Abstract
BackgroundSouth Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility. For women successfully obtaining care, time from last menstrual period to confirmation of pregnancy is significantly longer among those having an abortion later in the second trimester compared to earlier gestations. This study explores women’s experiences with recognition and confirmation of unintended pregnancy, their understanding of fertile periods within the menstrual cycle as well as healthcare providers’ and policy makers’ ideas for public sector strategies to facilitate prompt confirmation of pregnancy.MethodsWe recruited participants from July through September 2017, at an urban non-governmental organization (NGO) sexual and reproductive health (SRH) facility and two public sector hospitals, all providing abortion care into the second trimester. We conducted in-depth interviews and group discussions with 40 women to elicit information regarding pregnancy recognition and confirmation as well as fertility awareness. In addition, 5 providers at these same facilities and 2 provincial policy makers were interviewed. Data were analysed using thematic analysis.ResultsUncertainties regarding pregnancy signs and symptoms greatly impacted on recognition of pregnancy status. Women often mentioned that others, including family, friends, partners or colleagues noticed pregnancy signs and prompted them to take action. Several women were unaware of the fertility window and earliest timing for accurate pregnancy testing. Health care providers and policy makers called for strategies to raise awareness regarding risk and signs of pregnancy and for pregnancy tests to be made more readily accessible.ConclusionEarly recognition of unintended pregnancy in this setting is frustrated by poor understanding and awareness of fertility and pregnancy signs and symptoms, compounded by a distrust of commercially available pregnancy tests. Improving community awareness around risk and early signs of pregnancy and having free tests readily available may help women confirm their pregnancy status promptly.
Highlights
South Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility
This study explored the lived experiences leading up to pregnancy confirmation among women securing abortion care beyond 9 weeks gestational age, the legal limit for home use of medication for abortion
Our findings highlight the process of pregnancy recognition and confirmation and women’s knowledge of fertility, the menstrual cycle and when to test for pregnancy
Summary
South Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility. Despite abortion being legal in South Africa, many women are still denied care when seeking abortion services This has been largely attributed to being too far advanced in pregnancy at the time of presentation for care [1]. Where abortion services are legal and available, stigma experienced within communities has resulted in reluctance to seek care close to home [5] In their conceptual framework of trajectories to abortion, Coast et al classify and link abortion-specific experiences to individual and national contexts to map factors influencing a woman’s journey to obtaining abortion care. These include time-dependent processes, such as the timing of pregnancy awareness [6]. Interventions endorsed by women to strengthen timely pregnancy awareness include the provision of free pregnancy test kits for home use, routine pregnancy testing by visiting community health workers and outreach education programs [8,9,10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
