]

This paper is a sequel to a 2004 article that reviewed South Africa’s introduction of new sexual and reproductive health (SRH) and rights laws, policies and programmes, a decade into democracy. Similarly to the previous article, this paper focuses on key areas of women’s SRH: contraception and fertility, abortion, maternal health, HIV, cervical and breast cancer and sexual violence. In the last decade, South Africa has retained and expanded its sexual and reproductive health and rights (SRHR) policies in the areas of abortion, contraception, youth and HIV treatment (with the largest antiretroviral treatment programme in the world). These are positive examples within the SRHR policy arena. These improvements include fewer unsafe abortions, AIDS deaths and vertical HIV transmission, as well as the public provision of a human papillomavirus vaccine to prevent cervical cancer. However, persistent socio-economic inequities and gender inequality continue to profoundly affect South African women’s SRHR. The state shows mixed success over the past two decades in advancing measurable SRH social justice outcomes, and in confronting and ameliorating social norms that undermine SRHR. [ABSTRACT FROM AUTHOR]

Objective: To determine if either prophylactic tramadol 50 mg or ibuprofen 400 mg/metoclopramide 10 mg result in lower maximal pain compared to placebo in women ≤63 days' gestation having a mifepristone-misoprostol medical abortion.Study Design: We conducted a randomized, placebo-controlled trial in Nepal, South Africa, and Vietnam. Participants seeking medical abortion received active treatment or placebo, taken at time of misoprostol and repeated 4 hours later. All had access to additional analgesia. The primary outcome was mean maximum pain score within 8 hours. Participants self-assessed maximum pain using an 11-point numeric rating scale recorded in paper diaries; we analyzed these data using intention-to-treat analysis. Secondary outcomes included use of additional analgesia, side effects, and satisfaction.Results: We enrolled 563 patients between June 2016 and October 2017; 5 participants failed to follow up. Mean adjusted maximum pain scores within 8 hours in both active arms were lower than placebo (tramadol: n = 188, 6.78 (95% confidence interval [CI] 6.46, 7.11); ibuprofen/metoclopramide: n = 187, 6.43 (95% CI 6.10, 6.75); placebo: n = 188, 7.42 (95% CI 7.10, 7.74); p = 0.0001). Additional analgesia was used by 97 (52.2%) participants in the tramadol group, 80 (43.0%) in the ibuprofen/metoclopramide group, and 103 (55.7%) in the placebo group, p = 0.04. More dizziness (p = 0.004), headache (p = 0.03), and vomiting (p < 0.001) occurred in the tramadol group. More participants reported experienced pain was the same or less than expected in the ibuprofen/metoclopramide group (p = 0.05); overall abortion satisfaction did not differ by group (p = 0.44).Conclusions: Compared with placebo, tramadol or ibuprofen/metoclopramide co-administered with misoprostol and repeated 4 h later resulted in lower mean maximum pain scores that failed to achieve clinical significance. Women who received ibuprofen/metoclopramide were least likely to use additional analgesia and reported fewer side effects.Implications: Given that tramadol, ibuprofen, and metoclopramide are inexpensive, globally available; and, ibuprofen and metoclopramide are included on the World Health Organization Essential Medicines List, these medicines could be considered for prophylactic pain management during medical abortion. [ABSTRACT FROM AUTHOR]

Abortion in South Africa is a complex topic, rife with augmenting and limiting political, social, religious, and cultural factors. This study explores multiple age groups within Cato Manor and whether the attitudes towards abortion and factors impacting the choice of where and whether to receive an abortion differ. The study employs a general qualitative approach with inserted narratives highlighting individual perspectives and stories. The sample cohort was identified using purposive sampling of women, obtained via convenience through the gatekeeper in the community. The participants are from two generations, and two expert interviews were conducted to gain various perspectives. The sample population is from the greater Cato Manor community, and the interviews were conducted in a semi-structured format. The main goal of this study is to understand how socio-cultural factors impact abortion attitudes within each generation in Cato Manor and if community attitudes impact women's decisions on how and where to obtain medical abortions. The findings show that negative attitudes towards abortion persist in Cato Manor due to religious and cultural rationale. Greater acceptance occurs among younger generations following abortion legalization in South Africa, yet prejudice remains. The research reveals a range of factors that may pressure women to obtain illegal abortion options to avoid community shame. [ABSTRACT FROM AUTHOR]

