Background The Choice on Termination of Pregnancy Act (CTOPA) No 92 of 1996 replaced the Abortion and Sterilization Act of 1975. It promotes reproductive rights and the choice on termination of pregnancy. It aims to reduce deaths resulting from illegal abortions. It designates District Hospitals and Community Health Centres to render Termination of Pregnancy (TOP). In the Free State there are 24 District Hospitals and ten Community Health Centres. Currently nine render TOP. None are in Xhariep District. Aim of the study The study investigated barriers to the implementation of the CTOPA in Xhariep District among doctors, nurses and managers in District Hospitals. Methodology It was descriptive in nature, and was divided into the quantitative and qualitative parts. The quantitative part targeted doctors and nurses, while thelatter targeted management. The response rate was 95%. Findings The findings are summarised below:-  Ninety five per cent of the respondents were nurses.  Infrastructural and human resource deficiencies are a barrier to the implementation of the act.  There are insufficient budgets to procure equipment, consumables and pharmaceuticals to render the service.  Training on reproductive health and TOP is not sufficient, except for family planning.  There is stigma towards TOP from the community, and peers. Its origin is religion and culture.  There is no psychosocial and management support for those willing to participate in TOP.  Respondents are willing to refer patients for TOP, and believe that women are entitled to choose whether to terminate unwanted pregnancies or not.  There are no incentives to for those willing to implement the Act, nor provincial support to the Districts. Recommendations  Train staff on reproductive health and TOP.  Hold management accountable by including TOP and the reproductive health package in their performance agreements.  Negotiate incentives for those willing to implement TOP, and recogniseTOP as a speciality in line with the Occupation Specific Dispensation.  Provide infrastructure and equipment for the implementation of TOP.  Develop a recruitment and retention strategy for professionals. The policy on community service for health professionals is a case in point.  Resource the District Health System as a vehicle for Primary Health Care Services. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, [2010?].

A number of studies have attempted to describe and explain both the levels of and trend in support for abortion in the adult population and college students, yet there is a gap around abortion attitudes of adolescents. This quantitative study aims to examine the levels of knowledge and attitudes of abortion among male and female secondary school learners, to examine gender differences among the learners with regards to abortion attitudes and knowledge as well as to investigate the effect of religion in terms of abortion. A sample of 150 adolescent males and females from Grade 11 between the ages of 15 to 19 years old was chosen to be used in the study. This research study was conducted at a secondary school in a lower middle class suburb in Durban. The learners were required to complete a questionnaire measuring levels of knowledge (based on different components of the South African legislation regarding abortion, that is, the Choice on Termination of Pregnancy (CTOP) Act (1996); a rating scale of abortion attitudes (Esposito & Basow, 1995) and a short biographical component. The statistical programme SPSS 15.0 was used to analyze the data. The results show that the respondents' knowledge about South African legislation governing the act of abortion; varied, attitudes to abortion differed by gender, sexual status and the reasons for abortion. It was found that the older the person, the more positive their attitude towards the elective reasons for abortion. In this study, more positive attitudes towards abortion were prevalent in the Hindu sample as compared to the Christian sample. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

This dissertation deals with the moral permissibility of abortion. It is argued that abortion is morally justifiable when the pregnancy is a result of rape (but only during the first trimester of pregnancy), when the pregnancy threatens the woman's life or long-term health, or when tests indicate to a high degree of scientific certainty that the foetus will be abnormal to such an extent, so as never to be capable of acquiring any human characteristics other than basic biological properties. Potential is adopted as a suitable criterion by which a being acquires a serious right to life. Rationality is examined closely, but shown to be inadequate since it leads to inconsistencies and does not accord with our general belief and sentiments. It is argued that all living beings have some right to life, but that sentient beings have more moral standing than nonsentient ones. Potential is argued to be the suitable comparison criterion when comparing beings of different species, and sentience when comparing beings of the same species. The dissertation is rights-oriented and reasons are given why this approach was adopted in favour of a virtue-oriented one. It is argued that a rights-oriented approach is more precise. / Philosophy, Practical and Systemic Theology / M.A. (Philosophy)

