DOCSLIB.ORG

Termination of Pregnancy Policy and Services: an Appraisal of the Implementation and Operation of the Choice on Termination of Pregnancy Act (92 of 1996)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Termination of Pregnancy Policy and Services: an Appraisal of the Implementation and Operation of the Choice on Termination of Pregnancy Act (92 of 1996) TERMINATION OF PREGNANCY POLICY AND SERVICES: AN APPRAISAL OF THE IMPLEMENTATION AND OPERATION OF THE CHOICE ON TERMINATION OF PREGNANCY ACT (92 OF 1996) by MICHELLE CATHERINE ENGELBRECHT This thesis is submitted in accordance with the requirements for the degree PHILOSOPHIAE DOCTOR In the Faculty of Humanities (Departments of Psychology and Sociology) at the University of the Free State Promoter: Prof HCJ van Rensburg (Centre for Health Systems Research & Development, UFS) Co-promoter: Prof A Pelser (Department of Sociology, UFS) November 2005 DECLARATION I declare that this thesis submitted for the degree of Philosophiae Doctor at the University of the Free State is my own, independent work and has not previously been submitted by me at another university/faculty. I furthermore cede copyright of the thesis in favour of the University of the Free State. Michelle Engelbrecht Bloemfontein November 2005 For Adriaan, my husband ACKNOWLEDGEMENTS Sincere gratitude is hereby expressed to the following persons and organisations for their assistance and inspiration: Prof Dingie van Rensburg (Director: Centre for Health Systems Research & Development, University of the Free State) for his continued patience and guidance, as well as for the various academic and career development opportunities provided to me. His dedication and tremendous work ethic are inspirational. Prof André Pelser (Lecturer: Department of Sociology, University of the Free State) for supervision and support throughout the entire research endeavour. Profs Charles Ngwena (Lecturer: Department of Constitutional Law and the Philosophy of Law, University of the Free State) and Rebecca Cook (Lecturer: Faculty of Law, University of Toronto) for sharing their experiences and insight on numerous occasions. The Health Systems Trust and Ipas for initiating and funding the research projects. The Free State Department of Health for authorising the study and entertaining its findings. The National Research Foundation for the financial support. The health workers, TOP clients and other knowledgeable persons who generously shared their knowledge and experience; without their cooperation and enthusiasm the research would not have been possible. Aubrey and Ann O’Brien, my parents, for the excellent foundation that they gave me in life. [Your love and unwavering belief in me is deeply missed.] Adriaan, my husband, for his support and encouragement to complete the research, and my son, Dylan, for understanding that mommy was busy and not always able to spend time with him. Kevin O’Brien, my brother, for always believing in and supporting me. Francois Steyn, my friend and colleague, for his valuable comments and suggestions. The data gatherers and capturers, in particular Bridget Smit, Corrie le Roux and Mariëtte van Rensburg for their meticulous work. Michelle Engelbrecht Bloemfontein November 2005 i LIST OF ACRONYMS AND ABBREVIATIONS ANC African National Congress ARAG Abortion Reform Action Group CEDAW Convention on the Elimination of All Forms of Discrimination against Women CHC Community health centre CLA Christian Lawyers Association CTOPA Choice on Termination of Pregnancy Act DFL Doctors For Life HPCSA Health Professions Council of South Africa ICPD International Conference on Population and Development Ipas International Projects Advisory Service IPPF International Planned Parenthood Federation MCC Medicines Control Council MDG Millennium Development Goals MEC Member of the Executive Committee MRC Medical Research Council MVA Manual vacuum aspiration NACP National Abortion Care Programme NGO Non-government organisation PAC Post-abortion care PDP Population Development Programme PHC Primary health care PPASA Planned Parenthood Association of South Africa RDP Reconstruction and Development Programme RHRU Reproductive Health Research Unit RRA Reproductive Rights Alliance SANC South African Nursing Council SPSS Statistical Package for Social Sciences STIs Sexually transmitted infections TOP Termination of pregnancy UN United Nations UNFPA United Nations Population Fund USA United States of America USAID United States Agency