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Published in: BMC Public Health 1/2009

Open Access 01-12-2009 | Research article

Health care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa

Authors: Jane Harries, Kathryn Stinson, Phyllis Orner

Published in: BMC Public Health | Issue 1/2009

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Abstract

Background

Despite changes to the abortion legislation in South Africa in 1996, barriers to women accessing abortion services still exist including provider opposition to abortions and a shortage of trained and willing abortion care providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.
In South Africa, little is known about the personal and professional attitudes of individuals who are currently working in abortion service provision. Exploring the factors which determine health care providers' involvement or disengagement in abortion services may facilitate improvement in the planning and provision of future services.

Methods

Qualitative research methods were used to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach.

Results

Complex patterns of service delivery were prevalent throughout many of the health care facilities, and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Related to this was the need expressed by many providers for dedicated, stand-alone abortion clinics thereby creating a more supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision.

Conclusion

This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion and adds to the body of information addressing the barriers to safe abortion services. In order to sustain a pool of abortion providers, programmes which both attract prospective abortion providers, and retain existing providers, needs to be developed and financial compensation for abortion care providers needs to be considered.
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Literature
1.
go back to reference World Health Organization: Safe Abortion: Technical and Policy Guidance for Health Systems. 2004, World Health Organization: Geneva World Health Organization: Safe Abortion: Technical and Policy Guidance for Health Systems. 2004, World Health Organization: Geneva
2.
go back to reference Ganatra BR: What we know, what we need to know: review of current evidence on induced abortion in India. Women's reproductive health in India. Edited by: Jejeebhoy S, Ramasubban R. 2002, New Delhi:Rawat Publications Ganatra BR: What we know, what we need to know: review of current evidence on induced abortion in India. Women's reproductive health in India. Edited by: Jejeebhoy S, Ramasubban R. 2002, New Delhi:Rawat Publications
3.
go back to reference Warriner IK, Meirik O, Hoffman M, Morroni C, Harries J, My Huong NT, Vy ND, Seuc AH: Rates of complication in first-trimester manual vacuum aspiration abortion done by doctors and mid-level providers in South Africa and Vietnam: a randomised controlled equivalence trial. Lancet. 2006, 368 (9551): 1965-1972. 10.1016/S0140-6736(06)69742-0.CrossRefPubMed Warriner IK, Meirik O, Hoffman M, Morroni C, Harries J, My Huong NT, Vy ND, Seuc AH: Rates of complication in first-trimester manual vacuum aspiration abortion done by doctors and mid-level providers in South Africa and Vietnam: a randomised controlled equivalence trial. Lancet. 2006, 368 (9551): 1965-1972. 10.1016/S0140-6736(06)69742-0.CrossRefPubMed
4.
go back to reference Jewkes R, Rees H: Dramatic decline in abortion related mortality due to the Choice on Termination of Pregnancy Act. S Afr Med J. 2005, 95 (4): 250-PubMed Jewkes R, Rees H: Dramatic decline in abortion related mortality due to the Choice on Termination of Pregnancy Act. S Afr Med J. 2005, 95 (4): 250-PubMed
5.
go back to reference Harrison A, Montgomery E, Lurie M, Wilkinson D: Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal. Health Policy Plan. 2000, 15 (4): 424-431. 10.1093/heapol/15.4.424.CrossRefPubMed Harrison A, Montgomery E, Lurie M, Wilkinson D: Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal. Health Policy Plan. 2000, 15 (4): 424-431. 10.1093/heapol/15.4.424.CrossRefPubMed
