Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal

Harrison, Abigail, Montgomery, Elizabeth T., Lurie, Mark and Wilkinson, David (2000) Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal. Health Policy And Planning, 15 4: 424-431. doi:10.1093/heapol/15.4.424

Author Harrison, Abigail
Montgomery, Elizabeth T.
Lurie, Mark
Wilkinson, David
Title Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal
Journal name Health Policy And Planning   Check publisher's open access policy
ISSN 0268-1080
Publication date 2000-12-01
Sub-type Article (original research)
DOI 10.1093/heapol/15.4.424
Open Access Status Not Open Access
Volume 15
Issue 4
Start page 424
End page 431
Total pages 8
Place of publication Oxford, England
Publisher Oxford University Press
Language eng
Subject 1103 Clinical Sciences
1108 Medical Microbiology
1117 Public Health and Health Services
Formatted abstract
South Africa's Termination of Pregnancy Act, the most liberal abortion law in Africa, took effect early in 1997. In spite of the anticipated benefits to women's health, however, public reaction has been mixed. In the country's most populous province, KwaZulu/Natal, opposition is strong and most health care providers have refused to provide the service. This study explored attitudes and beliefs about abortion and the Termination of Pregnancy Act among primary care nurses and community members in a rural district in order to better understand barriers to implementation of the new law.

As part of a community survey on women's reproductive health (n = 138), questions on knowledge, attitudes and beliefs about abortion were asked, as well as awareness of the provisions of the Termination of Pregnancy Act. To better understand the perspectives of health care workers, a survey among primary care nurses on duty (n = 25) was also conducted. In-depth interviews were conducted with both nurses and women in the community to further pursue issues raised in the two surveys.

Support for the Act was low (11%) among both community members and nurses, and few supported abortion on request (18 and 6%, respectively). Within each group, however, a clear hierarchy of support was observed: a majority of nurses (56%) and community members (58%) supported abortion in the case of rape or incest, or if the continued pregnancy would endanger a woman's health (61 and 56%, respectively), but few supported abortion for social or economic reasons. In-depth interviews revealed that abortion is seen as contrary to prevailing community norms; nurses were poorly informed about the Termination of Pregnancy Act and felt confused in their professional responsibilities.

Conclusions and recommendations:
Legalization alone cannot ensure implementation of abortion services. In South Africa, extensive media coverage prior to passage of the law ensured almost universal awareness of the Act, but little public education took place at the same time. In spite of general opposition to the law, however, there is an encouraging level of support for abortion in some circumstances. These findings suggest that abortion services can be implemented, even in conservative rural areas, but that a process of information dissemination and community consent prior to implementation is essential. Locating abortion within broader reproductive health services could be an effective way to improve access and acceptability.
Keyword Developing-countries
Reproductive Health
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 35 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 48 times in Scopus Article | Citations
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Created: Tue, 07 Sep 2010, 23:02:13 EST