for International Development WHO World Health Organisation WHO-AFRO WHO Regional Office for Africa ii TABLE OF CONTENTS Acknowledgements i List of acronyms and abbreviations ii Table of contents iii List of tables vii List of figures viii List of maps viii PART 1: CHAPTER 1 RESEARCH PROBLEM AND METHODOLOGY 1. Introduction 1 2. Contextualisation and rationale 2 3. Aim and objectives 6 4. Research strategy and methodology 7 4.1 Design of the study 7 4.2 Analysis of existing documents and secondary statistics (unobtrusive research) 8 4.3 The Free State study 9 4.3.1 Sampling methods 10 4.3.2 Research techniques and instruments 12 4.3.3 Recruitment and training of data gatherers 15 4.3.4 Data gathering and quality control 16 4.3.5 Data analysis 18 4.3.6 Feedback workshops 18 4.3.7 Authorisation and ethical concerns 19 4.3.8 Limitations of the Free State case study 20 4.4 Triangulation of primary and secondary data 21 5. Defining the concepts 21 6. Arrangement of the material 23 PART 2: CHAPTER 2 ABORTION LEGISLATION WITHIN A HUMAN RIGHTS FRAMEWORK 1. Introduction 26 2. Reproductive health and human rights 27 2.1 The right to reproductive health care 29 2.2 The right to reproductive self-determination 30 3. International developments in reproductive rights 31 3.1 Developments prior to the 1994 ICPD 31 3.2 The ICPD and Beijing Conference 33 3.3 Follow-up reviews and beyond 35 4. Overview of abortion legislation worldwide 36 5. International abortion legislation: the USA and Britain 39 5.1 Abortion Law in the USA 39 5.1.1 The Global Gag Rule 42 5.2 Abortion law in Britain 43 6. Abortion legislation in African countries 45 6.1 History of abortion legislation in Africa 45 6.2 Developments in reproductive rights in Africa 46 6.3 Developments in abortion legislation in Africa 48 6.4 Abortion legislation in countries neighbouring South Africa 49 7. Summary 52 iii PART 2: CHAPTER 3 SOUTH AFRICAN ABORTION LAW: THE PERIOD PRIOR TO THE IMPLEMENTATION OF THE 1996 CHOICE ON TERMINATION OF PREGNANCY ACT 1. Introduction 55 2. The provision of reproductive health care prior to 1975 56 2.1 Family planning under the National Party government 56 2.2 The status of black South African women and its impact on family planning 57 2.3 Abortion law prior to 1975 59 2.3.1 The establishment of a select committee to investigate abortion law 60 3. The Abortion and Sterilisation Act of 1975 62 3.1 Provisions of the 1975 Act 62 3.2 Shortcomings of the 1975 Act 64 4. Events leading to the Choice on Termination of Pregnancy Act of 1996 67 4.1 A changing political environment 67 4.2 Establishment of an ad hoc parliamentary select committee to investigate the 1975 Act 69 4.3 Recommendations from the ad hoc parliamentary select committee 73 4.4 The Choice on Termination of Pregnancy Bill 74 5. Views of other interest groups towards abortion and the Choice on Termination of Pregnancy Bill 75 6. Advantages and disadvantages of legalising abortion 77 7. Summary 78 PART 2: CHAPTER 4 THE CHOICE ON TERMINATION OF PREGNANCY ACT (1996): IMPLEMENTATION AND TRENDS, ACHIEVEMENTS AND CHALLENGES 1. Introduction 80 2. The Choice on Termination of Pregnancy Act of 1996 82 2.1 Provisions of the 1996 CTOPA 82 2.2 Key elements of the CTOPA 84 2.2.1 Counselling 84 2.2.2 Minors 85 2.2.3 Designation of TOP service sites 86 2.2.4 Notification and keeping of records 87 2.2.5 Midwifery training 87 2.2.6 Health workers and conscientious objection 89 2.2.7 Offences and penalties 90 2.3 Amendments to the CTOPA 91 3. Implementation and operation of the CTOPA 91 3.1 The first year - 1997 91 3.2 The second year - 1998 93 3.3 The third year - 1999 94 3.4 The fourth year - 2000 95 3.5 The fifth year - 2001 96 3.6 The sixth year - 2002 97 3.7 The seventh year - 2003 98 4. Overview of trends, achievements and failures in TOP – 1997 to 2003 99 4.1 Achievements of the CTOPA 101 4.1.1 Cooperation with private facilities 101 4.1.2 Failure of legal challenges 101 4.1.3 Development of a National Strategic Plan for TOP 102 4.1.4 Values clarification workshops 103 4.2 Impediments to and challenges associated with the provision of TOP services 104 4.2.1 Key findings from the Oversight Hearings 105 4.2.2 Views and conduct regarding abortion 107 iv 4.2.3 Designation and location of TOP facilities 108 4.3 Key recommendations from the Oversight Hearings 110 5. Summary 111 PART 3: CHAPTER 5 THE EMPIRICAL STUDY: VIEWS AND EXPERIENCES OF HEALTH WORKERS AND STAKEHOLDERS 1. Introduction 115 2. Health workers in a position to