title: Unmet counselling need amongst women accessing an induced abortion service in KwaZulu-Natal, South Africa.
abstract: Provision of objective, evidence-based counselling in the context of induced abortion services is considered global good practise. However, there is limited understanding over the counselling needs of women accessing abortion services, particularly in sub-Saharan Africa. This study aimed to explore the content and quality of pre-abortion counselling amongst women accessing an abortion service in South Africa as well as client experience of the counselling process. Perceptions of nurse counsellors were also sought.
  
  
  
  This was a mixed methods study conducted at a Choice of Termination of Pregnancy clinic based at a district level hospital in KwaZulu-Natal, South Africa. Sixty women requesting an abortion were interviewed via a semi-structured questionnaire. In-depth interviews were conducted with four nurses who provided pre-abortion counselling at the clinic. Interviews were coded for emergent themes and categories.
  
  
  
  Clinic nurses had widely variable counselling training and experience, ranging from less than 2 months to 8 years, but all clients reported that they had been treated with respect at their counselling session. The group-based counselling format and biomedical and health promotion content did not accommodate clients' differential counselling needs, which included requests for support from women experiencing intimate partner violence (IPV). There was limited provider awareness of client's additional counselling needs.
  
  
  
  Abortion counselling services should be tailored to clients' differential counselling needs. Group-based counselling followed by optional one-on-one counselling sessions is one possible strategy to address unmet client need in South Africa. Provision of abortion provider training in IPV is recommended as well as establishment of referral pathways for women experiencing IPV.
  
  
  
  Paying attention to the differential counselling needs of women seeking an abortion should be a key component to the provision of abortion services. In this way, abortion services can provide a gateway to additional support for women living in violent relationships and/or other adverse social circumstances.
authors.affiliation: Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa. Electronic address: thebird001@yahoo.com.
authors.forename: Graeme
authors.initials: G
authors.lastname: Birdsey
authors.affiliation: Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, KwaZulu-Natal, South Africa. Electronic address: tlcrankshaw@gmail.com.
authors.forename: Tamaryn L
authors.initials: TL
authors.lastname: Crankshaw
authors.affiliation: Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa. Electronic address: moulddocs@telkomsa.net.
authors.forename: Sean
authors.initials: S
authors.lastname: Mould
authors.affiliation: School of Clinical Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, KwaZulu-Natal, South Africa, 4013. Electronic address: ramklasss@ukzn.ac.za.
authors.forename: Serela S
authors.initials: SS
authors.lastname: Ramklass
mesh_terms: D000028:Abortion, Induced; D000554:Ambulatory Care Facilities; D003376:Counseling; D003657:Decision Making; D004506:Education, Nursing; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D000066511:Intimate Partner Violence; D009726:Nurses; D011247:Pregnancy; D013019:South Africa; D011795:Surveys and Questionnaires
keywords: Intimate partner violence; Pre-abortion counselling; Termination of pregnancy; Unmet counselling need