Health care providers' attitudes towards termination of pregnancy: a qualitative study in South Africa.
BACKGROUND
Despite changes to the abortion legislation in South Africa in 1996, barriers to women accessing abortion services still exist including provider opposition to abortions and a shortage of trained and willing abortion care providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.In South Africa, little is known about the personal and professional attitudes of individuals who are currently working in abortion service provision. Exploring the factors which determine health care providers' involvement or disengagement in abortion services may facilitate improvement in the planning and provision of future services.


METHODS
Qualitative research methods were used to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach.


RESULTS
Complex patterns of service delivery were prevalent throughout many of the health care facilities, and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Related to this was the need expressed by many providers for dedicated, stand-alone abortion clinics thereby creating a more supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision.


CONCLUSIONS
This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion and adds to the body of information addressing the barriers to safe abortion services. In order to sustain a pool of abortion providers, programmes which both attract prospective abortion providers, and retain existing providers, needs to be developed and financial compensation for abortion care providers needs to be considered.
Harries
Jane
J
Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, South Africa. Jane.Harries@uct.ac.za
Stinson
Kathryn
K
Orner
Phyllis
P
D000028:Abortion, Induced / Q000523:psychology*; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D009014:Morals; D011247:Pregnancy; D012923:Social Class; D013019:South Africa
Obstet Gynecol. 2004 Apr;103(4):729-37
15051566
Lancet. 2006 Dec 2;368(9551):1965-72
17141703
Lancet. 2004 May 1;363(9419):1415-21
15121402
Reprod Health. 2006 Aug 03;3:7
16887015
Contraception. 2009 Jan;79(1):56-64
19041442
S Afr Med J. 2005 Apr;95(4):250
15889846
Reprod Health. 2007 Sep 20;4:7
17883835
BMC Pregnancy Childbirth. 2008 Jul 31;8:32
18667094
J Adv Nurs. 1994 Sep;20(3):567-76
7963066
BMC Public Health. 2009 Jan 15;9:20
19146657
Health Policy Plan. 2000 Dec;15(4):424-31
11124246
Curationis. 2006 Mar;29(1):32-9
16817490
BJOG. 2005 Sep;112(9):1236-42
16101602
Dev World Bioeth. 2008 Apr;8(1):11-22
18302539
Reprod Health Matters. 2008 May;16(31 Suppl):108-16
18772091
Soc Sci Med. 2002 Oct;55(7):1231-44
12365533
Soc Sci Med. 2007 Jun;64(11):2210-22
17408826
J Clin Nurs. 2008 Jul;17(13):1683-8
18592622