refer clients to TOP facilities 116 2.1 The respondents 116 2.2 The referral system 118 2.3 Knowledge of the CTOPA 123 2.4 Attitudes towards TOP 126 2.5 Challenges associated with the expansion of TOP services (2003) 129 3. TOP service providers 131 3.1 The respondents 131 3.2 Attitudes toward TOP 133 3.3 Emotional experiences, conduct of and support for TOP service providers 136 3.4 Abortion values clarification workshops 138 3.5 Resources for TOP service delivery 139 3.6 Evaluation of TOP services 141 3.6.1 Counselling 143 3.6.2 Procedures 144 3.7 Evaluation of the physical structure and infrastructure of TOP facilities 146 3.8 Challenges and strengths of providing TOP services 148 4. TOP stakeholders (2003) 149 4.1 The respondents 149 4.2 Achievements of the CTOPA as it applies to women in general 149 4.3 Main impediments to accessing TOP 150 4.4 Recommendations to improve access to TOP 151 4.5 Main challenges regarding access to TOP 151 5.
Load more

Recommended publications
  • Exploration of How a Mobile Health (Mhealth) Intervention May Support
    WHITE, A. 2018. Exploration of how a mobile health (mHealth) intervention may support midwives in the management and referral of women with pre-eclampsia in rural and remote areas of highland Scotland. Robert Gordon University [online], MRes thesis. Available from: https://openair.rgu.ac.uk Exploration of how a mobile health (mHealth) intervention may support midwives in the management and referral of women with pre- eclampsia in rural and remote areas of highland Scotland. WHITE, A. 2018 The author of this thesis retains the right to be identified as such on any occasion in which content from this thesis is referenced or re-used. The licence under which this thesis is distributed applies to the text and any original images only – re-use of any third-party content must still be cleared with the original copyright holder. This document was downloaded from https://openair.rgu.ac.uk Exploration of how a mobile health (mHealth) intervention may support midwives in the management and referral of women with pre-eclampsia in rural and remote areas of Highland Scotland A thesis presented for the degree of Master of Research (part-time) in Nursing and Midwifery by Research at the Robert Gordon University by Alan White 1601992 Supervisors: Prof Dr Susan Crowther and Dr Siew Hwa Lee This study was supported by a grant from The Scottish Digital Health and Care Institute (DHI) February 2018 1 Contents Page List of Tables 8 List of Figures 8 Abstract 9 Declaration of authorship 12 Acknowledgements 15 Glossary and definition of terms 17 CHAPTER 1– Introduction
    [Show full text]
  • Women's Experiences with Abortion Complications in the Post War Context of South Sudan
    Women's Experiences with Abortion Complications in the Post War Context of South Sudan Author: Monica Adhiambo Onyango Persistent link: http://hdl.handle.net/2345/1836 This work is posted on eScholarship@BC, Boston College University Libraries. Boston College Electronic Thesis or Dissertation, 2010 Copyright is held by the author, with all rights reserved, unless otherwise noted. Boston College William F. Connell School of Nursing WOMEN’S EXPERIENCES WITH ABORTION COMPLICATIONS IN THE POST WAR CONTEXT OF SOUTH SUDAN A dissertation by MONICA ADHIAMBO ONYANGO Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy May 2010 © Copyright by MONICA ADHIAMBO ONYANGO 2010 ii Women’s experiences with abortion complications in the post war context of South Sudan Monica Adhiambo Onyango Dissertation Chair: Rosanna Demarco, PhD, PHCNS-BC, ACRN, FAAN Committee Members: Sandra Mott, PhD, RNC and Pamela Grace, PhD, APRN Abstract For 21 years (1983-2004), the civil war in Sudan concentrated in the South resulting in massive population displacements and human suffering. Following the comprehensive peace agreement in 2005, the government of South Sudan is rebuilding the country’s infrastructure. However, the post war South Sudan has some of the worst health indicators, lack of basic services, poor health infrastructure and severe shortage of skilled labor. The maternal mortality ratio for example is 2,054/100,000 live births, currently the highest in the world. Abortion complication leads among causes of admission at the gynecology units. This research contributes nursing knowledge on reproductive health among populations affected by war. The purpose was to explore the experiences of women with abortion complications in the post war South Sudan.