South Africa has one of the most liberal abortion laws in the world, emphasising the right to reproductive choice, in keeping with the country's post-apartheid emphasis on human rights. Access to abortion may also be considered a public health consideration, due to the large number of complications associated with illegal abortions and the associated burden of care. Despite these justifications for a more permissive stance towards abortion, there remain large segments of South African society who are opposed to termination of pregnancy on request. This paper examines the status of reproductive rights in South Africa before looking more closely at public attitudes towards them in the country's largest city-region. It uses survey data considering attitudes towards abortion as well as the interaction of these attitudes with the variables of race, gender, education level and age using multinomial logistic regression. The results indicate that the largest proportion of respondents oppose abortion absolutely, while a smaller proportion would be open to abortion if the mother's life is in danger or if the pregnancy was a result of rape. Throughout, the smallest proportion of respondents was of the view that abortion on request is a human right. In terms of predictive value, educational attainment was a stronger predictor than age, race or gender, though there is a distinct lack of consistency in predictive validity of all factors, demonstrating the significant gap between the liberality of laws and the conservatism of public attitudes. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper describes experiences and lessons learned about how to establish safe second trimester abortion services in low-resource settings in the public health sector in three countries: Nepal, Viet Nam and South Africa. The key steps involved include securing the necessary approvals, selecting abortion methods, organising facilities, obtaining necessary equipment and supplies, training staff, setting up and managing services, and ensuring quality. It may take a number of months to gain the necessary approvals to introduce or expand second trimester services. Advocacy efforts are often required to raise awareness among key governmental and health system stakeholders. Providers and their teams require thorough training, including values clarification; monitoring and support following training prevents burn-out and ensures quality of care. This paper shows that good quality second trimester abortion services are achievable in even the most low-resource settings. Ultimately, improvements in second trimester abortion services will help to reduce abortion-related morbidity and mortality. Cet article décrit les expériences et les enseignements obtenus sur la création de services sûrs d'avortement du deuxième trimestre en situation de ressources limitées dans le secteur de la santé publique de trois pays : Népal, Viet Nam et Afrique du Sud. Les étapes clés étaient l'obtention des autorisations, la sélection des méthodes d'avortement, l'organisation des centres, l'acquisition des équipements et fournitures nécessaires, la formation du personnel, la mise en place et la gestion des services et la garantie de qualité. Plusieurs mois sont parfois nécessaires pour obtenir l'autorisation d'introduire ou d'élargir les services d'avortement du deuxième trimestre. Des activités de plaidoyer sont souvent requises pour sensibiliser les acteurs clés de l'administration et du système de santé. Les prestataires et leurs équipes exigent une formation approfondie, notamment une clarification des valeurs ; après la formation, un suivi et un soutien préviennent l'épuisement professionnel et garantissent la qualité des soins. L'article montre que des services de bonne qualité d'avortement au deuxième trimestre sont possibles même dans les environnements aux ressources les plus limitées. En fin de compte, les améliorations dans ces services aideront à réduire la morbidité et la mortalité liées à l'avortement. En este artículo se describen las experiencias y lecciones aprendidas sobre cómo establecer servicios seguros de aborto en el segundo trimestre, en lugares con escasos recursos, en el sector salud pública de tres países: Nepal, Vietnam y Sudáfrica. Los pasos fundamentales son: obtener la autorización necesaria, seleccionar los métodos de aborto, organizar los establecimientos de salud, obtener el equipo y los suministros necesarios, capacitar al personal, establecer y manejar los servicios y garantizar la calidad. Posiblemente tome varios meses obtener la autorización necesaria para lanzar o ampliar los servicios en el segundo trimestre. Por lo general, se necesitan esfuerzos de promoción y defensa para concientizar a las partes interesadas del gobierno y del sistema de salud. Los prestadores de servicios y su equipo necesitan capacitación completa, que incluya aclaración de valores; el monitoreo y apoyo post-capacitación ayudan a evitar agotamiento y garantizar la calidad de la atención. Es posible lograr servicios de alta calidad de aborto en el segundo trimestre, incluso en los lugares donde existe la mayor escasez de recursos. A la larga, las mejoras en los servicios de aborto en el segundo trimestre ayudarán a disminuir las tasas de morbilidad y mortalidad relacionadas con el aborto. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study aimed to explore the decision-making process of patients with pregnancies affected by serious congenital abnormalities. The study design was an exploratory qualitative study. The sample for this study was pregnant individuals who had a prenatal diagnosis of a serious congenital abnormality and were offered termination of pregnancy. Semi-structured face-to-face interviews with closed and open-ended questions, recorded and transcribed verbatim, were used to collect the data; this was then analyzed using a thematic data analysis approach. Five topics were developed: "Health care services", "Home", "Being a mother", "Finding meaning", and "The aftermath". The first four topics describe the decision-making process where the participants filtered through multiple factors to reach their final decision. Although the participants consulted with their families, partners, and community, they made the final decision themselves. The final topics describes activities which were necessary for closure and coping. This study has provided valuable insight into the decision-making process, which can be used to improve services offered to patients. Information should be communicated clearly with follow-up appointments to discuss further. Healthcare professional should show empathy and assure the participants that their decision is supported. • There are limited qualitative data on termination of pregnancy decision-making for serious congenital abnormalities in the African setting. • This paper provides insight into the decision-making process of pregnant individuals from the Western Cape, South Africa. • Decision-making for terminating pregnancy affected by congenital abnormality is multifaceted but with one deciding factor. • Contrary to what is anecdotally expected, in this study the participants made the final decision. • Tragic optimism was necessary for the participants to carry on with their lives. [ABSTRACT FROM AUTHOR]

