PHealth - Termination of Pregnancy Flashcards
Do all women have access to safe TOP services in South Africa? Explain your answer (10½)
No (½)
Inequitable distribution of services - not all designated services are providing TOP, greater gap in rural areas (2)
Staff resistance: conscientious objection,
Abusive treatment by hospital staff - women are insulted, judgemental & rude staff (1)
Fear of breaching confidentiality by nurses- women would not use legal abortion services as they were scared that staff members would leak the information (1)
Lack of trained personnel - There is also a lack of providers trained to perform TOP services (1)
Long waiting lists – in some instances, long waiting lists for abortions have deterred women from using public health abortion services (1)
Lack of knowledge of the TOP legislation (1)
Lack of knowledge of facilities providing abortions - many women are aware of the TOP legislation, but do not know which health facilities offer TOP services, so they don’t know where to go (1)
Stigma associated with abortions - Many women would not have an abortion due to religious and social stigmas (1)
Describe the current legislation on the termination of pregnancy in South Africa (6½)
- The choice of Termination of pregnancy Act (no 92 of 1996),
- The Act states that a pregnancy may be terminated upon a woman’s request during the first 12 weeks of gestation (1),
- at this point abortions may be provided by mid-level providers (i.e. health care workers who are not doctors) comprising trained professional nurses and midwives (1)
- After 12 weeks, abortions have to be provided by doctors (1)
- Beyond 12 weeks and up to 20 weeks (½) TOP’s are allowed for the following reasons:
o adverse effects on the woman’s mental or physical health (½) or
o socio-economic status (½),
o in cases of rape and incest (½),
o where the fetus would suffer from severe physical or mental abnormality (½) . (2½marks) - From 20 weeks onwards terminations are available under very limited circumstances (1)
The doctor attending to Mrs Abrahams was relieved that she declined to have a TOP. Outline the rights (according to TOP Act, 1996) of the health care worker who objects to perform a TOP (2½)
A health care provider may refuse to perform an abortion (½), however they are obliged to inform a woman of her reproductive right to choose an abortion (½), and to refer her to another provider or facility (½)
Irrespective of conscientious objection, a nurse must provide nursing care to the patient (½), including assistance with activities of daily living, emotional support, prescribed medications and comfort and pain relief measures.
A health care provider refusing to participate in the act of a TOP must lodge in writing his/her refusal to provide an abortion (½)
The doctor informs Mrs Hendricks that she has a right to a termination of her pregnancy and that the procedure can be performed at her attending hospital. Do all women have access to safe abortion services in South Africa? Explain your answer (5)
Answer (can include 5 of the following): No
- Most health care providers have refused to provide this service.
- Legalization alone cannot ensure implementation of abortion services.
- Legal abortion services are often inaccessible and percieved as unacceptable
- In KZN, home to one quarter of SA’s population, health care providers at most public hospitals and clinics have refused to provide abortions, or be trained to do so, hindering implementation of the act.
- More than 1 year after implementation, only 6 of more than 40 hospitals in the province provided terminations, and a list of designated providers has yet to be finalized.
- A shortage of trained personnel and staff refusals hinders access to abortion services.
- TOP faces significant opposition in some areas, and as a result has been difficult to implement outside major urban centres.
The baby’s parents were wondering how they would cope with raising this child, both emotionally and financially. They wanted to terminate the pregnancy but were turned away by the two clinics that they had access to and they did not know where else to go for this service.
Outline what the clinic staff should have done to ensure that the parents could access abortion services (½)
They should have referred them to a facility that performs abortions
Outline six (6) factors / reasons that may prevent access of women to termination of pregnancy (TOP) services in SA (6)
- Inequitable distribution of services- not all designated services are providing TOP, greater gap in rural areas
- Staff resistance: conscientious objection,
- Abusive treatment by hospital staff - women are insulted, judgemental & rude staff
- Fear of breaching confidentiality by nurses- women would not use legal abortion services as they were scared that staff members would leak the information
- Lack of trained personnel - There is also a lack of providers trained to perform TOP services
- Long waiting lists – in some instances, long waiting lists for abortions have deterred women from using public health abortion services
- Lack of knowledge of the TOP legislation
- Lack of knowledge of facilities providing abortions - many women are aware of the TOP legislation, but do not know which health facilities offer TOP services, so they don’t know where to go
- Stigma associated with abortions - Many women would not have an abortion due to religious and social stigmas