    [Show full text]
  • Availability, Accessibility and Utilization of Post-Abortion Care in Sub-Saharan Africa: a Systematic Review
    HEALTH CARE FOR WOMEN INTERNATIONAL https://doi.org/10.1080/07399332.2019.1703991 REVIEW ARTICLE Availability, accessibility and utilization of post-abortion care in Sub-Saharan Africa: A systematic review Chimaraoke Izugbaraa, Frederick Murunga Wekesahb , Meroji Sebanya, Elizabeth Echokac, Joshua Amo-Adjeid, and Winstoun Mugab aInternational Center for Research on Women, Washington, D.C, USA; bAfrican Population & Health Research Center, Nairobi, Kenya; cCentre for Public Health Research, Kenya Medical Research Institute - KEMRI, Nairobi, Kenya; dDepartment of Population and Health, University of Cape Coast, Cape Coast, Ghana ABSTRACT ARTICLE HISTORY At the 1994 ICPD, sub-Saharan African (SSA) states pledged, Received 28 June 2019 inter alia, to guarantee quality post-abortion care (PAC) serv- Accepted 9 December 2019 ices. We synthesized existing research on PAC services provi- sion, utilization and access in SSA since the 1994 ICPD. Generally, evidence on PAC is only available in a few countries in the sub-region. The available evidence however suggests that PAC constitutes a significant financial burden on public health systems in SSA; that accessibility, utilization and avail- ability of PAC services have expanded during the period; and that worrying inequities characterize PAC services. Manual and electrical vacuum aspiration and medication abortion drugs are increasingly common PAC methods in SSA, but poor-qual- ity treatment methods persist in many contexts. Complex socio-economic, infrastructural, cultural and political factors mediate the availability, accessibility and utilization of PAC services in SSA. Interventions that have been implemented to improve different aspects of PAC in the sub-region have had variable levels of success. Underexplored themes in the exist- ing literature include the individual and household level costs of PAC; the quality of PAC services; the provision of non-abor- tion reproductive health services in the context of PAC; and health care provider-community partnerships.
    [Show full text]
  • Birth Behind the Veil: African American Midwives and Mothers in the Rural South, 1921-1962 by Kelena Reid Maxwell a Dissertatio
    Birth Behind the Veil: African American Midwives and Mothers in the Rural South, 1921-1962 by Kelena Reid Maxwell A Dissertation submitted to the Graduate School-New Brunswick Rutgers, The State University of New Jersey in partial fulfillment of the requirements for the degree of Doctor of Philosophy Graduate Program in History written under the direction of Deborah Gray White and approved by ________________________ ________________________ ________________________ ________________________ New Brunswick, New Jersey October, 2009 ABSTRACT OF THE DISSERTATION Birth Behind the Veil: African American Midwives and Mothers in the Rural South, 1921-1962 By Kelena Reid Maxwell Dissertation Director: Deborah Gray White By the early twentieth century, the majority of white women living in the United States were giving birth in hospitals under the care of a physician. In 1921, the majority of women who gave birth under conditions that were indigenous, eclectic, spirit based, and not according to the standards of modern medicine, were the rural black women of the South. African American midwives and women of the South maintained the core qualities of the home birthing traditions, handed down through a matrilineal system of recruitment and training from the period of enslavement throughout the twentieth century. This occurred amidst a major program of midwife training and regulation. Public Health officials of the early twentieth century urged midwife regulation as a temporary measure. Medical professionals considered the lay midwives of the south a necessary evil. They were necessary because the population they served was left out of a medical system that operated according to the practices and laws of racial segregation.
