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

Kotze, Elcalien (2020-03)

Thesis (MNur)--Stellenbosch University, 2020.

Thesis

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.

AFRIKAANSE OPSOMMING : Agtergrond: In Suid-Afrika bepaal wetgewing dat aborsies op die versoek van ‘n vrou uitgevoer mag word tot op die gestasie van twaalf weke en verder tot ʼn gestasie van twintig weke indien die swangerskap lewensbereigend is, abnormaliteite by die foetus voorkom, die swangerskap die gevolg van verkragting was of wanneer die swangerskap sosiale en ekonomiese welvaart beïnvloed. Na twintig weke van swangerskap word aborsie toegelaat wanneer dit lewensbedreigend is of wanvorming of besering van die foetus bespeur word. Die publieke gesondheidsisteem verskaf gratis aborsiedienste in toeganklike omgewings vir die gemeenskap. Ten spyte van beskikbare, toeganklike aborsiedienste gaan vroue met onbeplande swangerskappe voort om onveilige aborsiepraktyke te volg. Die doel van hierdie studie is om die onderbenutting van aborsiedienste by vroue met onbeplande swangerskap in gemeenskapsgesondheidsentrums binne die Kaapse Metropool te beskryf. Metode: ʼn Kwalitatiewe benadering met ʼn enkel-beskrywende gevalstudie-ontwerp is benut om die onderbenutting van aborsiedienste onder vroue met onbeplande swangerskap wat gepresenteer het in die Gemeenskapsgesondheidsentrums binne die Kaapse Metropool te verken. Doelgerigte steekproefneming is toegepas om deelnemers te selekteer by Khayelitsha- en Mitchells Plain-Gemeenskapsgesondheidsentrums. Toestemming om die studie uit te voer is toegestaan deur die Navorsings- Etiese Komitee van die Universiteit van Stellenbosch en ook van die Departement van Gesondheid van die Wes-Kaap. Na die voltooiing van tien in-diepte- individuele, semigestruktureerde onderhoude het transkripsie plaasgevind en daarna is dit analiseer met die hulp van Robert Yin se analitiese tegnieke. Resultate: Die temas wat na vore gekom het vir beide eenhede van analise was die gebrek aan toegang tot aborsie-inligting en -dienste, die stigma rondom onbeplande swangerskappe en aborsies en omstandighede wat onveilige aborsiebesluite forseer het. Sommige deelnemers was bewus van aborsiewetgewing, maar het steeds onveilige aborsiemetodes gevolg. Gesondheidsdiensverskaffers het die nodige inligting rakende aborsiedienste verskaf, maar navraag by wyse van internettoegang en plakkate op lamppale en geboue was steeds teenwoordig. Die stigma van die waargeneemde mening van die gemeenskap en gesondheidsdiensverskaffer, verkragting en onbeplande swangerskappe tesame met persoonlike omstandighede soos moederlike ouderdom en pogings om die swangerskap geheim te hou, het hierdie vroue forseer om steeds onveilige aborsiebesluite te neem. Gevoelens van spyt is getoon nadat onveilige aborsiebesluite geneem is. Buiten die bogenoemde temas het nog ʼn tema uit die tweede eenheid van analise na vore gekom en dit behels gesondheidsdiensverskaffers se waarnemings oor onveilige aborsies. Gesondheidsdiensverskaffers was sensitief teenoor die vroue se omstandighede, maar sommige het verplig gevoel om die gevalle te rapporteer. Gebrek aan terugvoer van wetstoepassers en die afwesigheid van hanteringsriglyne het frustrasies laat ophoop. Slotsom: Die bevindinge demonstreer dat ondanks toegang tot, en inligting oor aborsiedienste, vroue met onbeplande swangerskappe steeds hierdie dienste onderbenut. Stigma verwant aan onbeplande swangerskappe, verkragting, moederlike ouderdom en finansiële probleme forseer hierdie vroue in ʼn poging om die swangerskappe geheim te hou en die toegang tot hierdie dienste het gefaal.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/108250
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