The purpose of the study was to evaluate the impact of the Termination of Pregnancy (TOP) programme in South Africa, using Mpumalanga as focal area, with the view of developing guidelines to assist service providers in the implementation of the Choice on Termination of Pregnancy (CTOP), Act 92 of 1996. The study was conducted in two phases. In phase 1, a qualitative, quantitative, contextual, explorative, descriptive and case study research design was utilised. The purpose was to explore and describe TOP service providers and facility managers’ knowledge regarding the CTOP Act, as well as their experiences and feelings regarding TOP provision, and the feelings and experiences of health care consumers utilising TOP services. Records of attendance regarding the utilisation of the services were also reviewed. Data was collected using unstructured and semi-structured interviews. Phase 2 of the study focused on the development of guidelines to assist in the translation of the CTOP Act to action at service level. The findings revealed that although the TOP programme was operating within the reproductive health for women initiative, TOP service providers and facility managers were not knowledgeable on other legislation that supports the CTOP Act to integrate its implementation. All the participants experienced emotional, physical and psychological discomfort in providing TOP services. Lack of support of the programme also posed a major challenge. These findings formed the basis for the development of the guidelines. / Health Studies / (D.Litt. et Phil. (Health Studies))

Women of child-bearing age sometimes fail to plan for pregnancies. Often they discover that they are pregnant and are not prepared or cannot afford to raise the child. Before 1996 there was no choice for women as regards pregnancies, all pregnancies must be carried to term and delivered except on health grounds and with stringent conditions. However after the TOP act was enacted in 1996, women were allowed a choice of TOP up to and including 20 weeks of pregnancy.<br /> <br /> Regardless of the availability of choice of TOP, some pregnant women still present late (after 12 weeks) for TOP when the risks of complications and costs are higher. Women who present late for TOP usually have to be admitted to a district or regional hospital and managed. The costs at such institutions are high. TOPs before 12 weeks (early TOP) are done in a primary health care (PHC) facility (TOP center) and no admission is required hence less cost. Complications of early TOP are also very mild and rare. In Lejweleputswa district there is only one TOP Center (Kopano TOP Clinic) and this serves both Lejweleputswa and the Northern Free State districts. Early TOPs (less than 12 weeks) are done and completed at this center. Late TOPs (above 12 weeks but not more than 20 weeks) are initiated at this TOP center and referred to district or regional hospitals nearest to the patient&rsquo / s home, in both districts for completion.<br /> <br /> Problems - An increasing number of women are seeking TOP service at late stages of pregnancies and the incidence of severe complications like severe bleeding, retained placenta, infection, amniotic fluid embolism, death etc, are increasing. The hospital&rsquo / s bed space and budget are stretched to the limit due to the influx of late term TOP to the hospitals. Lack of manpower, especially doctors, in these hospitals also create some problems, as the few doctors available have to attend to other ill patients as well. Sometimes bleeding TOP patients are transfused with blood and placed on a waiting list for theatre and this often increases the risk of complications. The emotional effect of late TOP on hospital staff (doctors and nurses) are enormous as the expelled fetus are much more developed than in early TOP where no fetus is seen at evacuation with simple Manual Vacuum Aspiration (MVA).<br />

Thesis (MPH.) -- University of Limpopo, 2014 / Legalising Termination of Pregnancy (TOP) in South Africa has given women the choice to decide to terminate an unwanted pregnancy. The implementation of the Choice on Termination of Pregnancy (CTOP) Act No. 92 of 1996 which was promulgated in 1997 engendered many challenges for the registered midwives performing TOP. A qualitative phenomenological study was conducted to explore and describe the experiences of registered midwives performing TOP at Polokwane / Mankweng Hospital Complex, which is one of the public hospitals in Limpopo Province. Registered midwives with 12 months or more experience in the TOP clinics participated in this study. Interviews were conducted with the participants. The audiotaped interviews and observational notes were transcribed and coded using Tesch’s qualitative and systematic approach of analysing textual data. The major themes that emerged from the data analysis include lack of resources, emotional and psychological trauma, lack of support, religious and cultural beliefs, blaming and coping mechanisms. Several sub-themes were identified that reflected the themes in greater detail. These were shortage of human and material resources, stress and frustration of midwives, rejection and labelling of midwives performing TOP, conscientious objection, cultural beliefs, lack of support by colleagues and management, failure by the community to use contraceptives, self-blaming, debriefing to assist registered midwives and self-acceptance. Guidelines based on contextualisation of these themes and sub-themes to improve identified challenges included retention of personnel through recognition and incentives, increase budgeting for essential equipment, planned debriefing sessions, promotion of positive attitudes by colleagues and intense training on reproductive health, including TOP.