A period of ten years has elapsed since the Choice on Termination of Pregnancy Act came into effect. Little has been done in South Africa to investigate public discourses concerning termination of pregnancy since the implementation of the Act. The social context and the quality of available support systems determine the outcome of the women’s feelings after the abortion. Knowledge about the social context is important, as it will help to understand the complexities and nuances of abortion. The aim of the research is to explore public discourses on Choice on Termination of Pregnancy (CTOP), and the potential implications of these discourses on the use of the CTOP service. The sample consisted of 23 black isiXhosa-speaking participants from the rural area of the Eastern Cape Province in South Africa. Four focus groups coming from different age groups (between the ages 18 and 52) with both men and women participated in the study. Fictitious vignettes that tap into two different scenarios regarding abortion based on women’s stories were used. Discourses that emerged from people’s text are explained, described and interpreted through a discourse analysis. Since the study was interested in public discourses it led to the discovery of 17 interpretative repertoires as follows: social stigma, abortion equated to murder, degradation of society, pregnancy as an irresponsible act, conditional acceptance, TOP in the context of marriage, future potentiality invested in the foetus, dehumanizing foetus into a clot, shared decision making responsibility, gender dynamics interpretative repertoire, negative post abortion consequences, the scolding versus the supportive nurse interpretative repertoire, alternatives interpretative repertoire, rights versus no responsibility interpretative repertoire, more knowledge needed, male and female or generational differentiation repertoire, and the positive effects repertoire. Abortion is opposed on religious and cultural grounds. TOP has been legalized in South Africa but with this a debate and conflicting views have arisen. These variations in people’s discourses may limit access to TOP for women who need the service.

The introduction of abortion legalisation in South Africa during 1997 gave rise to the need for pre- and post-abortion counselling. Two dominant counselling groups came to the fore namely pro-choice and pro-life, reflecting the respective stances of society on abortion. In order to answer the following research questions: "What value-challenges do abortion counsellors experience, if any?" and "What ways have they found in negotiating these challenges?" A narrative conversation was used to come to an understanding of these research questions in practice. Research was undertaken with counsellors from both pro-life and pro-choice stances. The influence of capitalism, patriarchy and religion on role players confronted with making decisions on abortion was explored. Pro-choice counsellors negotiated their values in terms of forgiveness based on the unconditional forgiveness they would expect from God and pro-life counsellors in terms of God's forgiveness for the client, accepting her own responsibility for the consequences of the abortion. / Practical Theology / M. Th. (Pastoral Therapy)

Text in Afrikaans / Summaries in Afrikaans and English / Hierdie studie toon dat vroue wat vir terminasie van swangerskappe aanmeld, se behoeftes wyer as bloot die verwydering van die fetus strek. Die diversiteit van probleme, vra 'n beradingsbenadering wat holisties van aard is. Indien die sosiale, psigiese en spirituele behoeftes nie aangespreek word nie, het ons in die holistiese hantering gefaal. Die Department Huisartskunde waar ek werksaam is, beywer hom vir 'n holistiese benadering van die pasient. Hierdie benadering word ook deur die huidige SuidAfrikaanse Regering onderskryf. Die vrou met die ongewenste swangerskap het 'n behoefte om, behalwe die fisieke probleme, in totaliteit verstaan en gehoor te word. Sy smag na 'n berader wat saam met haar deur die kompleksiteit van die probleem kan dink en voel. Die holistiese benadering behels die fisieke sowel as die psigiese, maatskaplike en spirituele behoeftes. Die studie het te doen met 'n soeke na 'n beradingsbenadering wat in al die behoeftesvan die vrou sal voorsien. / This study demonstrates that the needs of women requesting a termination of pregnancy extend much further than the mere removal of the foetus. The diversity of problems demands a counselling approach that is holistic in nature. We will fail in this holistic management, should the social, psychological and spiritual needs not be addressed. The Department of Family Medicine where I am employed strives towards a holistic approach to the patient. This approach is also endorsed by the present South African Government. The woman with an unwanted pregnancy needs to be heard and understood in totality, over-and-above the physical problem. She yearns for a counsellor who can think and feel through the complexity of the problem together with her. The holistic approach includes the physical, as well as the psychological, social and spiritual aspects. The study involves a search for a counselling approach which provides for all these needs of the women. / Practical Theology / M.Th. (Praktiese Teologie - met spesialisering in Pastorale Terapie)