    [Show full text]
  • A Model for Incorporating “Indigenous” Postnatal Care Practices Into the Midwifery Healthcare System in Mopani District, Limpopo Province, South Africa
    A MODEL FOR INCORPORATING “INDIGENOUS” POSTNATAL CARE PRACTICES INTO THE MIDWIFERY HEALTHCARE SYSTEM IN MOPANI DISTRICT, LIMPOPO PROVINCE, SOUTH AFRICA By Roinah Nkhensani Ngunyulu Submitted in fulfillment of the requirements for the degree of Philosophiae Doctor in the Department of Nursing Science Faculty of Health Sciences University of Pretoria October 2012 Promoter: Prof. Fhumulani Mavis Mulaudzi Co-Promoter: Dr M.D Peu © University of Pretoria DECLARATION I Roinah Nkhensani Ngunyulu declare that “A MODEL FOR INCORPORATING “INDIGENOUS: POSTNATAL CARE PRACTICES INTO MIDWIFERY HEALTH CARE PRACTICES IN MOPANI DISTRICT OF LIMPOPO PROVINCE, SOUTH AFRICA” is my own work, that all sources that I have used or quoted have been indicated and acknowledged by means of complete references, and that this work has not been submitted for any other degree at this or any other institution. ……………………………. …………………………… R.N. NGUNYULU DATE A model for incorporating indigenous postnatal care practices into midwifery health care system. R.N Ngunyulu Page ii DEDICATION This thesis is dedicated to: My father-in- law Masenyani Jackson Ngunyulu, who was eager to see me graduating but rested in peace before the study is completed. My daughter, Queen Victoria Ngunyulu who passed away during data collection. My Sister-in-law Ndaheni Irene Ngunyulu who passed away during the early stages of report writing. My Sister (co-worker) Priscilla Mabobo who motivated and encouraged me during the proposal development stage but passed away before completion of the study. Special gratitude goes to my dear husband, Magezi Elliot Ngunyulu (Makambeni), my sons Nkateko Glen and Kulani Chris, and my daughter Tlangelani Sharlote.
    [Show full text]
  • Traditional Birth Attendants' Experiences During the Provision Of
    Health SA Gesondheid ISSN: (Online) 2071-9736, (Print) 1025-9848 Page 1 of 8 Original Research Traditional birth attendants’ experiences during the provision of post-natal care in Mopani District, Limpopo province of South Africa Authors: Background: South African maternity care guidelines stipulate that post-natal patients can be 1,2 Roinah N. Ngunyulu discharged within 6 h after delivery, provided that the condition of mothers and neonates do Fhumulani M. Mulaudzi1 Mmampheko D. Peu1 not require medical, surgical or obstetric attention. Hence in many instances post-natal care is rendered at home by traditional birth attendants (TBAs). Traditional birth attendants play a Affiliations: crucial role in the care of women during pregnancy, birth and puerperium within communities. 1Department of Nursing Science, Faculty of Health Aim: To explore and describe the experiences of TBAs during the provision of post-natal care Sciences, University of to mothers and their neonates in order to make recommendations to improve the quality of Pretoria, Pretoria, post-natal care delivered at home. South Africa Setting: The community hall of a selected rural traditional community was used as a setting 2 Department of Nursing, for data collection. Faculty of Health Sciences, University of Johannesburg, Methods: A qualitative, exploratory and descriptive design was used. Three focus groups Johannesburg, South Africa were held with 26 TBAs whom were purposively selected. Data were analysed using qualitative Corresponding author: content analysis. Roinah N. Ngunyulu, [email protected] Results: The study confirmed two categories that included: lack of supportive working relationships between TBAs and midwives and lack of respect of TBAs, by post-natal women.
