Database: Ovid MEDLINE(R) <1996 to March Week 3 2010>
Search Strategy:
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1 *abortion, induced/ (3791)
2 South Africa/ (12265)
3 1 and 2 (36)
4 limit 3 to english language (36)
5 from 4 keep 1-36 (36)
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<1>
Unique Identifier
19689791
Status
MEDLINE
Authors
Harries J. Stinson K. Orner P.
Authors Full Name
Harries, Jane. Stinson, Kathryn. Orner, Phyllis.
Institution
Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, South Africa.
Title
Health care providers' attitudes towards termination of pregnancy: a qualitative study in South Africa.
Source
BMC Public Health. 9:296, 2009.
Other ID
Source: NLM. PMC2734857
Abstract
BACKGROUND: Despite changes to the abortion legislation in South Africa in 1996, barriers to women accessing abortion services still exist including provider opposition to abortions and a shortage of trained and willing abortion care providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.In South Africa, little is known about the personal and professional attitudes of individuals who are currently working in abortion service provision. Exploring the factors which determine health care providers' involvement or disengagement in abortion services may facilitate improvement in the planning and provision of future services. METHODS: Qualitative research methods were used to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. RESULTS: Complex patterns of service delivery were prevalent throughout many of the health care facilities, and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Related to this was the need expressed by many providers for dedicated, stand-alone abortion clinics thereby creating a more supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision. CONCLUSION: This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion and adds to the body of information addressing the barriers to safe abortion services. In order to sustain a pool of abortion providers, programmes which both attract prospective abortion providers, and retain existing providers, needs to be developed and financial compensation for abortion care providers needs to be considered.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
<2>
Unique Identifier
19418325
Status
MEDLINE
Authors
Patel CJ. Kooverjee T.
Authors Full Name
Patel, Cynthia J. Kooverjee, Trisha.
Institution
School of Psychology, University of KwaZulu-Natal, Durban, South Africa.
Title
Abortion and contraception: attitudes of South african university students.
Source
Health Care for Women International. 30(6):550-68, 2009 Jun.
Abstract
Despite the availability of contraception, the rates of abortion among young women in South Africa continue to increase. We designed a study to examine young people's attitudes about abortion and contraception. One hundred and eighty-eight South African university students (97 females and 91 males) completed the survey. While we found moral objections to abortion for the sample as a whole, females showed stronger support for availability of abortion and women's autonomy compared with males. The respondents acknowledged the importance of contraception at a personal and general level, but more than 40% of them believed that women who use contraception are promiscuous. Females expressed difficulty with usage more frequently than males and indicated that they would not consider sexual intercourse if contraception were not available. For health care workers involved in counseling young people about their sexual and reproductive choices, the challenge lies in promoting a culture of equal rights and respect for women's reproductive freedom.
Publication Type
Journal Article.
<3>
Unique Identifier
18772094
Status
MEDLINE
Authors
Hyman AG. Baird TL. Basnett I.
Authors Full Name
Hyman, Alyson G. Baird, Traci L. Basnett, Indira.
Institution
Ipas, Chapel Hill, NC, USA.
Title
Establishing second trimester abortion services: experiences in Nepal, Viet Nam and South Africa.
Source
Reproductive Health Matters. 16(31 Suppl):135-44, 2008 May.
Abstract
This paper describes experiences and lessons learned about how to establish safe second trimester abortion services in low-resource settings in the public health sector in three countries: Nepal, Viet Nam and South Africa. The key steps involved include securing the necessary approvals, selecting abortion methods, organising facilities, obtaining necessary equipment and supplies, training staff, setting up and managing services, and ensuring quality. It may take a number of months to gain the necessary approvals to introduce or expand second trimester services. Advocacy efforts are often required to raise awareness among key governmental and health system stakeholders. Providers and their teams require thorough training, including values clarification; monitoring and support following training prevents burn-out and ensures quality of care. This paper shows that good quality second trimester abortion services are achievable in even the most low-resource settings. Ultimately, improvements in second trimester abortion services will help to reduce abortion-related morbidity and mortality.
Publication Type
Journal Article.
<4>
Unique Identifier
18772091
Status
MEDLINE
Authors
Turner KL. Hyman AG. Gabriel MC.
Authors Full Name
Turner, Katherine L. Hyman, Alyson G. Gabriel, Mosotho C.
Institution
Ipas, Chapel Hill, NC, USA.
Title
Clarifying values and transforming attitudes to improve access to second trimester abortion.
Source
Reproductive Health Matters. 16(31 Suppl):108-16, 2008 May.
