Abstract
BackgroundDespite changes to the South African abortion legislation in 1996, barriers to women accessing abortions still exist. Second trimester abortions, an inherently more risky procedure, continue to be 20% of all abortions. Understanding the reasons why women delay seeking an abortion until the second trimester is important for informing interventions to reduce the proportion of second trimester abortions in South Africa.MethodsQualitative research methods were used to collect data. Twenty-seven in-depth interviews were conducted in 2006 with women seeking a second trimester abortion at one public sector tertiary hospital and two NGO health care facilities in the greater Cape Town area, South Africa. Data were analysed using a grounded theory approach.ResultsAlmost all women described multiple and interrelated factors that influenced the timing of seeking an abortion. Reasons why women delayed seeking an abortion were complex and were linked to changes in personal circumstances often leading to indecision, delays in detecting a pregnancy and health service related barriers that hindered access to abortion services.ConclusionUnderstanding the complex reasons why women delay seeking an abortion until the second trimester can inform health care interventions aimed at reducing the proportion of second trimester abortions in South Africa.
Highlights
Despite changes to the South African abortion legislation in 1996, barriers to women accessing abortions still exist
This paper reports on results from a qualitative study that explored the factors that contributed towards women accessing abortion services in their second trimester of pregnancy
Study sites The study was conducted over a four month period in 2006 at a public sector tertiary hospital and two non-governmental organization (NGO) health care clinics located in the greater Cape Town area, Western Cape, South Africa
Summary
Despite changes to the South African abortion legislation in 1996, barriers to women accessing abortions still exist. Understanding the reasons why women delay seeking an abortion until the second trimester is important for informing interventions to reduce the proportion of second trimester abortions in South Africa. The South African Choice on Termination of Pregnancy (CTOP) Act, no. of 1996, replaced the previously restrictive Abortion and Sterilization Act, no. of 1975. Despite the legislation there are still major barriers to women accessing abortion services. These include provider opposition, stigma associated with abortion, poor knowledge of abortion legislation, a lack of providers trained to perform abortions and facilities designated to provide abortion services in the rural areas [3,4,5,6]. The CTOP Act provides for abortion on request up to and including 12
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