    [Show full text]
  • Drawing a Line Between Hope and Accountability: Midwives' Response to a “Psychosocial Antenatal Care” Pilot Project In
    Article Drawing a Line between Hope and Accountability: Midwives’ Response to a “Psychosocial Antenatal Care” Pilot Project in Gauteng, South Africa Johanna M. Mathibe-Neke Kgomotso E. Makobe https://orcid.org/0000-0002-5811-8680 https://orcid.org/0000-0003-4500-1077 University of South Africa Ann Latsky Nursing College, South [email protected] Africa [email protected] Abstract Psychosocial care during pregnancy is embedded in women-centred care, and the improvement of quality care based on compassion has become a top priority for healthcare providers. Compassion is a deep feeling of connecting to human beings’ suffering, a moral response that leads to patient care with comfort. Such caring is skilful and worthy, respects the dignity of individuals and is intertwined with professional competency. The purpose of the pilot project was to raise the midwives’ awareness of the importance of psychosocial care during pregnancy, to assess the use of the psychosocial assessment tool, to fill the gap between routine physical antenatal care and psychosocial care, and to enhance the use of psychosocial services. An exploratory and descriptive study design was applied. The study population consisted of 34 midwives who participated in the implementation of the assessment tool in the 12 participating health facilities in Gauteng, South Africa. The data collection was conducted in two phases. Phase 1 consisted of a self-administered questionnaire to establish competency when using the assessment tool. Phase 2 consisted of focus group discussions. The four main themes that emerged were the importance of psychosocial risk assessments, experiences of the implementation of the assessment tool, challenges and barriers, and identified risk factors.
    [Show full text]
  • An Evaluation of the Knowledge of the Registered Midwives Managing Hypertensive Disorders at Primary Health Care Level in the Eastern Cape
    i AN EVALUATION OF THE KNOWLEDGE OF THE REGISTERED MIDWIVES MANAGING HYPERTENSIVE DISORDERS AT PRIMARY HEALTH CARE LEVEL IN THE EASTERN CAPE NOMPUMELELO LORRAINE NGWEKAZI RESEARCH ASSIGNMENT PRESENTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF NURSING AT THE FACULTY OF HEALTH SCIENCES STELLENBOSCH UNIVERSITY SUPERVISOR: DR E.L. STELLENBERG MARCH 2010 ii DECLARATION By submitting this research assignment electronically, I declare that the entirety of the work contained therein is my own, original work, that I am the authorship owner thereof and that I have not previously in its entirety or in part submitted it for obtaining any qualification. Signature: Date: 4 February 2010 Copyright@ 2010 Stellenbosch University All rights reserved iii ACKNOWLEDGEMENTS I would like to express my sincere thanks to: • My heavenly father, all praise and thanks to him. • My husband, Lungile, for his patience and constant support. • My son, Tando, for doing his bit by contributing his IT skills. • My daughter, Ntsikie, for supporting and encouraging me. • My supervisor, Dr EL Stellenberg. • My colleague, Mrs Z. Peter for always being there for me. • Dr M Kidd for the statistical analysis of the data. • All the nursing staff who participated in the survey. iv ABSTRACT Hypertensive disorders are one of the leading causes of maternal morbidity and mortality in South Africa. The morbidity and mortality rate can be decreased by early detection and management of hypertensive disorders at primary health care Level. The midwives should therefore be knowledgeable and competent in the assessment and diagnosis of pregnant women who are at risk of developing a hypertensive disorder, and be able to manage the problem.
    [Show full text]
  • Of 54 Professional Mission and Personal Beliefs: Ethiopian Midwives' Roles in Expanding Access to Abortion Services in the Wake of Legal Reform
    Professional Mission and Personal Beliefs: Ethiopian Midwives' Role in Expanding Access to Abortion Services in the Wake of Legal Reform Aster Berhe, School of Nursing & Midwifery, Addis Ababa University Amsale Cherie, School of Nursing & Midwifery, Addis Ababa University Sarah Jane Holcombe, School of Public Health, University of California, Berkeley** Abstract In 2005, Ethiopia enacted a rare reform, liberalizing abortion law as part of the overhaul of its Criminal Code. The reform’s goal was to reduce the country’s high levels of maternal mortality that are due in significant part to unsafe abortion. It also aimed to further broaden access to services through regulations authorizing mid-level providers, including midwives, to offer abortion services. This research explores one facet of what makes a reform ‘real’: midwives as frontline service providers have the potential to shape whether and how a policy is actually implemented. Similar socially contentious reforms in other culturally conservative countries have not resulted in women having increased access to services. Using a 2013 survey of midwives (n=188) and twelve in-depth interviews with third-year Midwifery students, this cross- sectional research examines the knowledge, attitudes and practices of midwives on abortion and abortion provision in order to understand what underlies their decisions about service provision post reform . A majority of midwives (72%) were willing or possibly willing to provide abortion services, and that willingness was negatively related to respondents’ number of years as a midwife and frequency of religious service attendance, and positively related to their knowledge of the law, and past experience with provision of medical abortion.