Abstract
Access to safe second trimester abortion services is poor in many countries, sometimes despite liberal laws and policies. Addressing the myriad factors hindering access to safe abortion care requires a multi-pronged strategy. Workshops aimed at clarifying values are useful for addressing barriers to access stemming from misinformation, stigmatization of women and providers, and negative attitudes and obstructionist behaviours. They engage health care providers and administrators, policymakers, community members and others in a process of self-examination with the goal of transforming abortion-related attitudes and behaviours in a direction supportive of women seeking abortion. This is especially important for women seeking second trimester abortion, which tends to be even more stigmatized than first trimester abortion. This paper reports on some promising experiences and results from workshops in Viet Nam, Nepal and South Africa. Some recommendations that emerge are that values clarification should be included in abortion training, service delivery and advocacy programmes. Evaluations of such interventions are also needed.
Publication Type
Journal Article.
<5>
Unique Identifier
18772086
Status
MEDLINE
Authors
Alblas M.
Authors Full Name
Alblas, Marijke.
Institution
Medical Consultant, Cape Town, South Africa.
Title
A week in the life of an abortion doctor, Western Cape Province, South Africa.
Source
Reproductive Health Matters. 16(31 Suppl):69-73, 2008 May.
Abstract
South Africa legalized abortion in 1996. I am originally from the Netherlands and came to South Africa in 2000, to assist in the Termination of Pregnancy programme. In March 2007, at an international conference on second trimester abortion, I described my life as an abortion doctor living in Cape Town, South Africa. I was urged to write down what my working life in the Western Cape is like, and this paper is the result. It is a diary of a typical work week, recorded in early 2008.
Publication Type
Journal Article.
<6>
Unique Identifier
17888919
Status
MEDLINE
Authors
van Bogaert LJ.
Authors Full Name
van Bogaert, L J.
Institution
Department of Obstetrics and Gynecology, Saint Rita's Hospital, Limpopo, South Africa.
Title
Termination of pregnancy with misoprostol in the scarred uterus.
Source
International Journal of Gynaecology & Obstetrics. 100(1):80-1, 2008 Jan.
Publication Type
Journal Article.
<7>
Unique Identifier
18264602
Status
MEDLINE
Authors
Bateman C.
Authors Full Name
Bateman, Chris.
Title
Maternal mortalities 90% down as legal TOPs more than triple. [Review] [0 refs]
Source
South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 97(12):1238-42, 2007 Dec.
Publication Type
Journal Article. Review.
<8>
Unique Identifier
17701803
Status
MEDLINE
Authors
van Bogaert LJ. Sedibe TM.
Authors Full Name
van Bogaert, L-J. Sedibe, T M.
Institution
Department of Obstetrics and Gynaecology, St Rita's Hospital, Glen Cowie, South Africa.
Title
Efficacy of a single misoprostol regimen in the first and second trimester termination of pregnancy.
Source
Journal of Obstetrics & Gynaecology. 27(5):510-2, 2007 Jul.
Abstract
A total of 273 women underwent termination of pregnancy (TOP) with a single regimen of misoprostol (400 microg orally and 800 microg vaginally), without mifepristone. A total of 98 (35.9%) were first trimester and 175 (64.1%) second trimester gestations. Of these women, 189 (69.2%) responded to a single administration of misoprostol and 84 (30.8%) required between two and six administrations of misoprostol. The medical TOP was complete in 90.8% of all cases. A surgical intervention was needed in 23 (27.4%) of those requiring repeated administrations of misoprostol vs only two (1.1%) of those responding to a single administration. Age, parity and gestational age did not affect the response rate to the misoprostol regimen. The need for a D&C was related to the response to misoprostol: most D&Cs were needed in cases of repeat administrations of misoprostol. This study shows the feasibility of medical TOP in the developing world. It has the great advantage of significantly reducing the need for surgical termination where the required skills are scarce.
Publication Type
Journal Article.
<9>
Unique Identifier
17439565
Status
MEDLINE
Authors
Blanchard K. Cooper D. Dickson K. Cullingworth L. Mavimbela N. von Mollendorf C. van Bogaert LJ. Winikoff B.
Authors Full Name
Blanchard, K. Cooper, D. Dickson, K. Cullingworth, L. Mavimbela, N. von Mollendorf, C. van Bogaert, L J. Winikoff, B.
Institution
Ibis Reproductive Health, Cambridge, MA 02138, USA.
Title
A comparison of women's, providers' and ultrasound assessments of pregnancy duration among termination of pregnancy clients in South Africa.
Source
BJOG: An International Journal of Obstetrics & Gynaecology. 114(5):569-75, 2007 May.
