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. / Philosophy, Practical and Systematic 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. / Philosophy, Practical and Systematic 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)

The Choice on Termination of Pregnancy Act (CTOP Act 92 of 1996) is perhaps the most revolutionary piece of legislation internationally ever to have been promulgated to regulate abortion and as such women’s reproductive lives. Abortion research tends to focus on the experiences of women and thus cast abortion as solely a territory that represents women’s reproductive concerns and the power to choose to procreate. While the CTOP Act safeguards women’s right of choice and a form of determination relating to what happens to their bodies, it also fails to recognise or even make pronouncements about the role that a man plays in the choice to terminate a pregnancy as well as how abortion affects a man’s life. This therefore implies that legally, men do not have a stake to influencing the decision to terminate a pregnancy. This qualitative study was undertaken to explore how young unmarried males whose partners have undergone an abortion construct abortion and the meanings that they attach to the experience of abortion. Interviews were conducted and the data was analysed using discourse analysis. Some of the young men knew about the woman’s decision to have an abortion and others did not know. Common findings include a sense of helplessness due to feeling that the decision is ultimately that of the woman, anger for those who did not know about the decision to abort and a lack of forgiveness towards their partners. / Psychology / M.A. (Clinical Psychology)

Thesis (PhD (Education)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Before the implementation of abortion legislation in South Africa in February 1997, illegal abortions were the only way out for women with unwanted pregnancies. Because of the high morbidity and mortality rate of the women concerned, abortion legislation was implemented with the aim of ending illegal abortions in South Africa by having abortions carried out legally on request in designated health care facilities. The abortion legislation stipulates that registered nurses who have undergone the proposed abortion care training may terminate a pregnancy upon request of a woman during the first twelve weeks of the gestation period of her pregnancy. Although legislation authorises registered nurses to carry out first trimester abortions, an inadequate number of nurses are being trained in the Western Cape to provide pregnant women with guidance and counselling services, carry out the abortions and/or refer problem cases. Since the implementation of the abortion legislation no real attempts have been made by higher education institutions in the Western Cape to offer abortion care training for nurses. A need has therefore been identified to develop a comprehensive training framework for higher education institutions in the Western Cape for the training of nurses in abortion care. The case study was used as research design and the specific unit of analysis on which the researcher focused were the registered nurses who had received training in abortion care and the context in which they provide abortion care at the various levels of service provision in the different regions of the Western Cape. A random, stratified sample (non-proportional) was taken of the designated state health care facilities in the Western Cape, as well as a non-probability purposive sampling of registered nurses who provide abortion care, a non-probability convenience sample of women who have received abortion care and a non-probability purposive sampling of final-year pre-registration nursing students. Data was generated by means of questionnaires to the women who received abortions and/or counselling, the registered nurses who carried out abortions as well as final-year preregistration nursing students. A checklist was used to observe the abortions that were carried out by registered nurses in an objective and non-participatory manner and semi-structured interviews were conducted with various role-players in abortion care and training. The main findings of this study indicate that the necessary infrastructure within which the services could be provided according to the abortion legislation was adequate, but that the ongoing shortage of trained health care practitioners hampers the abortion care services. Only 10 (n=10) of the 15 certified nurses employed in state health care facilities actively offered abortion care services in the various designated facilities in the Western Cape. Deficiencies were identified in the existing provincial protocol and it was clear that some of the guidelines are either not in use or have become obsolete in the light of new research findings. It was found that midwives with appropriate and effective training are the ideal category of health practitioner for the provision of abortion care. The certified nurses who have been trained by the various regional offices of the Department of Health: Western Cape are skilled