Women of child-bearing age sometimes fail to plan for pregnancies. Often they discover that they are pregnant and are not prepared or cannot afford to raise the child. Before 1996 there was no choice for women as regards pregnancies, all pregnancies must be carried to term and delivered except on health grounds and with stringent conditions. However after the TOP act was enacted in 1996, women were allowed a choice of TOP up to and including 20 weeks of pregnancy.<br /> <br /> Regardless of the availability of choice of TOP, some pregnant women still present late (after 12 weeks) for TOP when the risks of complications and costs are higher. Women who present late for TOP usually have to be admitted to a district or regional hospital and managed. The costs at such institutions are high. TOPs before 12 weeks (early TOP) are done in a primary health care (PHC) facility (TOP center) and no admission is required hence less cost. Complications of early TOP are also very mild and rare. In Lejweleputswa district there is only one TOP Center (Kopano TOP Clinic) and this serves both Lejweleputswa and the Northern Free State districts. Early TOPs (less than 12 weeks) are done and completed at this center. Late TOPs (above 12 weeks but not more than 20 weeks) are initiated at this TOP center and referred to district or regional hospitals nearest to the patient&rsquo / s home, in both districts for completion.<br /> <br /> Problems - An increasing number of women are seeking TOP service at late stages of pregnancies and the incidence of severe complications like severe bleeding, retained placenta, infection, amniotic fluid embolism, death etc, are increasing. The hospital&rsquo / s bed space and budget are stretched to the limit due to the influx of late term TOP to the hospitals. Lack of manpower, especially doctors, in these hospitals also create some problems, as the few doctors available have to attend to other ill patients as well. Sometimes bleeding TOP patients are transfused with blood and placed on a waiting list for theatre and this often increases the risk of complications. The emotional effect of late TOP on hospital staff (doctors and nurses) are enormous as the expelled fetus are much more developed than in early TOP where no fetus is seen at evacuation with simple Manual Vacuum Aspiration (MVA).<br />

The purpose of the study was to evaluate the impact of the Termination of Pregnancy (TOP) programme in South Africa, using Mpumalanga as focal area, with the view of developing guidelines to assist service providers in the implementation of the Choice on Termination of Pregnancy (CTOP), Act 92 of 1996. The study was conducted in two phases. In phase 1, a qualitative, quantitative, contextual, explorative, descriptive and case study research design was utilised. The purpose was to explore and describe TOP service providers and facility managers’ knowledge regarding the CTOP Act, as well as their experiences and feelings regarding TOP provision, and the feelings and experiences of health care consumers utilising TOP services. Records of attendance regarding the utilisation of the services were also reviewed. Data was collected using unstructured and semi-structured interviews. Phase 2 of the study focused on the development of guidelines to assist in the translation of the CTOP Act to action at service level. The findings revealed that although the TOP programme was operating within the reproductive health for women initiative, TOP service providers and facility managers were not knowledgeable on other legislation that supports the CTOP Act to integrate its implementation. All the participants experienced emotional, physical and psychological discomfort in providing TOP services. Lack of support of the programme also posed a major challenge. These findings formed the basis for the development of the guidelines. / Health Studies / (D.Litt. et Phil. (Health Studies))

Since the introduction of the Choice on Termination of Pregnancy Act in 1996, research concerning abortion has primarily focused on public health issues or on the personal experience of women. The cultural and social context within which women experience a termination of pregnancy and in which services are offered has received less attention. The purpose of this study was to analyse public discourses around abortion in a low-income community in the Western Cape. Focus groups were used to gather data from three women’s and three men’s groups. The findings suggest that the agenda of pro-life discourses in this community is not always to defend the life of the fetus. Rather these discourses serve to protect, preserve and maintain the power of the traditional nuclear family, headed by the husband, over women’s reproduction and sexuality. Religious and moral arguments serve to disguise the gender issues at stake. However, instances also occurred where TOP was supported if the husband participated in the decision-making process. Therefore, his presence normalised abortion. Thus, the prevailing public discourses around abortion in this community either support or negate abortion in order to further the agenda of patriarchy.