Abstract
OBJECTIVE: To compare providers' and women's estimates of duration of pregnancy with ultrasound estimates for determining medical abortion eligibility. DESIGN: Cross-sectional study. SETTING: Public termination of pregnancy (TOP) services in three provinces. SAMPLE: A total of 673 women attending the above services for TOP. METHODS: Women participating in a medical abortion feasibility study in South Africa provided estimates of pregnancy duration and date of last menstrual period (LMP). Each woman also had clinical and ultrasound exams. We compared estimates using the four methods, calculating the proportion of women in the 'caution zone' (< or = 8 weeks gestation by woman or provider estimate and > 8 weeks by ultrasound). MAIN OUTCOME MEASURES: Mean gestational age by each method; difference between provider and LMP estimates and ultrasound estimates; and percentage of women in the 'caution zone'. RESULTS: Women's estimates of pregnancy duration were 19 days fewer than ultrasound estimates (95% CI = -27 to 63). Mean provider- and LMP-based estimates were two (95% CI = -30 to 35) and less than one day(s) (95% CI = -46 to 51) fewer than ultrasound estimates. Comparing provider and ultrasound estimates, 15% of women were in the 'caution zone'; this fell to 12% if estimates of 9 weeks or fewer were considered acceptable. CONCLUSIONS: Provider estimates of gestational age were sufficiently accurate for determining eligibility for medical abortion. LMP-based estimates were also accurate on average, but included more extreme differences from ultrasound estimates. Medical abortion could be provided in TOP facilities without ultrasound or with ultrasound on referral.
Publication Type
Comparative Study. Journal Article. Multicenter Study. Research Support, Non-U.S. Gov't.
<10>
Unique Identifier
17484194
Status
MEDLINE
Authors
Blanchard K. Schaffer K. McLeod S. Winikoff B.
Authors Full Name
Blanchard, Kelly. Schaffer, Kate. McLeod, Shamiema. Winikoff, Beverly.
Institution
Ibis Reproductive Health, Cambridge, MA 02138, USA.
Title
Medication abortion in the private sector in South Africa.
Source
European Journal of Contraception & Reproductive Health Care. 11(4):285-90, 2006 Dec.
Abstract
OBJECTIVES: To collect information about how private physicians in South Africa provide medication abortion services to their patients. METHODS: In April 2003 we asked physicians in private practice in South Africa who had purchased mifepristone (Mifegyne) from the South African distributor about the medication abortion regimen they offered, satisfaction with the method, and how services have been incorporated into their practices. RESULTS: Forty-four providers participated in the survey. They report using a range of doses and regimens. Most respondents offer mifepristone-misoprostol to their patients, although a significant minority also offer misoprostol-alone for pregnancy termination. While the majority of medication abortion providers also offer surgical abortions, a significant number of non-surgical providers were only offering medication abortion. CONCLUSION: South African medication abortion providers find the method acceptable, indicate that their staff are largely supportive of offering it to their patients, and report that clients like the method. Those surveyed believe that most of their patients are eligible for the regimen, although uptake has been limited.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
<11>
Unique Identifier
17167706
Status
MEDLINE
Authors
Pattinson RC. Snyman LC. Macdonald AP.
Authors Full Name
Pattinson, R C. Snyman, L C. Macdonald, A P.
Institution
MRC Maternal and Infant Health Care Strategies Research Unit and Department of Obstetrics and Gynaecology, University of Pretoria, South Africa.
Title
Evaluation of a strict protocol approach in managing women with severe disease due to abortion.
Source
South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 96(11):1191-4, 2006 Nov.
Abstract
AIM: To evaluate whether the introduction of a strict protocol approach based on the systemic evaluation of critically ill pregnant women with complications of abortion affected outcome. SETTING: Indigent South Africans managed in the regional and tertiary hospitals of the Pretoria Academic Complex. METHOD: Since 1997 a standard definition of severe acute maternal morbidity (SAMM) has been used in the Pretoria Academic Complex. All cases of SAMM and maternal deaths were entered on the Maternal Morbidity and Mortality Audit System programme. A comparison of outcome of severely ill women who had complications of abortion was made between 1997-1998 (original protocol) and 2002-2004 (strict protocol). OUTCOME MEASURES: The mortality index and prevalence of organ system failure or dysfunction. RESULTS: In 1997-1998 there were 43 women with SAMM who survived and a further 10 maternal deaths due to complications of abortion, compared with 107 women with SAMM and 7 maternal deaths during 2002-2004. The mortality index declined from 18.9% in 1997-1998 to 6.1% in 2002-2004 (p = 0.02, odds ratio 0.28, 95% confidence limits 0.10 - 0.79). Significantly more women had hypovolaemic shock in 2002-2004 compared with 1997-1998 (54.4% v. 35.8%, p = 0.04), but fewer women had immune system failure including septic shock (18.4% v. 47.2%, p = 0.0002) and metabolic dysfunction (0 v. 5.7%, p = 0.03) and there was a trend to less renal failure (10.5% v. 22.6%, p = 0.06) and cardiac failure (4.4% v. 13.2%, p = 0.08). CONCLUSION: The strict protocol approach based on systemic evaluation in managing critically ill pregnant women with complications of abortion, coupled with an intensive, regular feedback mechanism, has been associated with a reduction in the mortality index.