Why are women still aborting outside designated facilities in metropolitan South Africa?
OBJECTIVE
To explore why South African women still abort outside designated services where there is substantial legal service provision.


METHODS
Descriptive study.


METHODS
Three hospitals in Gauteng Province in South Africa. Sample Forty-six women attending hospital with incomplete abortion who had abortions induced outside of designated facilities.


METHODS
An interviewer-administered questionnaire with open and closed questions was completed. Induction status was determined from answers to a set of closed questions. Open-ended questions explored the circumstances of induction. Main focus of interviews Methods of induction used, barriers to legal service use.


RESULTS
Nearly two-thirds of women (n= 38) had self-induced or had consulted a traditional healer. A minority of these women (n= 11) indicated that they did this because they experienced barriers to legal service use. For others it was presented as a 'natural' response to a health problem (unwanted pregnancy). Several women (n= 10) were given misoprostol by a doctor, nurse, or pharmacist. Fifty-four percent of the women had not used legal services because they did not know about the law, while 15% knew of their legal rights, but did not know of a legal facility. Others did know where to access legal services but feared rude staff (17%) or breaches of confidentiality (6.5%). Others (6.5%) had been unable to get a legal abortion early enough in pregnancy to comply with the law.


CONCLUSIONS
Lack of information on abortion rights under the Act and perceived poor quality of designated facilities were the most important barriers to access and should be addressed by policymakers and health service management. The willingness of women to self-medicate and visit traditional healers in these circumstances may influence the overall ability of the new legislation to reduce abortion morbidity.
Jewkes
Rachel K
RK
Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa.
Gumede
Tebogo
T
Westaway
Margaret S
MS
Dickson
Kim
K
Brown
Heather
H
Rees
Helen
H
D000019:Abortifacient Agents / Q000600:supply & distribution; D000028:Abortion, Induced / Q000379:methods* / Q000706:statistics & numerical data; D000328:Adult; D005260:Female; D006268:Health Facilities; D006297:Health Services Accessibility; D006795:Household Products; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data; D016488:Medicine, African Traditional; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires
D000019:Abortifacient Agents