Surgical and medical second trimester abortion in South Africa: A cross-sectional study

Abstract

BackgroundA high percentage of abortions performed in South Africa are in the second trimester. However, little research focuses on women's experiences seeking second trimester abortion or the efficacy and safety of these services.The objectives are to document clinical and acceptability outcomes of second trimester medical and surgical abortion as performed at public hospitals in the Western Cape Province.MethodsWe performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. Two hundred and twenty women underwent D&E with misoprostol cervical priming, and 84 underwent induction with misoprostol alone. Information was obtained about the procedure and immediate complications, and women were interviewed after recovery.ResultsMedian gestational age at abortion was earlier for D&E clients compared to induction (16.0 weeks vs. 18.1 weeks, p < 0.001). D&E clients reported shorter intervals between first clinic visit and abortion (median 17 vs. 30 days, p < 0.001). D&E was more effective than induction (99.5% vs. 50.0% of cases completed on-site without unplanned surgical procedure, p < 0.001). Although immediate complications were similar (43.8% D&E vs. 52.4% induction), all three major complications occurred with induction. Early fetal expulsion occurred in 43.3% of D&E cases. While D&E clients reported higher pain levels and emotional discomfort, most women were satisfied with their experience.ConclusionsAs currently performed in South Africa, second trimester abortions by D&E were more effective than induction procedures, required shorter hospital stay, had fewer major immediate complications and were associated with shorter delays accessing care. Both services can be improved by implementing evidence-based protocols.

Safe abortion in South Africa: “We have wonderful laws but we don't have people to implement those laws”

“…Interviewees reported that this occurs because often women do not know they are pregnant. Explanations for this included the wide use of Depo‐Provera and associated amenorrhea, difficulty in scheduling appointments for abortions, and/or long wait times at facilities …”

Self-induction of abortion among women accessing second-trimester abortion services in the public sector, Western Cape Province, South Africa: An exploratory study

“…The baseline survey was completed in 2008, [9] and the data reported here are derived from a second round of data collection in 2010. Study sites included four public hospitals in the Western Cape that provided second-trimester abortion services, which were selected according to the volume of women seeking abortion services.…”

“…Service provision also needs to be strengthened by making services more acceptable and woman-friendly, including reducing the delays experienced by women seeking abortion care at public facilities. [9] …”

“…[6] More recent research in SA has identified additional barriers to safe abortion, such as uneven provision between rural Self-induction of abortion among women accessing secondtrimester abortion services in the public sector, Western Cape Province, South Africa: An exploratory study and urban areas, unsubstantiated rumours around potential harms related to abortion, and intimidation by and negative attitudes from pre-abortion counsellors. [7.8] Grossman et al [9] found that delays in accessing services were common among women seeking second-trimester abortion services in the Western Cape, SA. We hypothesised that these delays may have been associated with prior attempts to self-induce, and undertook this exploratory study to assess this question.…”

Abortion attitudes among South Africans: findings from the 2013 social attitudes survey

“…Evidence further suggests that women who are of lower socioeconomic status (Harries et al 2015; Trueman and Magwentshu 2013), (Black) African (Constant et al 2014), living with HIV (National Committee for the Confidential Enquiries into Maternal Deaths 2014; Orner et al 2011; Stevens 2012) and/or residing in Gauteng, Limpopo or KwaZulu-Natal (National Committee for the Confidential Enquiries into Maternal Deaths 2014) are at higher risk of unsafe abortion and its health consequences than women who are more affluent, White, living without HIV and/or residing in other provinces. South African women have identified a number of barriers to safe abortion care including fear of discrimination or confidentiality breech, abuse and neglect by health workers, a dearth of abortion providers, waiting lists, gestational limits, long distances, insufficient knowledge about abortion laws and financial constraints (Constant et al 2014; Cooper et al 2004; Grossman et al 2011; Harries et al 2007, 2015; Jewkes et al. 2005; Trueman and Magwentshu 2013; Stevens 2012; Vincent 2012).…”