in carrying out the abortion procedure, but the other aspects of abortion care, that are mainly carried out by other categories of nurses, will probably require greater attention. The recommendations, which are based on a thorough literature study as well as on the findings and conclusions that arose from the empirical part of this study, have been included in a training framework. The researcher recommends that the training framework provide the basis for the development of a formal programme or programmes for the training of nurses in abortion care at higher education institutions. The purpose of the proposed framework is therefore to determine the context within which curriculation ought to take place, and to provide a focus or format for those who develop the curriculum for prospective students. / AFRIKAANSE OPSOMMING: Voor die implementering van aborsiewetgewing in Februarie 1997 was onwettige aborsies die enigste uitweg vir vroue met ongewenste swangerskappe in Suid-Afrika. Weens die hoë morbiditeit- en mortaliteitsyfer van die betrokke vroue is aborsiewetgewing geïmplementeer met die doel om onwettige aborsies in Suid-Afrika te beëindig en aborsies op versoek wettiglik in aangewysde gesondheidsorgfasiliteite uit te voer. Die aborsiewetgewing stipuleer dat verpleegkundiges wat die voorgestelde aborsiesorgopleiding ondergaan het, ‘n swangerskap kan beëindig op versoek van ‘n vrou gedurende die eerste 12 weke van die draagtyd van haar swangerskap. Ten spyte van wetgewing wat verpleegkundiges magtig om eerste trimester aborsies uit te voer, word daar om verskeie redes onvoldoende aantal verpleegkundiges in die Wes-Kaap opgelei wat voorligting en berading aan swanger vroue gee, die aborsies uitvoer en/of probleemgevalle moet verwys. Geen daadwerklike pogings is sedert die inwerkingstelling van die aborsiewetgewing deur hoëronderwysinstellings in die Wes-Kaap aangewend om aborsiesorgopleiding vir verpleegkundiges aan te bied nie. Derhalwe is ’n behoefte geïdentifiseer om ’n omvattende opleidingsraamwerk vir hoëronderwysinstellings in die Wes- Kaap te ontwikkel vir die opleiding van verpleegkundiges in aborsiesorg. Die gevallestudie is as navorsingsontwerp gebruik en die spesifieke eenheid van analise waarop gefokus is was die verpleegkundiges wat opleiding in aborsiesorg ontvang het en die konteks waarbinne hulle aborsiesorg lewer by die onderskeie vlakke van dienslewering in die onderskeie streke van die Wes-Kaap. ’n Ewekansige, gestratifiseerde steekproef (nie-proporsioneel) is geneem van die aangewysde staatsgesondheidsorgfasiliteite in die Wes-Kaap, sowel as ’n nie-waarskynlike, doelbewuste steekproefneming van verpleegkundiges wat aborsiesorg verskaf, ’n nie-waarskynlike gerieflikheidsteekproefneming van vroue wat aborsiesorg ontvang het en ’n nie-waarskynlike, doelbewuste steekproefneming van finalejaar voorregistrasie verpleegstudente. Data is gegenereer met behulp van vraelyste aan onderskeidelik die vroue wat aborsies en/of berading ontvang het, die verpleegkundiges wat aborsies uitgevoer het, asook finalejaar voorregistrasie verpleegstudente. ’n Kontrolelys is gebruik om die aborsies wat deur verpleegkundiges uitgevoer is objektief en nie-deelnemend te observeer en semigestruktureerde onderhoude is met verskeie rolspelers in aborsiesorgdienste en -opleiding gevoer. Die hoofbevindings van hierdie studie dui daarop dat die nodige infrastruktuur waarbinne die dienste ingevolge die aborsiewetgewing gelewer kon word voldoende was, maar dat die voortslepende tekort aan opgeleide gesondheidsorgpraktisyns die aborsiesorgdienste kortwiek. Slegs 10 (n=10) van die 15 gesertifiseerde verpleegkundiges in diens van staatsgesondheidsorgfasiliteite het aktief aborsiesorgdienste aangebied in die onderskeie aangewysde fasiliteite in die Wes-Kaap. Leemtes is in die bestaande provinsiale protokol geïdentifiseer en dit het in die lig van nuwe navorsingsbevindings geblyk dat sommige van die riglyne óf nie in gebruik was nie, óf dat hulle intussen verouderd geraak het. Daar is bevind dat vroedvroue met toepaslike en doeltreffende opleiding die ideale kategorie gesondheidsorgpraktisyn is vir die verskaffing van aborsiesorg. Die gesertifiseerde verpleegkundiges wat deur die Departement van Gesondheid: Wes-Kaap se onderskeie streekskantore opgelei is, is vaardig in die uitvoer van die aborsieprosedure as sulks, maar die ander aspekte van aborsiesorg, wat meestal ook deur ander kategorieë verpleegkundiges uitgevoer word, sal waarskynlik groter aandag moet kry. Die aanbevelings is gegrond op ’n deeglike literatuurstudie sowel as op die bevindings en gevolgtrekkings wat uit die empiriese gedeelte van hierdie studie spruit en is vervat in ’n opleidingsraamwerk. Die navorser beveel aan dat die opleidingsraamwerk die grondslag sal bied vir die ontwikkeling van ’n formele program of programme vir die opleiding van verpleegkundiges in aborsiesorg aan hoëronderwysinstellings. Die doel van die voorgestelde raamwerk is dus om die konteks te bepaal waarbinne kurrikulering moet plaasvind, asook om ’n fokus of formaat te verskaf vir diegene wat die kurrikulum vir voornemende studente ontwikkel.