The aim of this study was to explore the psychological effects of termination of pregnancy by choice amongst adolescents within the ages of 18 to 21 years. Exploratory, contextual, qualitative design was used to determine the psychological effects of termination of pregnancy by choice amongst adolescents. Purposive sampling method as well as snowballing were used to select participants for the study. Data collection was done through in-depth, one-on-one, face-to-face interviews, using a semi-structured interview guide. The study highlighted that adolescents who seek abortion are unmarried and mostly still studying. The results revealed that adolescents experience mental ill health after termination of pregnancy due to feelings of guilt. All participants stated that abortion is murder of a life person and that it is a bad thing to do. The study revealed that counselling that is done before TOP focuses on the procedure of TOP. There is need for a holistic approach to counselling. As a guide, policy makers need to specify the mandatory counselling in the Choice on Termination of Pregnancy Act (Act No 92 of 1996). / Health Studies / M.A. (Nursing Science)

Thesis (MA (Philosophy))--University of Stellenbosch, 2008. / The practice of abortion continues to provoke controversy and disagreement. However, within the context of this wider debate, a greater level of consensus appears to have been reached as to the moral acceptability of the practice of prenatal screening, and selective abortion following the detection of foetal abnormality. This study seeks to interrogate whether justifications of this practice lend credence to the moral permissibility of selective abortion. In particular, it considers whether justifications for this practice amount to, or perpetuate, discrimination on the basis of the characteristic of disability, as selective abortion entails choosing against a particular foetus because of its characteristics. This study poses this question in two contexts – where the moral permissibility of selective abortion is regarded as an exception to the general moral impermissibility of abortion, and where selective abortion is regarded as one distinct justification within the context of the general moral permissibility of abortion. This study attempts to show that while justifications of selective abortion are directly discriminatory in the former case, they are not necessarily discriminatory in the latter case. This latter conclusion, however, recommends maintaining vigilance against the possibility that such justifications could rely upon or perpetuate prejudice, or restrict reproductive autonomy. These conclusions are considered within the South African context; in particular, with regard to their application to the Choice on Termination of Pregnancy Act of 1996.