The topic of abortion was in the limelight again in Dobbs v Jackson, where the US Supreme Court overturned the decision of Roe v Wade, 'which guaranteed women and pregnant people a constitutional right to abortion'. While not bound by the judgment, this gives us an opportunity to reflect on the current law in South Africa which regulates the termination of pregnancy. The primary piece of legislation which governs abortion is the Choice on Termination of Pregnancy Act. Section 2 of the Act lists the grounds under which one may lawfully terminate a pregnancy. One of those grounds relates to the period of the 13th up until the 20th week of the gestation period, and states that if a medical practitioner, after consultation with the pregnant woman, is of the opinion that the continued pregnancy would significantly affect the social or economic circumstances of the woman, then the pregnancy may be lawfully terminated. The question is: What exactly is meant by 'social grounds'? This article considers this aspect from a legal perspective and attempts to provide clarity on the issue, in the hope that this will be of assistance to medical practitioners who are concerned about the outcome of their actions, when assisting persons in this position. [ABSTRACT FROM AUTHOR]

Respondent-driven sampling (RDS) is a potential strategy for addressing challenges in accurate estimation of abortion incidence, but it relies on often untested assumptions. We conducted an RDS study to estimate the cumulative lifetime incidence of abortion in Soweto, Johannesburg, South Africa (April–December 2018), to evaluate whether RDS assumptions were met, and to compare RDS estimates of incidence with estimates adjusted for employment and age based on census data. A total of 849 participants were recruited from 11 seed participants between April and December 2018. The assumption that individuals can identify target population members and the assumption of approximation of sampling with replacement was met. There were minor violations of the assumptions of seed independence from the final sample and reciprocity of ties. Assumptions of accurate degree reporting and random recruitment were not met. Failure to meet assumptions yielded a study sample with different employment characteristics than those of the target population; this could not be resolved by standard RDS methods. The RDS estimate of cumulative lifetime abortion incidence was 12.1% (95% confidence interval: 9.8, 14.3), and the employment-adjusted estimate was 16.9% (95% confidence interval: 12.8, 22.1). We caution researchers in using RDS for representative estimates of abortion incidence. Use of postsurvey weights to adjust for differences in characteristics between the sample and the target population may yield more representative results. [ABSTRACT FROM AUTHOR]

Adverse pregnancy outcomes (APOs) are common occurrences that contribute to negative maternal and child health outcomes. Our aim was to test the hypothesis that trauma exposure and depression are drivers of the better-recognised risk factors for miscarriage, abortion and stillbirths. Our comparative cohort study based in Durban, South Africa recruited women who reported a recent rape (n = 852) and those who had never experienced rape (n = 853), with follow-up for 36 months. We explored APOs (miscarriage, abortion or stillbirth) among those having a pregnancy during follow-up (n = 453). Potential mediators were baseline depression, post-traumatic stress symptoms, substance abuse, HbA1C, BMI, hypertension and smoking. A structural equation model (SEM) was used to determine direct and indirect paths to APO. Overall, 26.6% of the women had a pregnancy in the follow-up period and 29.4% ended in an APO, with miscarriage (19.9%) the most common outcome, followed by abortion (6.6%) and stillbirths (2.9%). The SEM showed two direct pathways from exposure to childhood trauma, rape and other trauma, to APO which were ultimately mediated by hypertension and/or BMI, but all paths to BMI were mediated by depression and IPV-mediated pathways from childhood and other trauma to hypertension. Food insecurity mediated a pathway from experiences of trauma in childhood to depression. Our study confirms the important role of trauma exposure, including rape, and depression on APOs, through their impact on hypertension and BMI. It is critical that violence against women and mental health are more systematically addressed in antenatal, pregnancy and postnatal care. [ABSTRACT FROM AUTHOR]

Background: The implementation of choice arising from the Termination of Pregnancy Act of 1996 (Act 92 of 1996) is a challenge in South Africa as there are many abortions that are still carried out by illegal abortionists in the Transkei region. This raises the serious question as to why the women do not prefer to go instead to a designated legal abortion clinic which carries out safe abortions in South Africa. Objective: To study the underlying factors which prevent women from going for an abortion to designated legal abortion facilities. Method: This qualitative research was carried out by medical students who visited both the legal and illegal facilities in Mthatha in 2015 for their assignment during the rotation of their subject of speciality. Result: The legal clinics are not user-friendly, the staff misbehave with the girls, they cast doubt on their confidentiality, and they take a long time to do the abortions, while the illegal abortionists charge money for their services but they are quick and keep confidentiality. Conclusion: Legal abortion clinics are not user friendly. [ABSTRACT FROM AUTHOR]