    [Show full text]
  • Saving Mothers 2017 Annual Report)
    Contents Section Page Contents i Abbreviations ii Acknowledgements ii Foreword iii Summary and recommendations iv 1 Overview 2017 1.1. Introduction 1 1.2. Maternal deaths 2017: Comparison between DHIS and NCCEMD data 1 1.3. Maternal deaths, mortality ratios and trends 3 1.4. Underlying causes for 2017 and timing of emergency event and death 5 1.5. Comparison of underlying causes from 2011-2017 7 1.6. Comparison of underlying causes between provinces 9 1.7. Safe Caesarean delivery 14 1.8. Levels of care and mortality 15 1.9. Potentially preventable deaths 21 1.10. Avoidable factors, underlying causes and levels of care 25 1.11 Mortality ratios and level of care per province 30 1.12. Summary of findings 33 1.13. Conclusions and recommendations 34 1.14 Suggested recommendations per province 35 Appendices 1. Comparison of maternal deaths in DHIS and MaMMAS per district 39 2. Detail of underlying causes 2017 40 3. iMMR per district and province 2017 42 4. iMMR of provinces and districts ranked from highest to lowest 44 5. Number of health care professional avoidable factors per level of care 46 2 Progress report on reducing deaths associated with caesarean section 47 Appendices 1. Caesarean delivery and BLDACD CFR per province and district 58 2. Ranking of Caesarean delivery CFR per province 60 3. Ranking of CD CFR per district 61 4. Ranking of BLDACD CFR per province 62 5. Ranking of BLDACD CFR per district 63 6. Proportion of maternal deaths with CD due to BLDACD, per province and district 64 3 Managing Hypertensive Diseases in Pregnancy
    [Show full text]
  • Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components
    REVIEW Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components Douglas Huber,a Carolyn Curtis,b Laili Irani,c Sara Pappa,d Lauren Arringtone Twenty years of postabortion care (PAC) studies yield strong evidence that: Misoprostol and vacuum aspiration are comparable in safety and effectiveness for treating incomplete abortion. Misoprostol, which can be provided by trained nurses and midwives, shows substantial promise for extending PAC services to secondary hospitals and primary health posts. Postabortion family planning uptake generally increases rapidly–and unintended pregnancies and repeat abortions can decline as a result–when a range of free contraceptives, including long-acting methods, are offered at the point of treatment; male involvement in counseling–always with the woman's concurrence– can increase family planning uptake and support. ABSTRACT Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration.
    [Show full text]
  • Introduction Elite Birthing Care in South Africa
    INTRODUCTION ELITE BIRTHING CARE IN SOUTH AFRICA he floor to ceiling wall made entirely of glass offered a clear, Texpansive view of the ocean. The living room was open-plan, and bright as light streamed in through the glass walls and ceiling. The dining table, with a fresh flower centrepiece, was contempo- rary and surrounded by Scandinavian modern chairs, scattered with sheepskins, a fashion in 2015. Sandy, as I call her, welcomed me into her home, offering me filtered water infused with cucum- ber; she showed me where her private, one-to-one Hypnobirthing classes were going to take place in the living room. She explained that her husband travelled for work much of the time and fitting in birthing classes was easier if these took place in their home, at a time that suited the couple. Participating in Hypnobirthing classes was a common activity for women using private midwives; they understood the classes as a method that would help facilitate the ‘natural’ births they desired. Sandy’s home and her aspirations are typical of the circum- stances and birthing desires of women using private midwives who I would come to know and observe over my year in the midwives’ practices. Yet these women and their socio-economic contexts are atypical in South Africa. The group of women with whom I worked are unusual in South Africa’s birthing sector for two reasons. The first reason is that they are able to access private health care, a form of care that is only available to South Africa’s (largely white) financially elite class.
    [Show full text]