Thesis (PhD)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: Problem statement For utilitarians, human beings have intrinsic moral significance based on only two acquired characteristics: sentience, or the ability to suffer, and psychological personhood. Sentience is the entrance-requirement for moral significance, but does not justify a "right to life" claim; at most a "right" not to suffer. Personhood, described as some sort of self-conscious awareness with a concept of the future, may justify a "right to life" claim. However, since personhood is absent in prenatal beings, and only develops some time after birth, the implication is that such beings have little moral significance and may, for instance, be killed "at will". The moral problem that I address in this dissertation is to investigate, assess and evaluate the utilitarian position on the moral status or value of prenatal life. Methodology and results I firstly, on the basis of an extensive literature study, make a detailed analysis of the utilitarian position with reference to a number of themes that I have identified in their argument. This is followed by a critical philosophical evaluation of the utilitarian position, based on six particular arguments: • Utilitarianism is philosophically incoherent. It over-simplifies the moral argument in claiming that consequences are all that matter morally. Its underlying moral theory is at odds with moral claims contained in contemporary notions of human rights and individual justice. It ignores the moral significance of special obligations to special groups. • Utilitarianism potentially has unacceptable consequences. It IS inherently discriminatory and may lead to legitimate "slippery slope" fears. • Utilitarianism clashes with our fundamental moral intuitions on the value of prenatal life. These intuitions are cherished in most world religions. • Contrary to the utilitarian position, speciesism is inevitable to the human condition, especially argued from a position of existential phenomenology. Self- constitution, simultaneous constitution of the world as we know it, and the very possibility of morality are possible only within a particular notion of speciesism. • The potentiality of pre-persons to develop into persons cannot be as convincingly ignored as is done by the utilitarian. • There is a basic and underlying need and intuition to protect vulnerable human beings, of which pre-persons are exemplars. These notions clash with utilitarian theory. As an alternative, I introduce, set out and evaluate a two-phased position on the moral significance of pre-personal human life, a position of respectfulness of prenatal and pre-personal human life based upon its humanity, potentiality and separation-viability. This leads, firstly, to the conclusion of a graded, sliding scale conception of human prepersonal moral significance in line with the level of development and with the actuation of potentiality. Secondly, it leads to the conclusion that the advent of separationsurvivability (viability) is a morally significant cut-off point beyond which the human fetus may "normally" have a justifiable right to the continuation of its life. In as far as the application of my argument is concerned, I develop a "moderate" position with reference to the abortion debate. Whilst I recognize that all human prenatal beings of which it can be argued that they have a reasonable chance to develop their intrinsic potentiality, i.e., to become full-fledged persons, should have the opportunity to do so, I also recognize that neither this position, nor the complexities of life make it possible to hold "absolute" positions on the justifiability of abortion. I explore this extremely problematic notion in the text. That having been said, the advent of separation-survivability may imply a "moral cut-off point", beyond which termination is only rarely justified. I argue that I find no moral hindrance to wellmotivated research on human pre-embryos and stem cells. / AFRIKAANSE OPSOMMING: Probleemstelling Utilitariste huldig sterk omlynde standpunte oor die waarde van lewe. Hulle redeneer dat menslike (inderwaarheid, alle lewende) wesens slegs op grond van twee eienskappe intrinsieke morele waarde kan verwerf: sentiëntisme, d.i. die vermoë om lyding te ervaar, en persoonstatus. Sentiëntisme is 'n bepalende vereiste vir morele status, maar regverdig nie 'n "reg op lewe"-aanspraak nie. Persoonsyn, verstaan as 'n vorm van selfbewustheid tesame met 'n bewuste belang by die voortsetting van eie bestaan, mag wel so 'n aanspraak regverdig. Voorgeboortelike (en "voorpersoonlike") wesens is egter nie persone nie; hulle word eers (aansienlik) ná geboorte volwaardige persone. Die implikasie is dat sulke wesens weinig morele status het, en byvoorbeeld, na willekeur gedood mag word. Die morele probleem wat ek in hierdie dissertasie aanspreek is om die utilitaristiese beskouing ten opsigte van die morale status of waarde van voorgeboortelike lewe krities-filosofies te ondersoek en te evalueer. Metodologie en gevolgtrekkings Eerstens maak ek na aanleiding van 'n gedetaileerde literatuurstudie 'n in-diepte analise van van die utilitaristiese posisie aan die hand van 'n aantal temas wat ek in hul argument geïdentifiseer het. Daarna volg 'n krities-filosofiese evaluasie van die utilitaristiese posisie, aan die hand van ses argumente: • Utilitarisme is filosofies onsamehangend. Dit oorvereenvoudig die morele argument deur voor te gee dat gevolge al is wat moreel saakmaak. Die onderliggende utilitaristiese teorie bots met die morele eise vervat in kontemporêre sienings van menseregte en geregtigheid. Dit negeer die morele belangrikheid van spesiale verpligtinge teenoor spesiale belangegroepe. • Utilitarisme het potensieelonaanvaarbare gevolge. Dit IS inherent diskriminerend en kan lei tot onkeerbare glybaan ("slippery slope")-argumente. Utilitarisme bots met ons fundamentele morele intuïsies betreffende die waarde van voorgeboortelike lewe. Hierdie intuïsies word onder meer ondersteun deur die meeste hoofstroom godsdienste. • Spesiësisme is, in kontras met die utilitaristiese beskouing, onafwendbaar vir ons selfverstaan as mense, soos aangetoon kan word met 'n beroep op die eksistensiële fenomenologie. Self-konstituering, gelyktydige konstituering van die wêreld van die mens, en selfs die moontlikheid van moraliteit is slegs moontlik vanuit' n bepaalde spesiësistiese beskouing. • Die potensialiteit van "pre-persone" om tot volwaardige persone te ontwikkel kan nie, soos die utilitaris doen, sonder meer geïgnoreer word nie. • Daar is 'n basiese en onderliggende morele eis om swak en weerlose menslike wesens te beskerm. Hierdie idees bots lynreg met utilitaristiese teorie. As 'n alternatief tot die utilitaristiese beskouing, ontwikkel ek 'n twee-fase posisie betreffende die morele waarde van voorgeboortelike menslike lewe. Ek noem hierdie posisie agting vir voorgeboortelike en voor-persoonlike menslike lewe gebaseer op die menslikheid, potensialiteit en oorleefbaarheid van prenatale mense. Dit lei, eerstens, tot die gevolgtrekking van 'n gegradeerde glyskaal konsepsie van voor-persoonlike menslike morele waarde, min of meer parallel aan die vlak van ontwikkeling en die ontwikkeling van potensialiteit. Tweedens lei dit tot die gevolgtrekking dat die ontwikkeling van lewensvatbaarheid 'n moreel-beduidende afsnypunt is waarna die menslike fetus "normaalweg" aanspraak kan maak op 'n reg dat sy lewe voortgesit moet word. In soverre dit die toepassing van my argument betref, ontwikkel ek 'n "gematigde" posisie vis-á-vis aborsie. Ek redeneer dat alle menslike voorgeboortelike wesens wat 'n redelike kans het dat hul intrinsieke potensialiteit verder sal ontwikkel, die geleentheid daartoe gegun behoort te word. Ek aanvaar ook dat nog hierdie beskouing, nog die kompleksiteit van die menslike bestaan "absolute" posisies moreel regverdig. Die problematiek en inherente spanning tussen hierdie oënskynlik-opponerende posisies word in die teks bespreek. Nogtans beskou ek die ontwikkeling van lewensvatbaarheid as 'n moreel insiggewende afsnypunt waarna terminasie net in buitengewone omstandighede moreel regverdigbaar is.