Access to safe second trimester abortion services is poor in many countries, sometimes despite liberal laws and policies. Addressing the myriad factors hindering access to safe abortion care requires a multi-pronged strategy. Workshops aimed at clarifying values are useful for addressing barriers to access stemming from misinformation, stigmatisation of women and providers, and negative attitudes and obstructionist behaviours. They engage health care providers and administrators, policymakers, community members and others in a process of self-examination with the goal of transforming abortion-related attitudes and behaviours in a direction supportive of women seeking abortion. This is especially important for women seeking second trimester abortion, which tends to be even more stigmatised than first trimester abortion. This paper reports on some promising experiences and results from workshops in Viet Nam, Nepal and South Africa. Some recommendations that emerge are that values clarification should be included in abortion training, service delivery and advocacy programmes. Evaluations of such interventions are also needed. Dans beaucoup de pays, l'accès aux services d'avortement du deuxième trimestre est médiocre, parfois en dépit de lois et de politiques libérales. Pour s'attaquer aux multiples facteurs qui entravent l'accès à des soins sécurisés, il faut appliquer une stratégie à plusieurs volets. Des ateliers destinés à clarifier les valeurs et transformer les attitudes sont utiles pour lever les obstacles créés par les idées fausses, la stigmatisation à l'égard des femmes et des prestataires de services et aussi par les attitudes négatives et les comportements obstructionnistes. Ils engagent les soignants et les administrateurs, les décideurs, les membres de la communauté et d'autres catégories dans un processus d'auto-examen qui a pour but de réorienter leurs attitudes et leurs comportements, de façon à soutenir les femmes qui souhaitent avorter. C'est particulièrement important pour celles qui veulent avorter au deuxième trimestre, car elles sont en général encore plus stigmatisées que celles qui le font au premier trimestre. Cet article décrit des expériences prometteuses et les résultats positifs d'ateliers au Viet Nam, au Népal et en Afrique du Sud. La clarification des valeurs devrait être incluse dans la formation à l'avortement, la prestation des services et les programmes de plaidoyer. Des évaluations de ces interventions sont également nécessaires. Muchos países carecen de acceso a servicios seguros de aborto en el segundo trimestre, a veces pese a leyes y políticas liberales. Para tratar los diversos factores que obstaculizan el acceso a los servicios de aborto seguro se necesita una estrategia de múltiples facetas. Los talleres de aclaración de valores y transformación de actitudes sirven para eliminar las barreras al acceso que surgen de información errónea, estigmatización de mujeres y prestadores de servicios, actitudes negativas y comportamientos obstruccionistas. En estos talleres, los administradores y prestadores de servicios de salud, formuladores de políticas, miembros de la comunidad y otros participan en un proceso de autoexamen con el objetivo de transformar sus actitudes y comportamientos respecto al aborto con el fin de brindar apoyo a las mujeres que buscan un aborto. Esto es de particular relevancia para aquéllas que necesitan servicios de aborto en el segundo trimestre, que tiende a ser aun más estigmatizado que el aborto en el primer trimestre. En este artículo se informa sobre experiencias y resultados prometedores de talleres en Vietnam, Nepal y Sudáfrica. Algunas recomendaciones que emergen son que la aclaración de valores debe incluirse en la capacitación, la prestación de servicios y los programas de promoción y defensa relacionados con el aborto. También es necesario evaluar dichas intervenciones. [ABSTRACT FROM AUTHOR]

Background: Although abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, the sources of information used to make their decisions and the factors that contribute to their seeking of informal sector abortion in Cape Town, South Africa. Methods: We conducted 15 semi-structured in-depth interviews in English with women who had accessed an abortion outside of the formal health care sector. Women were recruited with the assistance of a community-based key informant. Data was analyzed using a thematic analysis approach. Results: Participants were aware that abortions were legal and accessible in public clinics, however they were concerned that others would find out about their unintended pregnancy and abortion if they went to legal providers. Women were also concerned about judgment and mistreatment from providers during their care. Rather than seek care in the formal sector, women looked past concerns around the safety and effectiveness of informal sector abortions and often relied on their social networks for referrals to informal providers. Conclusions: The findings highlight the decision-making processes employed by women when seeking abortion services in a setting where abortion is legal and demonstrate the role of institutional and societal barriers to safe abortion access. Abortion service delivery models should adapt to women's needs to enhance the preferences and priorities of those seeking abortion care-including those who prefer facility-based care as well as those who might prefer self-managed medical abortions. Plain language summary: Although abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, who they discuss and seek help from, and the factors that influence their decision to seek an abortion outside of the formal health care sector. We interviewed 15 women who had obtained an abortion outside of the health care sector in Cape Town, South Africa. Women were aware that abortions were legal and available in public clinics, but they were concerned about negative and judgmental attitudes from health care providers even though some women were aware of the possible health safety issues related to seeking an abortion outside of the clinic setting. Abortion services should adapt to women's needs and offer them options of facility-based care but also self-managed medical abortions under the guidance of health care providers. [ABSTRACT FROM AUTHOR]

Little research tackles healthcare providers' experiences in conducting pre-abortion counselling sessions in circumstances where pregnant persons may request an abortion. We report on a study conducted in South Africa, in which two nurses and two counsellors were asked about how they conduct these counselling sessions. Using a synthetic narrative approach, we present these health workers' micro-narratives about their motivations for providing abortion services, the purpose of the counselling, their information-giving practices, and whether and how third parties are included in the counselling. We highlight how these micro-narratives are premised on discursive resources that problematise unintended pregnancy and abortion. These resources enable and justify directive counselling that undermines pregnant peoples' reproductive autonomy. We locate such directiveness within dominant anti-abortion discourse and call for training to reframe normative understandings of abortion. [ABSTRACT FROM AUTHOR]

