Termination of pregnancy (TOP) remains one of the most controversial health issues, and yet despite the long-standing stigmas and opposition to its practice, remains a common experience for some women around the world. According to WHO, globally, six out of 10 of all unintended pregnancies end in an induced abortion. However a large proportion of these procedures - around 45% of all abortions - are unsafe, of which 97% take place in developing countries. Unsafe abortion is a leading – but preventable – cause of maternal deaths and morbidities. It can lead to physical and mental health complications and social and financial burdens for women, communities and health systems. Hence the lack of access to safe, timely, affordable and respectful abortion care is a critical public health and human rights issue.
South Africa is one of the countries that allows termination of pregnancy within its legislative and policy frameworks:
● The Choice on Termination of Pregnancy Act of 1996 gives women the right to request termination of pregnancy up to and including the 12th week of pregnancy and under certain circumstances between the 13th and 20th week of pregnancy by a certified nurse practitioner or medical doctor.
● In 2004, an amendment was added in order to make termination of pregnancy services more available for women. This amendment allowed for any health facility that has a 24-hour maternity service to offer first trimester abortion services.
● The 2004 amendment also allowed registered nurses that have completed a TOP training course to provide first trimester terminations, expanding the base of providers for abortions.
As a result of the above, studies suggest that South Africa has seen a reduction in maternal deaths from unsafe abortions, although they are still occurring. Unsafe termination of pregnancies continues to be practiced due to a variety of 1 Ashley Gresh and Pranitha Maharaj, Termination of pregnancy: Perspectives of female students in Durban, South Africa. 2014 2 Orner,P, de Bruyn M, A qualitative exploration of HIV-positive pregnant women’s decision making regarding abortion in Cape Town interconnected factors such as women lacking awareness of the availability of safe abortions; the knowledge of the time for abortion on request not being widely known, resulting in delays to seek abortion to a time beyond the limit set by the law. Furthermore, the stigmatization of abortion services make their provision by the care providers a difficult task.
It is against this backdrop that the current intervention will take place. Comprehensive abortion care addresses mitigating factors and barriers for the provision of safe abortion services by tackling four key areas which include:
Knowledge
Providing information on sexual and reproductive health services including abortion services can addresses stigma and reduce harassment on care providers. Information and awareness on abortion and abortion services can motivate the recruitment and retention of abortion care providers. Increased community awareness services can provide women with information about and access to contraceptive services (Wcgcares.org, 2018:18).
Skills
Comprehensive abortion care ensures that practitioners providing abortion services are trained to improve the quality of clinical abortion care. Provider skills also help them address interpersonal stigma and beliefs related to the provision of abortion services (Wcgcares.org, 2018:18).
Infrastructure
Comprehensive abortion care ensures that abortion facilities are adequately equipped to offer abortion services with quality infrastructure to enhance service delivery. Physical infrastructure includes the provision of private rooms, sanitation facilities, clean linen, medicinal resources such as painkillers and that there is enough equipment for the abortion procedures. Additional infrastructure components to enhance services also include the provision of adequate staffing to increase the quantity of abortion services available (Wcgcares.org, 2018:16). 3 Wcgcares.org. 2018. Five years of improving abortion care: Lessons learned from the Max Programme in Kenya and South Africa
Enabling environment
Comprehensive abortion care ensures that providers work in an enabling environment. An enabling environment is one that ensures social policy and regulations that support abortion and post-abortion contraception delivery and counselling exist and are implemented.
In the South African context, the support of managers, clear guidelines and medical abortion policies and practices is essential because without managerial support, providers may be prohibited from carrying out services (Wcgcares.org, 2018:20). Therefore a comprehensive abortion care has to incorporate intervention methods that address these key areas in order to provide safe abortion services in South Africa.