Factors Influencing the Implementation of Termination of Pregnancy Policy in Gauteng Department of Health: A Multi-Method Study

Abstract

Aim: This study aimed to explore and describe the factors influencing the implementation of the termination of pregnancy policy in Gauteng Department of Health to recommend how to better align the TOP services with guidelines of the Gauteng province under the CTOP (Act of 1996) as amended by the CTOPA 2008. Method: A multi-method research design included a scoping review, semi-structured interviews with selected stakeholders and an audit of the demand for TOP services and the resources and facilities. The study was conducted in phases, ending with a triangulation of the data derived from the first three phases to answer the research question. Findings: The scoping review revealed that access to abortions remains a problem in many countries, whether there is legal provision for the practice or not. Negative attitudes abound in societies, and poor knowledge of the legislation and processes exists. The ethical considerations, including the conscientious objection clause found in some policies, result in limited provision of services. Cultural and societal influences impact women wishing to seek termination of pregnancy and the providers of the service. Participants in the semi-structured interviews indicated that the working conditions were not ideal. They feel there is a lack of managerial support, and working alone without the support of colleagues makes the work stressful. The audit indicated that most of the equipment listed as requirements in the guidelines is present. Still, the participants in the interviews said that the supply of medications for TOP is intermittent. There is no physical space for providers to offer a confidential service. While providers only assisted an average of one patient an hour, this finding should be seen in the light that they are required to participate in other work in the health establishments. Patients bypass the clinics in their first trimester and choose to attend hospitals meant to provide second-trimester TOP. Recommendations: Specific recommendations were made for the Gauteng Department of Health based on the findings of this study. Recommendations related to: optimisation and expansion of available space for TOP services; Dealing with conscientious objection and stigma; ensuring the constant supply of abortion drugs; vi Management support; the provision of second-trimester abortion services; and reducing complications related to unsafe abortions. In addition, recommendations were made for further research and nursing education. Conclusion: The constrained working environment and negative attitudes in the community and amongst health professionals negatively influence the implementation of the TOP policy. Based on the recommendations of this study, it is hoped that measures will be put in place to improve access to TOP and implementation of the TOP policy.