Abortion providers and pregnant people who undergo abortion potentially face significant stigma. Researchers have started to explore how womxn respond to abortion stigma, usually focusing on individual strategies in managing or reducing stigma effects. Drawing on narrative data from research conducted on womxn's and healthcare providers' experiences of the pre-abortion healthcare encounter in the South African public health sector, we highlight how stigma may be resisted in social ways within this context. Everyday chatter and informal social support amongst womxn in the waiting room provided a counterpoint for health service providers' ascription of shame to the womxn, and a sense of solidarity amongst the womxn. Health service providers narrated their decision to do abortion work through the socially affirming hero canonical narrative, and womxn described their counselling as helpful. These social and discursive practices resist the awfulisation of abortion and provide relief for the womxn and the healthcare providers in particular contexts. [ABSTRACT FROM AUTHOR]

Abstract: Focusing on compassion satisfaction, burnout and secondary traumatic stress (STS) among termination of pregnancy (TOP) providers, a cross ‐ sectional study was conducted among these providers in Gauteng and North West provinces of South Africa during 2014 and 2015. During 2014 and 2015, a cross‐sectional study was conducted among TOP service providers in Gauteng and North West provinces. Consented providers completed a self‐administered professional quality of life (PRoQOL) questionnaire, sociodemographic information and possible reasons for working as TOP providers. STATA 13 was used for data analysis. We recruited 105 TOP providers, obtaining 98% response rate. Participants mean age was 43.4 (standard deviation [SD] = 8.7), majority were nurses (70.9%), female (82%), married (47.6%) and 63% were working in hospitals. The overall mean score for compassion satisfaction was high at 42 (SD 5.5). Predictors of compassion satisfaction were finding work stimulating, belief in making a difference, enjoying relationships with other nurses and years of TOP service (P < 0.05). Province and gender were significant, with significant interaction. Burnout mean scores were average at 33 (SD = 4.0), with belief in helping women to make informed choices a marginally significant predictor of burnout. The overall STS mean score was average with a mean of 23 (SD = 6.8). Significant predictors of STS scores were finding work stimulating, belief in women's rights, belief in allowing informed choices, age and gender. Health policy makers and managers should endeavor to provide employee assistance programs that enhance compassion satisfaction and reduce burnout and STS among TOP providers. [ABSTRACT FROM AUTHOR]

Background: In settings where abortion is legally restricted, or permitted but not widely accessible, women face significant barriers to abortion access, sometimes leading them to seek services outside legal facilities. The advent of medication abortion has further increased the prevalence of informal sector abortion. This study investigates the reasons for attempting self-induction, methods used, complications, and sources of information about informal sector abortion, and tests a specific recruitment method which could lead to improved estimates of informal sector abortion prevalence among an at-risk population.Methods: We recruited women who have sought informal sector abortion services in Cape Town, South Africa using respondent driven sampling (RDS). An initial seed recruiter was responsible for initiating recruitment using a structured coupon system. Participants completed face-to-face questionnaires, which included information about demographics, informal sector abortion seeking, and safe abortion access needs.Results: We enrolled 42 women, nearly one-third of whom reported they were sex workers. Thirty-four women (81%) reported having had one informal sector abortion within the past 5 years, 14% reported having had two, and 5% reported having had three. These women consumed home remedies, herbal mixtures from traditional healers, or tablets from an unregistered provider. Twelve sought additional care for potential warning signs of complications. Privacy and fear of mistreatment at public sector facilities were among the main reported reasons for attempting informal sector abortion. Most women (67%) cited other community members as their source of information about informal sector abortion; posted signs and fliers in public spaces also served as an important source of information.Conclusions: Women are attempting informal sector abortion because they seek privacy and fear mistreatment and stigma in health facilities. Some were unaware how or where to seek formal sector services, or believed the cost was too high. Many informal methods are ineffective and unsafe, leading to potential warning signs of complications and continued pregnancy. Sex workers may be at particular risk of unsafe abortion. Based on these results, it is essential that future studies sample women outside of the formal health sector. The use of innovative sampling methods would greatly improve our knowledge about informal sector abortion in South Africa. [ABSTRACT FROM AUTHOR]

Background: Allowing a broader range of trained health workers to deliver services can be an important way of improving access to safe abortion care. However, the expansion of health worker roles may be challenging to implement. This study aimed to explore factors influencing the implementation of role expansion strategies for non-physician providers to include the delivery of abortion care.Methods: We conducted a multi-country case study synthesis in Bangladesh, Ethiopia, Nepal, South Africa and Uruguay, where the roles of non-physician providers have been formally expanded to include the provision of abortion care. We searched for documentation from each country related to non-physician providers, abortion care services and role expansion through general internet searches, Google Scholar and PubMed, and gathered feedback from 12 key informants. We carried out a thematic analysis of the data, drawing on categories from the SURE Framework of factors affecting the implementation of policy options.Results: Several factors appeared to affect the successful implementation of including non-physician providers to provide abortion care services. These included health workers' knowledge about abortion legislation and services; and health workers' willingness to provide abortion care. Health workers' willingness appeared to be influenced by their personal views about abortion, the method of abortion and stage of pregnancy and their perceptions of their professional roles. While managers' and co-workers' attitudes towards the use of non-physician providers varied, the synthesis suggests that female clients focused less on the type of health worker and more on factors such as trust, privacy, cost, and closeness to home. Health systems factors also played a role, including workloads and incentives, training, supervision and support, supplies, referral systems, and monitoring and evaluation. Strategies used, with varying success, to address some of these issues in the study countries included values clarification workshops, health worker rotation, access to emotional support for health workers, the incorporation of abortion care services into pre-service curricula, and in-service training strategies.Conclusions: To increase the likelihood of success for role expansion strategies in the area of safe abortion, programme planners must consider how to ensure motivation, support and reasonable working conditions for affected health workers. [ABSTRACT FROM AUTHOR]

