Department of Nursing and Midwifery

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Browsing Department of Nursing and Midwifery by Subject "Abortion services -- Use studies -- City of Cape Town (South Africa)"

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    The underutilisation of termination of pregnancy (TOP) services by women with unintended pregnancies : a descriptive case study in community health centres within the Cape Metropole, South Africa
    (Stellenbosch : Stellenbosch University, 2020-03) Kotze, Elcalien; Kaura, Doreen Kainyu; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
    ENGLISH SUMMARY : Background: Legislation in South Africa permits termination of pregnancies (TOPs) up to a gestational age of twelve weeks on request of a woman and furthermore to a gestational age of twenty weeks if the pregnancies pose significant risks to women’s wellbeing or if the foetus suffers severe abnormalities, if the pregnancy resulted from rape or if the continuation of the pregnancy would affect the social or economic circumstances of the woman. After the twentieth week of pregnancy, termination is permitted when the woman’s life is in danger or when severe malformation of the foetus is detected and injury to the foetus is evident. The public healthcare system provides free TOP services in settings easily accessible to the community. It has been found that despite available and accessible TOP services, women with unintended pregnancies still complied with unsafe TOP practices. The aim of this study was to describe the underutilisation of TOP services amongst women with unintended pregnancies in Community Health Centres (CHCs) within the Cape Metropole. Methods: A qualitative approach with a single-descriptive case study design was used to explore the underutilisation of TOP services amongst women with unintended pregnancies that presented in the CHCs and who were seeking care after unsafe abortion attempts. The study applied purposive sampling to select participants from the Khayelitsha and Mitchells Plain CHCs. Permission to conduct the study was granted by The Health Research Ethics Committee of Stellenbosch University and the Western Cape Department of Health. Ten indepth individual semi-structured interviews were conducted, transcribed and analysed, using the analytic technique as described by Robert Yin. Results: The themes that emerged from both units of analysis were lack of access to information and services regarding TOP services, the stigma surrounding unintended pregnancies and the circumstances forcing unsafe TOP decisions. Some participants displayed awareness of TOP legislation, but still sought unsafe TOP methods. Healthcare providers were adequate in their provision of information regarding TOP services, but enquiries regarding these unsafe TOP services were based on information on the internet and advertisements on lampposts and the walls of buildings. Stigma due to the perceived opinion of the community and healthcare providers, the occurrence of rape and unintended pregnancy, in conjunction with personal circumstances such as maternal age and efforts to hide the pregnancy, forced these women to make unsafe TOP decisions. Feelings of regret were displayed only after an unsafe TOP decision had been made. In addition to the above themes, another theme emerged from the second unit of analysis and this was related to healthcare providers’ perceptions of unsafe TOPs. Healthcare providers were sensitive towards the women’s circumstances, but some felt obliged to report the cases. Lack of feedback from law enforcement and the absence of management guidelines resulted in increased frustration. Conclusion: The findings demonstrated that despite access to, and information regarding TOP services, women with unintended pregnancies still underutilised these services. In most cases, the stigma related to unwanted pregnancies, rape, maternal age and financial difficulties put pressure on these women in their effort to hide the pregnancy and they failed to access these services.