The purpose of this hermeneutic phenomenological study was to understand the essence of the lived experience of women after having an abnormal prenatal ultrasound. One hundred years ago, health disciplines had limited therapies for prenatal and neonatal disorders. During this period, the eugenics movement influenced leaders to involuntarily sterilize individuals who were sought to be "unfit" to prevent disorders in offspring. ... One of these contemporary reproductive genetic technologies is the use of ultrasound and serum bio-medical markers for detection of congenital, chromosome, and genetic disorders. When ultrasounds reveal abnormal findings, the perceived perfect pregnancy vanishes and gives way to feelings of shock, disbelief, fear, guilt, loss, and threats to self and their unborn baby. Twelve women who had an abnormal ultrasound were interviewed within the context of their cultural values and beliefs. The method of van Manen's hermeneutic phenomenology illuminated the meaning for these women in their life worlds. ... They endured this experience through their own coping mechanisms, but often felt uncertainty and emotional turmoil until the birth. The women also sought comfort through their cultural values, beliefs, and traditions. In coping with the risks found on this abnormal ultrasound, women often selected silence or blocking perceived threats. With these coping methods, they were alone in their suffering. ... Health providers, in not recognizing these women's misunderstandings and emotional fears, abandoned them in their psychosocial and cultural needs. The significance reveals that nurses and health providers need to infuse human caring ways of being, knowing, and doing within advanced technological environments. / by Jeanne Chatham Gottlieb. / Thesis (Ph.D.)--Florida Atlantic University, 2013. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.