6.
go back to reference Varkey SJ: Abortion services in South Africa: available yet not accessible to all. Int Fam Plan Perspect. 2000, 26 (2): 87-88. 10.2307/2648273.CrossRef Varkey SJ: Abortion services in South Africa: available yet not accessible to all. Int Fam Plan Perspect. 2000, 26 (2): 87-88. 10.2307/2648273.CrossRef
7.
go back to reference Jewkes R, Gumede T, Westaway M, Dickson K, Brown H, Rees H: Why are women still aborting outside designated facilities in metropolitan South Africa?. Int J Obstet Gynecol. 2005, 112: 1236-1242. Jewkes R, Gumede T, Westaway M, Dickson K, Brown H, Rees H: Why are women still aborting outside designated facilities in metropolitan South Africa?. Int J Obstet Gynecol. 2005, 112: 1236-1242.
8.
go back to reference Morroni C, Myer L, Tibazarwa K: Knowledge of the abortion legislation among South African women: a cross-sectional study. Reprod Health. 2006, 3: 7-10.1186/1742-4755-3-7.CrossRefPubMedPubMedCentral Morroni C, Myer L, Tibazarwa K: Knowledge of the abortion legislation among South African women: a cross-sectional study. Reprod Health. 2006, 3: 7-10.1186/1742-4755-3-7.CrossRefPubMedPubMedCentral
9.
go back to reference Mokgethi N, Ehlers V, Merwe van der M: Professional nurses' attitudes towards providing termination of pregnancy services in a tertiary hospital in the North West province of South Africa. Curationis. 2006, 29 (1): 32-9.CrossRefPubMed Mokgethi N, Ehlers V, Merwe van der M: Professional nurses' attitudes towards providing termination of pregnancy services in a tertiary hospital in the North West province of South Africa. Curationis. 2006, 29 (1): 32-9.CrossRefPubMed
10.
go back to reference Harries J, Orner P, Gabriel M, Mitchell E: Delays in seeking an abortion in the second trimester: a qualitative study in South Africa. Reprod Health. 2007, 20:4 (1): 7-10.1186/1742-4755-4-7.CrossRef Harries J, Orner P, Gabriel M, Mitchell E: Delays in seeking an abortion in the second trimester: a qualitative study in South Africa. Reprod Health. 2007, 20:4 (1): 7-10.1186/1742-4755-4-7.CrossRef
11.
go back to reference South African Department of Health: Termination of Pregnancy Update Cumulative Statistics through 2004. 2005, Pretoria: Department of Health South African Department of Health: Termination of Pregnancy Update Cumulative Statistics through 2004. 2005, Pretoria: Department of Health
12.
go back to reference Dickson-Teteh K, Billings D: Abortion Care Services Provided by Registered Midwives in South Africa. Int Fam Plan Perspect. 2002, 28 (3): 144-150. 10.2307/3088257.CrossRef Dickson-Teteh K, Billings D: Abortion Care Services Provided by Registered Midwives in South Africa. Int Fam Plan Perspect. 2002, 28 (3): 144-150. 10.2307/3088257.CrossRef
13.
go back to reference Lipp A: A review of termination of pregnancy: prevalent health care professional attitudes and ways of influencing them. J Clin Nurs. 2008, 17 (13): 1683-8. 10.1111/j.1365-2702.2007.02205.x.CrossRefPubMed Lipp A: A review of termination of pregnancy: prevalent health care professional attitudes and ways of influencing them. J Clin Nurs. 2008, 17 (13): 1683-8. 10.1111/j.1365-2702.2007.02205.x.CrossRefPubMed
14.
go back to reference Marshall S, Gould D, Roberts J: Nurses' attitudes towards termination of pregnancy. J Adv Nurs. 1994, 20 (3): 567-76. 10.1111/j.1365-2648.1994.tb02397.x.CrossRefPubMed Marshall S, Gould D, Roberts J: Nurses' attitudes towards termination of pregnancy. J Adv Nurs. 1994, 20 (3): 567-76. 10.1111/j.1365-2648.1994.tb02397.x.CrossRefPubMed
15.
go back to reference Silva M, Billings DL, Garcia SG, Lara D: Physicians' agreement with and willingness to provide abortion services in the case of pregnancy from rape in Mexico. Contraception. 2009, 79 (1): 56-64. 10.1016/j.contraception.2008.07.016.CrossRefPubMed Silva M, Billings DL, Garcia SG, Lara D: Physicians' agreement with and willingness to provide abortion services in the case of pregnancy from rape in Mexico. Contraception. 2009, 79 (1): 56-64. 10.1016/j.contraception.2008.07.016.CrossRefPubMed
16.
