title: An exploratory study of what happens to women who are denied abortions in Cape Town, South Africa.
abstract: BACKGROUND
  Despite the change in legal status of abortion in South Africa in 1996, barriers to access remain. Stigma associated with abortion provision and care, privacy concerns, and negative provider attitudes often discourage women from seeking legal abortion services and sometimes force women outside of the legal system. What happens when women present for abortion at a designated abortion facility and are denied abortions due to gestational limits or other factors-is unknown. Whether women seek care at referral facilities, seek illegal abortion, or carry pregnancies to term has never been documented. This study, part of a multi-country Global Turnaway Study, explored the experiences of women after denial of legal abortion services.
  
  
  METHODS
  Qualitative research methods were used to collect data at two non-governmental organization health care facilities providing abortion services. In depth interviews were held with women 2 to 3 months after they were denied an abortion. Data were analyzed using a thematic analysis approach.
  
  
  RESULTS
  The most common reason for being turned away was due to gestational age over 12 weeks with some women denied abortions that day because they did not have enough money to pay for the procedure. Almost all women were extremely upset at being denied an abortion on the day that they visited the health care facility. Some women were so distressed that they openly discussed the option of seeking an illegal provider or exploring the possibility of securing another health care professional who would assist them.
  
  
  CONCLUSIONS
  Despite South Africa's liberal abortion law and the relatively widespread availability of abortion services in urban settings, women in South Africa are denied abortion services largely due to being beyond the legal limits to obtain an abortion. A high proportion of women who were initially denied an abortion at legal facilities went on to seek options for pregnancy termination outside of the legal system through internet searches--some of which could have led to unsafe abortion practices. Further efforts should be directed towards informing women in all communities about the availability of free services in the public sector and educating them about the dangers of unsafe methods of pregnancy termination.
authors.affiliation: 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.
authors.forename: Jane
authors.initials: J
authors.lastname: Harries
authors.affiliation: Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway St, Suite 1100, Oakland, CA, 94612, USA. Caitlin.Gerdts@ucsf.edu.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Gerdts
authors.affiliation: 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. Mariette.Momberg@uct.ac.za.
authors.forename: Mariette
authors.initials: M
authors.lastname: Momberg
authors.affiliation: Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway St, Suite 1100, Oakland, CA, 94612, USA. diana.greenefoster@ucsf.edu.
authors.forename: Diana
authors.initials: D
authors.lastname: Greene Foster
mesh_terms: D000023:Abortion Applicants / Q000523:psychology*; D000028:Abortion, Induced / Q000523:psychology*; D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D011275:Pregnancy, Unwanted / Q000523:psychology*; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D055815:Young Adult