Background: The requirement for ultrasound to establish gestational age among women seeking abortion can be a barrier to access. Last menstrual period dating without clinical examination should be a reasonable alternative among selected women, and if reliable, can be task-shared with non-clinicians. This study determines the accuracy of gestational age estimation using last menstrual period (LMP) assessed by community health care workers (CHWs), and explores providers' and CHWs' perspectives on task sharing this activity. The study purpose is to expand access to early medical abortion services. Methods: We conducted a multi-center cross-sectional study at four urban non-governmental reproductive health clinics in South Africa. CHWs interviewed women seeking abortion, recorded their LMP and gestational age from a pregnancy wheel if within 63 days. Thereafter, providers performed a standard examination including ultrasound to determine gestational age. Lastly, investigators calculated gestational age for all LMP dates recorded by CHWs. We compared mean gestational age from LMP dates to mean gestational age by ultrasound using t-tests and calculated proportions for those incorrectly assessed as eligible for medical abortion from LMP. In addition, in-depth interviews were conducted with six providers and seven CHWs. Results: Mean gestational age was 5 days (by pregnancy wheel) and 9 days (by LMP calculation) less than ultrasound gestational age. Twelve percent of women were eligible for medical abortion by LMP calculation but ineligible by ultrasound. Uncertainty of LMP date was associated with incorrect assessment of gestational age eligibility for medical abortion (p = 0.015). For women certain their LMP date was within 56 days, 3% had ultrasound gestational ages >70 days. In general, providers and CHWs were in favour of task sharing screening and referral for abortion, but were doubtful that women reported accurate LMP dates. Different perspectives emerged on how to implement task sharing gestational age eligibility for medical abortion. Conclusions: If LMP recall is within 56 days, most women will be eligible for early medical abortion and LMP can substitute for ultrasound dating. Task sharing gestational age estimation is feasible in South Africa, but its implementation should meet women's privacy needs and address healthcare workers' concerns on managing any procedural risk. [ABSTRACT FROM AUTHOR]

The right to life and reproductive health has been firmly established by a number of international human rights and gender equality instruments to which Namibia is a signatory. Human rights and reproductive justice frameworks affirm women’s right to bodily integrity and reproductive autonomy without violence, coercion or discrimination on the basis of race, class, ethnicity or disability. The restrictive Namibian abortion law infringes upon all these rights. It is particularly discriminatory against poor and mainly black women who do not have the means to seek safe and legal abortions outside the borders of the country. The high levels of morbidity and mortality related to unsafe illegal abortions show that criminllisation does not stop illegal abortions from taking place. Government has made some attempts at reviewing the outdated law, but progress has been stymied by politically conservative attitudes and the lack of awareness of gender equality and reproductive rights. Although people (in this case youth) are aware of the risks of unsafe illegal abortions to women’s lives and health, they do not see a need for change. This raises broader questions about the status of women in our society and whether women’s lives matter. [ABSTRACT FROM AUTHOR]

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The abortion decision-making process is embedded within overlapping power relations. Using a post-colonial feminist framework, we analyse South African and Zimbabwean women’s narratives regarding their abortion decision. As neighbouring countries, South Africa and Zimbabwe provide a useful counterpoint as they have common and differing social histories and very different abortion legislation. In our analysis, we unpick transversal commonalities and divergences in the discursive resources deployed by the women in their narratives in the two sites. Commonalities included the women feeling compelled to justify their abortion decision in the interactive interview space, an absence of a reproductive rights discourse, and the deployment of relationship embedded discourses in the justificatory work performed by the women. The “conjugalisation of reproduction”, “imperative of good mothering”, and “unstable partner relationships” discourses featured across both sites but the manner in which these were deployed differed. These discursive resources allowed the women to position themselves as making responsible decisions. The Zimbabwean women spoke of shame and hiding, a discursive resource that was explicitly absent in the South African women’s accounts. We conclude by arguing that our post-colonial feminist approach allows for a contextualised reproductive justice stance to abortion decision-making that identifies both transnational and context-specific power relations. [ABSTRACT FROM AUTHOR]

