Challenges encountered by women who requested termination of pregnancy services in the North West Province of South Africa

Abstract

In 1996 the South African government legalised the termination of pregnancy (TOP) services, allowing women to choose to terminate unplanned pregnancies at designated facilities. Although TOP services are available, pregnant women continue to use illegal abortion services, with potentially life-risking consequences. The purpose of this study was to identify challenges encountered by women requesting TOP services, and to make recommendations for improved policies and practices, enabling more women in the North West Province (NWP) to access TOP services. This was a non-experimental, exploratory, descriptive and quantitative study. Structured interviews were conducted with 150 women who had used TOP services in phase 1, with 50 women who were unable to access TOP services in phase 2 and with 20 professional nurses providing TOP services in the NWP in phase 3. In phase 1, 96.0% (n=144) of the women needed transport to access TOP services, and 73.2% (n=109) indicated that nurses put women’s names on waiting lists, posing barriers to such access in the NWP. In phase 2, 92.0% (n=46) of these respondents had reportedly requested TOPs for the first time, but 89.0% (n=44) could not access TOP services. In phase 3, only 14 out of 19 designated facilities in the NWP, and only 20 nurses, provided TOP services during the study period. Out of the 20 interviewed nurses, 74.0% (n=14) regarded the Choice on Termination of Pregnancy Act, Act 92 of 1996 (CTOP Act) was being unclear requiring a revision. These professional nurses provided TOP services in NWP, by choice. Unless more facilities and more nurses can provide TOP services to the women of the NWP, these services will continue to remain inaccessible, necessitating the continued utilisation of illegal abortion services, in spite of the TOP Act’s prescriptions. It is also recommended that management will provide sufficient support and training opportunities for professional nurses working in TOP services in the NWP.