go back to reference Bartlett L, Berg C, Shulman H, Zane S, Green C, Whitebread S, Atrash H: Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol. 2004, 103 (4): 729-737.CrossRefPubMed Bartlett L, Berg C, Shulman H, Zane S, Green C, Whitebread S, Atrash H: Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol. 2004, 103 (4): 729-737.CrossRefPubMed
17.
go back to reference Dunkle K, Jewkes R, Brown H, Gray G, McIntryre J, Harlow S: Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004, 363 (9419): 1415-1421. 10.1016/S0140-6736(04)16098-4.CrossRefPubMed Dunkle K, Jewkes R, Brown H, Gray G, McIntryre J, Harlow S: Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004, 363 (9419): 1415-1421. 10.1016/S0140-6736(04)16098-4.CrossRefPubMed
18.
go back to reference Jewkes R, Abrahams N: The epidemiology of rape and sexual coercion in South Africa: An overview. Soc Sci Med. 2002, 55 (7): 1231-1244. 10.1016/S0277-9536(01)00242-8.CrossRefPubMed Jewkes R, Abrahams N: The epidemiology of rape and sexual coercion in South Africa: An overview. Soc Sci Med. 2002, 55 (7): 1231-1244. 10.1016/S0277-9536(01)00242-8.CrossRefPubMed
19.
go back to reference Hall W, Roberts J: Understanding the Impact of Decentralisation on Reproductive Health Services in Africa: South Africa Report. 2006, Durban: Health Systems Trust Hall W, Roberts J: Understanding the Impact of Decentralisation on Reproductive Health Services in Africa: South Africa Report. 2006, Durban: Health Systems Trust
20.
go back to reference London L, Orner P, Myers L: "Even if you're positive, you still have rights because you are a person": Human rights and the reproductive choice of HIV-positive persons. Dev World Bioeth. 2008, 8 (1): 11-22. 10.1111/j.1471-8847.2007.00223.x.CrossRefPubMed London L, Orner P, Myers L: "Even if you're positive, you still have rights because you are a person": Human rights and the reproductive choice of HIV-positive persons. Dev World Bioeth. 2008, 8 (1): 11-22. 10.1111/j.1471-8847.2007.00223.x.CrossRefPubMed
21.
go back to reference Turner K, Hyman A, Gabriel M: Clarifying values and transforming attitudes to improve access to second trimester abortion. Reprod Health Matters. 2008, 16 (31): 108-116. 10.1016/S0968-8080(08)31389-5.CrossRefPubMed Turner K, Hyman A, Gabriel M: Clarifying values and transforming attitudes to improve access to second trimester abortion. Reprod Health Matters. 2008, 16 (31): 108-116. 10.1016/S0968-8080(08)31389-5.CrossRefPubMed
22.
go back to reference Rasch V, Yambesi F, Massawe S: Medium and long-term adherence to post abortion contraception among women having experienced unsafe abortion in Dar es Salaam, Tanzania. BMC Pregnancy Childbirth. 2008, 31 (8): 32-10.1186/1471-2393-8-32.CrossRef Rasch V, Yambesi F, Massawe S: Medium and long-term adherence to post abortion contraception among women having experienced unsafe abortion in Dar es Salaam, Tanzania. BMC Pregnancy Childbirth. 2008, 31 (8): 32-10.1186/1471-2393-8-32.CrossRef
23.
go back to reference Ceylan A, Ertem M, Saka G, Akdeniz N: Post abortion family planning counseling as a tool to increase contraception use. BMC Public Health. 2009, 15 (9): 20-10.1186/1471-2458-9-20.CrossRef Ceylan A, Ertem M, Saka G, Akdeniz N: Post abortion family planning counseling as a tool to increase contraception use. BMC Public Health. 2009, 15 (9): 20-10.1186/1471-2458-9-20.CrossRef
24.
go back to reference Billings DL, Crane BB, Benson J, Solo J, Fetters T: Scaling-up a public health innovation: a comparative study of post abortion care in Bolivia and Mexico. Soc Sci Med. 2007, 64 (11): 2210-22. 10.1016/j.socscimed.2007.02.026.CrossRefPubMed Billings DL, Crane BB, Benson J, Solo J, Fetters T: Scaling-up a public health innovation: a comparative study of post abortion care in Bolivia and Mexico. Soc Sci Med. 2007, 64 (11): 2210-22. 10.1016/j.socscimed.2007.02.026.CrossRefPubMed
Metadata
Title
Health care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa
Authors
Jane Harries
Kathryn Stinson
Phyllis Orner
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2009
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-9-296

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