Background: Pain is often cited as one of the worst features of medical abortion. Further, inadequate pain management may motivate some women to seek unnecessary clinical care. There is a need to identify effective methods for pain control in this setting. Methods/Design: We propose a randomized, placebo-controlled trial. 576 participants (288 nulliparous; 288 parous) from study sites in Nepal, South Africa and Vietnam will be randomly allocated to one of three treatments: (1) ibuprofen 400 mg PO and metoclopramide 10 mg PO; (2) tramadol 50 mg PO and a placebo; or (3) two placebo pills, to be taken immediately before misoprostol and repeated once four hours later. All women will be provided with supplementary analgesia for use as needed during the medical abortion. We hypothesize that women receiving prophylactic analgesia will report lower maximal pain scores in the first 8 h following misoprostol administration compared to women receiving placebos for medical abortion through 63 days' gestation. Our primary objective is to determine whether prophylactic administration of ibuprofen and metoclopramide or tramadol provides superior pain relief compared to analgesia administration after pain begins, measured during the first eight hours after misoprostol administration. Secondary objectives include identifying covariates associated with higher reported pain scores; determining any impact of the study medicines on medical abortion success; and, qualitatively exploring women's physical experiences of medical abortion, especially related to pain, and how can they be improved. Data sources include medical records, participant symptom diaries and interview data obtained on the day of enrollment, during the medical abortion, and at follow-up. Participants will be contacted via telephone on day 3 and return for follow-up will occur approximately 14 days after mifepristone, concluding study participation. A subset of 42 women will also be invited to undergo in-depth qualitative interviews following study completion. Discussion: Although pain is one of the most common side effects encountered with medical abortion, little is known about optimal pain management for this process. This multi-arm trial design offers an efficient approach to evaluating two prophylactic pain management regimens compared to use of pain medication as needed. [ABSTRACT FROM AUTHOR]

Background: The copper intrauterine device (IUD) is under-utilised in South Africa, where injectable progestin contraception (IPC) dominates contraception usage. There is a lack of robust comparative data on these contraceptive options to inform policy, programs, clinical counseling, and women's choices. Methods: Within the context of a South African program to increase women's access to the IUD, we conducted a pragmatic, open-label, parallel-arm, randomised controlled trial of the IUD versus IPC at two South African hospitals. The target sample size was 7,000 women and the randomisation ratio was 1:1. The random sequence was computer-generated and group allocation was concealed in sealed, opaque, consecutively-numbered envelopes. Counselled, consenting women attending termination of pregnancy services were randomly assigned to IUD or IPC immediately post-termination. Condoms were promoted for the prevention of sexually-transmitted infections. The primary outcome was pregnancy; secondary outcomes were discontinuation, side-effects, and HIV acquisition and disease progression. Pregnancy and discontinuation outcomes are reported here. Results: The trial closed early with 2,493 participants randomised (IUD = 1,247, IPC = 1,246), due to international concerns regarding a possible association between IPC and HIV acquisition. Median follow-up was 20 months; 982 and 1000 participants were followed up in the IUD and IPC groups, respectively. Baseline group characteristics were comparable. Pregnancy occurred significantly less frequently among women allocated to the IUD than IPC: 56/971 (5.8 %) versus 83/992 (8.4 %), respectively; risk ratio (RR) 0.69, 95 % confidence interval (CI) 0.50 to 0.96; P= 0.025. There were more protocol violations in the IUD group; however, discontinuation rates were similar between IUD and IPC groups (141/855 [16.5 %] and 143/974 [14.7 %], respectively). Women in the IUD group were more likely to discontinue contraceptive use due to abdominal pain or backache and non-specific symptoms, and those in the IPC group due to oligo- or amenorhoea and lack of sexual activity. Conclusions: The IUD was significantly more effective in preventing pregnancy than IPC. Efforts to expand contraception options and improve access to the IUD in settings where it is under-utilised are worthwhile. This trial shows that randomising long-acting, reversible contraceptives is feasible. [ABSTRACT FROM AUTHOR]

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Abortion is a common medical experience, globally and in South Africa. Worldwide, approximately one in five pregnancies ends in abortion. But many societies understand abortion as a moral transgression, even if its benefits to public health are sanctioned legally. South Africa’s abortion culture reveals this paradox: abortion is often publicly condemned – by political authorities, healthcare workers, patients and their families – but privately sanctioned. The apartheid state sought to control the sexual behaviour of its subjects, and passed laws to regulate reproduction. These laws were defied en masse, by patients, doctors and clandestine providers. This article explores the apartheid state’s failure to police abortion, arguing that post-apartheid abortion culture has powerful continuities with the past. Abortion was legalised in 1996, during South Africa’s transition to democracy. While the Choice on Termination of Pregnancy Act has reduced mortality and morbidity resulting from unsafe abortion, illegal abortion remains popular. Unsafe abortion is notoriously difficult to quantify. In South Africa, high rates of maternal morbidity and mortality, including from uterine sepsis, point to the persistence of unsafe, illegal abortion. Women continue to terminate unwanted pregnancies as they always have: away from the glare of public censure, in the shadows of the reproductive arena. [ABSTRACT FROM PUBLISHER]

