‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces

Abstract

Background: Globally, universal access to sexual and reproductive health care services has been re-emphasised. One-third of maternal deaths could be averted by improving access to safe abortion services. Anecdotal evidence suggests that the implementation of the Choice of Termination of Pregnancy Act has been suboptimal in South Africa. Objectives: In two South African provinces, determine: the proportion of designated termination of pregnancy (TOP) facilities that provide these services; explore the factors that influence the provision of TOP services; and explore the work experiences of health care providers at designated TOP facilities. Methods: During 2014 and 2015, we conducted a cross-sectional study at designated TOP facilities in Gauteng and North West provinces. A combination of methods was used, consisting of: site visits to, and observation of, each of the designated facilities using a checklist, and in-depth interviews with a sub-set of 30 TOP service providers, using a semi-structured interview schedule. The interview questions focused on the factors influencing TOP service provision, and the work experiences of TOP service providers. We used interpretative phenomenological analysis to analyse the data from the interviews. Results: Overall, 77% (47/61) of designated facilities were providing TOP services, with 87.5% (28/32) in Gauteng Province, compared with 65.5% (19/29) in North West Province. Service provision was influenced by health system deficiencies, human resource challenges, lack of prioritisation and lack of management support. Study participants reported a heavy burden of care provision and expressed an overwhelming feeling of loneliness, courtesy stigma and lack of support from other nurses and doctors, which further influence TOP service provision. Conclusions: South Africa has an enabling legal environment for the provision of TOP services. Supportive management, prioritisation of TOP services and employee wellness programmes to address the psychosocial issues experienced by providers are critical elements of an enabling health policy environment.

Compassion satisfaction, burnout and secondary traumatic stress among termination of pregnancy providers in two South African provinces

“…We did not measure stigma in the survey, and this could explain the difference in findings. However, the findings in the quantitative study contradict those in the qualitative study among a sample of TOP provides who reported on the feelings of loneliness and the courtesy stigma experienced by these providers …”

“…We obtained a 2014 list of these designated TOP facilities from the national department of health, which was compared with the provincial data base from each of the study provinces. The details of these TOP facilities are described elsewhere …”

“…The details of these TOP facilities are described elsewhere. 8 The principal researcher visited each of the designated facilities between July 2014 and August 2015. All TOP service providers constituted the population of interest.…”

“…CTOPA requires that all women seeking TOP services must be given information on the available contraception methods, including emergency contraception, and be offered any contraceptive method of their choice . Difficulties in access to safe TOP services include: negative attitudes by other staff members and the community towards TOP services and the staff who provide TOP services; staff shortages including skilled TOP providers and lack of an enabling environment, including insufficient management support . In contrast, an enabling or positive practice environment has numerous benefits for health service delivery, quality of care, health worker performance and patient outcomes .…”

“…5 Difficulties in access to safe TOP services include: negative attitudes by other staff members and the community towards TOP services and the staff who provide TOP services; staff shortages including skilled TOP providers 6 and lack of an enabling environment, including insufficient management support. 7,8 In contrast, an enabling or positive practice environment has numerous benefits for health service delivery, quality of care, health worker performance and patient outcomes. 9 Such an enabling environment includes occupational health, safety and wellness policies and programs.…”