Contradictions in womxn’s experiences of pre‐abortion counselling in South Africa: Implications for client‐centred practice

Abstract

Pre‐abortion counselling may play a key role in abortion seekers’ understanding of their decision to terminate a pregnancy and the subsequent emotions that they feel. In this paper, we report on a study conducted in the Eastern Cape province of South Africa concerning womxn's experiences of the pre‐abortion counselling offered as part of the implementation of the Choice of Termination Act that governs the provision of legal abortion in the country. Using a narrative‐discursive lens, the analysis revealed four micro‐narratives in which participants appreciated non‐directive and empathic counselling, as well as being provided with information. They also indicated that the counselling was upsetting and hurtful, particularly when providers drew on the awfulisation of abortion discourse to suggest that abortion leads to terrible consequences, and foetal personhood discourse to intimate that terminating the pregnancy is wrong and other alternatives (adoption, parenting) are better. The connection between these broadly positive and negative responses may lie in the dominance of anti‐abortion discourses coupled with the powerful positioning of healthcare providers as experts. The attendant disempowerment of clients within the health clinic setting may constrain pregnant people's ability to question such ‘expert’ information. The implications for feminist client‐centred pre‐abortion counselling are discussed.

Pathways to adverse pregnancy outcomes: exploring the mediating role of intimate partner violence and depression: results from a South African rape cohort study

“…Few abortions were reported in our study. It is possible that even after more than 2 decades of legalisation of abortion in the country, women may still not be keen to report having an abortion (self-induced or through the formal health system), as reported in recent research, because of the continued stigma and shame attached to it (Mavuso and Macleod 2020 ).…”

Understanding the violation of directive anti-abortion counselling [and cisnormativity]: Obstruction to access or reproductive violence?

“…Recent investigations by Open Democracy have revealed a global network of US-funded Christian-based pregnancy crisis centres, and that South Africa alone has about 70 operating, some with similar arrangements with public abortion facilities (Kahn 2020). Elsewhere (Mavuso & Macleod 2019a, 2019bMavuso & Macleod 2020), myself and a colleague have published the findings of the research on abortion seekers' and providers' experiences of pre-abortion counselling referred to here. Below, I limit myself to describing the findings so as to give room for the kinds of discussion I would like to advance about how we might understand the violence of coercive anti-abortion counselling.…”

“…In their interviews with me, none of the providers framed abortion as a reproductive right to which abortion seekers were entitled (Mavuso 2018). And while the two nurses framed legal abortion service provision as necessary to save lives from the threat of backstreet abortion, all four providers constructed abortion as problematic in some way and described abortion counselling as serving the purpose of preventing future abortions and the one being requested.…”

“…Abortion seekers were positioned as (cis) women/mothers. Abortion seekers described some instances of supportive counselling (see Mavuso & Macleod 2019a). I focus here on their experiences of coercive anti-abortion counselling.…”

“…This article proceeds in four sections. In the next section, I describe the research referred to above, as well as the findings which have been published elsewhere (Mavuso & Macleod 2019a, 2019bMavuso & Macleod 2020). In the second and third sections, I explore the possibilities and limitations for understanding coercive anti-abortion counselling as obstruction to access to counselling that should be non-directive, and for understanding this counselling as reproductive violence.…”