Background: Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion often on the grounds of religious or moral beliefs including the unregulated practice of conscientious objection. Few studies have explored how providers in South Africa make sense of, or understand, conscientious objection in terms of refusing to provide abortion care services and the consequent impact on abortion access. Methods: A qualitative approach was used which included 48 in-depth interviews with a purposively selected population of abortion related health service providers, managers and policy influentials in the Western Cape Province, South Africa. Data were analyzed using a thematic analysis approach. Results: The ways in which conscientious objection was interpreted and practiced, and its impact on abortion service provision was explored. In most public sector facilities there was a general lack of understanding concerning the circumstances in which health care providers were entitled to invoke their right to refuse to provide, or assist in abortion services. Providers seemed to have poor understandings of how conscientious objection was to be implemented, but were also constrained in that there were few guidelines or systems in place to guide them in the process. Conclusions: Exploring the ways in which conscientious objection was interpreted and applied by differing levels of health care workers in relation to abortion provision raised multiple and contradictory issues. From providers' accounts it was often difficult to distinguish what constituted confusion with regards to the specifics of how conscientious objection was to be implemented in terms of the Choice on Termination of Pregnancy Act, and what was refusal of abortion care based on opposition to abortion in general. In order to disentangle what is resistance to abortion provision in general, and what is conscientious objection on religious or moral grounds, clear guidelines need to be provided including what measures need to be undertaken in order to lodge one's right to conscientious objection. This would facilitate long term contingency plans for overall abortion service provision. [ABSTRACT FROM AUTHOR]

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This article explores the medical history of abortion in South Africa during the last three decades of the twentieth century, focusing on the role played by doctors in their clinical encounters with abortion patients. It also examines doctors' views of the state's contested policies on abortion, while locating these policies within the wider global movement towards the legalisation of abortion. Many doctors and public health officials employed by the apartheid state occupied an ambiguous space, taking a racist and paternalistic approach to their patients, while also providing the services these patients demanded for the protection of their health, including contraception and abortion. I combine the analysis of medical articles, laws and policies governing abortion with the oral-historical recollections of doctors, to examine how changes in abortion laws were understood in medical writing and practice during this time. Two key issues dominated public debates about abortion from the 1970s: the procurement of abortion on psychiatric grounds and the health outcomes of illegal abortions. Ultimately, changes in abortion laws reflected the political transition from apartheid to democracy, during a period in which political leaders and women's health advocates championed the legalisation of abortion despite public opposition. [ABSTRACT FROM PUBLISHER]

The article demonstrates termination-of-pregnancy legislation in South Africa to the extent where women can terminate first- and second-trimester pregnancies on demand and for socio-economic reasons. A common law starts at birth and requires that the child must be separate from the mother's body and must survive independently of the mother after separation. It informs that the Choice Act both advances and limits female reproductive rights. It mentions that South Africa is in the process of successfully balancing the opposing custom of female reproductive rights and foetal interests.

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Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A rich literature exists on local democracy and participation in South Africa. While the importance of participation is routinely built into the rhetoric of government, debate has increasingly focused on the dysfunctionality of participatory mechanisms and institutions in post-apartheid South Africa. Processes aimed ostensibly at empowering citizens, act in practice as instruments of social control, disempowerment and cooptation. The present article contributes to these debates by way of a critique of the approach used by the South African state, in partnership with the non-governmental sector, in what are called abortion ‘values clarification’ (VC) workshops. This article examines the workshop materials, methodology and pedagogical tools employed in South African abortion VC workshops which emanate from the organization Ipas — a global body working to enhance women’s sexual and reproductive rights and to reduce abortion-related deaths and injuries. VC workshops represent an instance of a more general trend in which participation is seen as a tool for generating legitimacy and ‘buy-in’ for central state directives rather than as a means for genuinely deepening democratic communication. The manipulation of participation by elites may serve as a means to achieve socially desirable goals in the short term but the long-term outlook for a vibrant democracy invigorated by a knowledgeable, active and engaged citizenry that is accustomed to being required to exercise careful reflection and to its views being respected, is undermined. Alternative models of democratic communication, because they are based on the important democratic principles of inclusivity and equality, have the potential both to be more legitimate and more effective in overcoming difficult social challenges in ways that promote justice. [ABSTRACT FROM PUBLISHER]

The article presents a study on surgical and medical second trimester abortion in South Africa. We performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. It was found that second trimester abortions by dilation and evacuation were more effective than induction procedures, required shorter hospital stay, and were associated with shorter delays accessing care.

South Africa underwent a massive political change in 1994 when Nelson Mandela became the first democratically elected president. Since then, many changes in the law have been enacted, not all acceptable to Christians and Catholics in particular. This article describes the most important changes that were made and the efforts of Catholics to influence their content. Possible methodologies for future action are also discussed. [ABSTRACT FROM AUTHOR]

This study was undertaken to assess the risk of being infected with a known sexually transmitted pathogen at the time of presentation for termination of pregnancy. Endocervical and vaginal swabs were collected for the diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. Single infections were found in 21.5% of the women, with C. trachomatis being the commonest (10.0%). Mixed infections were found in nine women, with trichomoniasis and chlamydial infections in six. During speculum examination, vaginal discharge was observed in 73% of the women. The commonest organism detected in patients with vaginal discharge was C. trachomatis (11.6%), while T. vaginalis (11.1%) was the most common in women without visible vaginal discharge. No significant differences were found when comparing symptomatic and non-symptomatic women. This study strongly recommends that women presenting for termination of pregnancy be screened for STIs and receive relevant sexual health education. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)