Literature reveals that reproductive coercion is a major contributor to unwanted pregnancy and a factor that influences the choice to terminate pregnancy in many adolescents. Adolescents represent a population vulnerable to a number of physical and psychological problems. Purpose The overall aim of this thesis was to develop a model of self-forgiveness for women who terminated pregnancy in adolescence. Objectives The study objectives are aligned according to the phases of the study as follows: Phase 1: Desk review Explore what is already known about the topic and identify gaps. Phase 2: Lived experiences of participants about TOP Explore the lived experiences of participants who terminated pregnancy in adolescence. Phase 3: Development of a model Develop a model of self-forgiveness for women who terminated pregnancy in adolescence. The social-ecological model (Bronfenbrenner 1992), through which individuals are understood to influence and be influenced by people, organisations, institutions, societal norms, rules and beliefs with whom they interact, was followed. The model offered a holistic framework for exploring interrelationships related to TOP Methodology A qualitative approach based on Heidegger (1962) interpretive phenomenological approach was used. The study was conducted at a Health Care Centre in Tshwane Municipality, Gauteng Province, South Africa. The population consisted of women, 20-35 years old, who terminated pregnancy in adolescence. A purposive and snowball sampling techniques were used to recruit 30 participants who had terminated pregnancy in adolescence. An interview guide was used to solicit information from participants. Audiotaped interviews were held at the time, date and place agreed by participants. Colaizzi’s (1978) approach of data analysis was used. Results Five major themes emerged, with 17 sub-themes as transgressing one of nature’s strongest instincts: the mother’s protection of her young; unplanned pregnancy; intra-and interpersonal relationships; experience of caring by health care professionals and a need for counselling. A model of self-forgiveness for women who did TOP in adolescence, based on the components of self-condemnation and self-blame, cultural and spiritual, as well as reproductive coercion, was developed. Conclusion Participants carried the burden of shame and guilt of having terminated pregnancy in adolescence. The influence of culture and religion were the major contributing factors to women failing to forgive themselves after termination of pregnancy. A model of self-forgiveness is needed to allow those who terminated pregnancy in adolescence to move on with their life. / Health Studies / D. Litt. et Phil. (Health Studies)

Unintended and unwanted pregnancies are major reproductive health problems impacting negatively on women’s health globally. When faced with these pregnancies, many women choose termination of pregnancy (TOP) as their recourse. The purpose of the study was to explore and describe physical, psychological and social implications of TOP on the woman’s health. A qualitative and descriptive research design was used. The population comprised women who had TOP three months to one year before the study and were willing to participate in the study. A non-probability purposive sampling was used to select participants for the study. In-depth phenomenological interviews were used for data collection until data saturation was reached with 20 participants. The findings reveal that women had psychological, physical and social implications after TOP which impacted negatively on their health. Recommendations were made to improve the services of women choosing to terminate a pregnancy to lessen negative implications. / Health Studies / M.A. (Health Studies)

The Choice on Termination of Pregnancy Act (CTOP Act 92 of 1996) is perhaps the most revolutionary piece of legislation internationally ever to have been promulgated to regulate abortion and as such women’s reproductive lives. Abortion research tends to focus on the experiences of women and thus cast abortion as solely a territory that represents women’s reproductive concerns and the power to choose to procreate. While the CTOP Act safeguards women’s right of choice and a form of determination relating to what happens to their bodies, it also fails to recognise or even make pronouncements about the role that a man plays in the choice to terminate a pregnancy as well as how abortion affects a man’s life. This therefore implies that legally, men do not have a stake to influencing the decision to terminate a pregnancy. This qualitative study was undertaken to explore how young unmarried males whose partners have undergone an abortion construct abortion and the meanings that they attach to the experience of abortion. Interviews were conducted and the data was analysed using discourse analysis. Some of the young men knew about the woman’s decision to have an abortion and others did not know. Common findings include a sense of helplessness due to feeling that the decision is ultimately that of the woman, anger for those who did not know about the decision to abort and a lack of forgiveness towards their partners. / Psychology / M. A. (Clinical Psychology)

Contraceptives are available free of charge throughout South Africa. Nevertheless the number of requests for termination of pregnancy (TOP) services continues to increase. This research investigated challenges preventing women from using contraceptives effectively. Structured interviews were conducted with 47 women who requested TOP services. Gender and financial issues posed challenges for some women to access contraceptives as well as their reported inability to access contraceptives. Most (85,5%) of the respondents used contraceptives. They discontinued using contraceptives because they experienced side-effects, necessitating them to request TOPs. Knowledge about, access to, nor the actual use of contraceptive enabled these women to prevent unwanted pregnancies. More effective counselling about the side-effects of contraceptives and enhanced accessibility of contraceptives during weekends and lunch breaks could enable more women to prevent unwanted pregnancies and reduce the number of requests for TOPs in the Gert Sibande District (Mpumalanga). / Health Studies / M.A. (Health Studies)

Teenage pregnancies are currently a social problem in South Africa and in the rest of the world. Social workers are involved with teenage girls by providing guidance during their pregnancies and face many challenges by accepting this role. The objective of this qualitative study was to identify and describe the needs of social workers when guiding pregnant teenage girls. A conceptual framework with the Gestalt approach as the theoretical framework for the study was stated after which an empirical study took place. In-depth interviews took place with nine social workers. Results were then verified in a focus group discussion. From the empirical data themes and sub themes were identified and verified with relevant literature. These themes and sub themes were then interpreted through the Gestalt approach. Conclusions and recommendations were made to social workers and interdisciplinary teams, which form part of the network that are involved with pregnant teenage girls. / Thesis (M.Diac. (Spelterapie)