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THE CHALLENGES OF OFFERING PUBLIC SECOND TRIMESTER ABORTION SERVICES IN SOUTH AFRICA: HEALTH CARE PROVIDERS' PERSPECTIVES

Published online by Cambridge University Press:  17 November 2011

J. HARRIES ,
N. LINCE ,
D. CONSTANT ,
A. HARGEY  and
D. GROSSMAN
J. HARRIES
Affiliation:
Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa
N. LINCE
Affiliation:
Ibis Reproductive Health, South Africa
D. CONSTANT
Affiliation:
Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa
A. HARGEY
Affiliation:
Ibis Reproductive Health, South Africa
D. GROSSMAN
Affiliation:
Ibis Reproductive Health, USA
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Summary

Around 25% of abortions in South Africa are performed in the second trimester. This study aimed to better understand what doctors, nurses and hospital managers involved in second trimester abortion care thought about these services and how they could be improved. Nineteen in-depth interviews with abortion-related service providers and managers in the Western Cape Province, South Africa, were undertaken. Data were analysed using a thematic analysis approach. Participants expressed resistance to the dilation and evacuation (D&E) procedure, as this required more active provider involvement. Medical abortion was preferred as it required less provider involvement in the abortion process. A shortage of providers willing to perform D&E resulted in most public sector services being outsourced to private sector doctors. Respondents noted an increased demand for services and a concomitant lack of infrastructure, physical space and personnel to respond to these demands, sometimes resulting in fragmented or poor quality care. At medical induction sites, most thought introducing the combined mifepristone–misoprostol regimen would improve service capacity, although they were concerned about cost. Improving contraceptive services was also seen as a much-needed intervention to improve care and prevent abortion. Ongoing training, including values clarification, as well as emotional support and team-building for providers are needed to ensure sustainable, high-quality second trimester abortion services.

Type
Research Article
Information
Journal of Biosocial Science , Volume 44 , Issue 2 , March 2012 , pp. 197 - 208
Copyright
Copyright © Cambridge University Press 2011

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