Of ambivalence, shame and guilt: Perceptions regarding termination of pregnancy among South African women

Abstract

Termination of pregnancy (TOP) for health or other reasons is an emotive and contentious issue, steeped in the context of a political, moral and religious climate. For most women, the decision to have a TOP is not easy, regardless of the reason. While early literature [1][2][3] supported the notion that that there is little in the way of negative sequelae following TOP, more recent long-term studies [4][5][6] have suggested that negative sequelae may be more common than was previously thought. Risk factors for the development of negative sequelae include the attitude projected by those providing the procedure (negative attitudes of providers tend to promote emotional sequelae in women undergoing TOP), previous psychological/psychiatric history (associated with higher rates of post-traumatic stress disorder (PTSD) and depression [6] following TOP), and low income (with women from low-income groups having higher admission rates for depression and PTSD after TOP [4] ). A recent survey involved 102 women undergoing TOP at two clinics in Johannesburg, SA (51 from each), one serving women with few economic resources (site 1) and the other serving women with adequate resources (site 2). The women were recruited and followed up for 3 months. At baseline, biographical data were obtained and there were no significant demographic differences between women recruited from the two sites.The Beck Depression Inventory (BDI), [7] a 21-item self-rating scale that is a validated and reliable instrument to assess depression, was administered to all the women.To explore the meaning that the decision to undergo TOP had for women, the consensual qualitative research method [8] was used to analyse the transcripts of 22 women, 13 from site 1 and 9 from site 2, 1 month after the procedure. The women were administered a short questionnaire during a semistructured interview that sought to capture: (i) their reasons for TOP; (ii) their thoughts and feelings before the procedure; (iii) their thoughts and feelings after the procedure; and (iv) their experiences of the procedure (any positive and/or negative feelings about the actual procedure). To elicit symptoms of PTSD, together with the BDI, the revised version of the Impact of Events Scale (IES-R) [9] was administered to assess women's subjective experience, including intrusive thoughts, re-experiencing and avoidance reactions, each on a severity rating of 0 -5.The women who willingly answered the question 'What was the reason for the TOP?' were generally younger, better educated and more likely to be employed than those who did not answer the question. There were no differences in scores for depression and PTSD in those who answered the question compared with those who did not. There were also no differences between the responses of women of lower socioeconomic status (site 1) and higher socioeconomic status (site 2).Major themes and subthemes were identified independently by three reviewers, and consensus was obtained to ensure credibility and reliability of the interpretations made by...

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An exploration of the reasons women give for choosing legal termination of pregnancy at Soshanguve Community Health Centre, Pretoria, South Africa

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