Accessibility and acceptability of women receiving medical terminations of pregnancy at Kalafong Provincial Tertiary Hospital

Abstract

BACKGROUND : The South African Choice on Termination of Pregnancy Act was passed in 1996, legalizing a women’s right to request a termination of pregnancy. Despite this legislation, there are still a large number of women who seek out unsafe abortions, with estimates as high as 50% of all abortions. Barriers to accessing safe and legal abortions at designated healthcare facilities is an important public health issue. In a study by Frederico et al during the period of 2014-2016, unsafe abortions were an avoidable factor in 24,8% of deaths due to miscarriage. OBJECTIVES : The aim of the study is to describe the population making use of the TOP service at Kalafong Provincial Tertiary Hospital (KPTH), to determine the accessibility and evaluate the experiences of the services provided and to evaluate the Mifepristone – misoprostol outpatient medical TOP regimen. METHODS : A prospective descriptive study was conducted at the KPTH Women’s Health Clinic (KWHC), in Atteridgeville, Pretoria between February and April 2020. A self-administered questionnaire and the interviewer-administered follow-up questionnaire were anonymously completed. RESULTS : 245 participants completed the initial questionnaire, and 102 participants completed the follow-up questionnaire. Most of the study population were between the ages of 19 to 35 78.4% (n=193) and 9.8% (n=24 were between the ages of 16 and 18. 18.4% (n=45) of participants had a previous TOP. 9.8% (n=24)) of participants said that they do not feel safe attending the KWHC for various reasons. Prior to falling pregnant, 65.3% (n=160) of participants were not making use of any contraceptive methods. CONCLUSION : TOP remains a highly stigmatized topic. Comprehensive sexual health and contraceptive training, at KPTH and its feeder healthcare facilities is required to ensure a decentralization of TOP services. Youth-focused, community-based public health campaigns on safe sexual practices; appropriate timing of TOP and accessible and free contraceptive services are essential in addressing the age old need for TOP and associated maternal morbidity and mortality.