The focus of the study was to evaluate the attitudes of midwives towards the implementation of the Choice on Termination of Pregnancy Act in the O.R. Tambo District hospitals in the Eastern Cape. There was no provision for termination of pregnancy (TOP) for unplanned pregnancy until 1994 when the Choice on Termination of Pregnancy (CTOP) Act was introduced. This act allowed any pregnant woman to request TOP when she wished for TOP. The midwives could voluntarily undergo training in TOP services and the designated institutions started offering TOP services, but stopped at a later stage. This resulted in overcrowding in health institutions which continued rendering TOP services. The researcher posed one question to be answered as: What are the attitudes of the midwives who are employed by health institutions in the O.R. Tambo District in the Eastern Cape Province towards the implementation of the Choice on Termination of Pregnancy Act? The aim of the study was to evaluate the attitude of midwives towards the implementation of the CTOP Act in the O.R. Tambo District hospitals. The objective of this study was to determine the attitudes of these midwives towards the implementation of these services in the O.R. Tambo District in the Eastern Cape Province. A quantitative descriptive design was used in this study. The population consisted of 150 midwives from two hospitals in the O.R. Tambo District. The sample consisted of 75 midwives; 30 midwives from Hospital 1 and 45 midwives from Hospital 2. Random systemic sampling was used in selecting the participants. Data were collected using a questionnaire developed by the researcher and approved by the supervisor and the University of Fort Hare Ethics Committee. In the study, using a sample of (n = 75), the attitude on the implementation of CTOP scale had high reliability of 0.81. Data were analysed with the help of a statistician using Statistix 8.1 software for Windows. Approval to conduct the study was obtained from the University of Fort Hare Ethics Committee, Eastern Cape Department of Health and Hospital 1 and Hospital 2 before the study was conducted. The dignity of the participants was maintained by explaining v the topic of the research study, the aim and objectives of the study, the method to be used for data collection and the significance of the study. The participants were allowed to ask questions and the name and telephone of the supervisor were provided in case they needed some clarity. Voluntary, written informed consent was obtained before the interviews were conducted. Privacy, anonymity and confidentiality were ensured and maintained through all the stages of the research process. The finding of this study was that the midwives employed by the health institutions in O. R. Tambo District Municipality displayed positive responses in the majority (n=11/61.1%) of 18 items in the questionnaire. Since the midwives in this study demonstrated a positive attitude towards TOP, it was recommended that the reason for stopping the TOP services in the concerned institutions should be investigated. The following are also recommended: Compulsory training of midwives should include aspects of reproductive epidemiology, in particular, the epidemiology of unsafe abortions. Training in TOP services should continue, so that there will be adequate number of midwives to provide the TOP services, and consideration of special remuneration for TOP providers. Employment of managers trained in TOP and voluntary training of managers working in TOP sections should be considered so that they may provide effective support to TOP providers. Formation of support centres for TOP providers at Provincial and National levels. Education of the community in prevention of unwanted pregnancies by means of contraceptives and indications for a need to provide TOP services, to prevent victimisation of the TOP providers. Availability of a toll free number for reporting victimisation of the TOP providers.

The purpose of this study was to explore and describe the contributory factors to the high teenage pregnancy rate within a district hospital in the Ehlanzeni district of the Mpumalanga Province, South Africa. Quantitative, non-experimental, descriptive and exploratory research was conducted to explore the contributory factors to the high teenage pregnancy rate. Data collection was done using a self-designed structured interview schedule. The findings of the study supported the assumptions that there are factors related to biography, individual perceptions, knowledge and awareness of; and practices, perceptions regarding the use of contraception. Perceived seriousness and barriers to the use of safeguards that could have prevented pregnancy contribute to the high teenage pregnancy rate thus emphasise the need to develop strategies to prevent teenage pregnancies / Health Studies / M.A. (Health Studies)

Thesis (MA)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: The aim of this pilot study was to do a needs analysis with a selected group of nurses with regard to the following three aspects: nurses' experiences of their involvement in termination of pregnancy (TOP) services, the effects of their involvement in TOP service provision on a personal, familial and career level, as well as their needs with regard to support. An important aspect of the needs analysis was to develop a questionnaire which can be used as basis for future research purposes. A qualitative, explorative, descriptive and contextual research design was applied in order to conduct this study. Participants were recruited from a health care facility in the Western Cape, v~ and the small sample group (seven out of a possible fifteen) consisted of a selected group of nurses who are currently involved in performing TOPs, as well as nurses involved in pre- and/or post-procedure care of patients. Each participant completed a self-administered biographical dataand semi-structured questionnaire, which was compiled specifically for the purpose of the pilot study. Specific guidelines according to previous research findings were incorporated. The results of the pilot study revealed that most of the participants experience some sort of cognitive, emotional and/or behavioural reaction before, during and after TOP procedures are performed. -Feelings of anxiety, sadness, anger, depression and guilt were reported in some cases, as well as moral-ethical conflicts. With regard to the effect on a personal, familial and career level, it was confirmed that the work has an effect on the majority of respondents' personal life and career to a certain extent, although family life did not seem te be affected significantly. The results conveyed that the majority of the nurses experienced that the impact of their work with TOPs seemed to be different from that of their other nursing duties. It was found that participating nurses are in need of some sort of support service, and that the practicality of the services which are currently provided, should be investigated further. Although the ability to generalise the results, was limited by the small research sample, valuable information was gained with regard to nurses' needs for support, as confirmed by other South African research findings. Suggestions for improvements in the questionnaire, as well as other further research possibilities, are provided. / AFRIKAANSE OPSOMMING: Die doel van hierdie loodsstudie was om 'n behoeftebepaling te doen met 'n geselekteerde groep verpleegpersoneel met betrekking tot die volgende drie aspekte: verpleegpersoneel se ervaring van hul betrokkenheid by terminasie van swangerskap (TOP) dienste, die effek van hul betrokkenheid by TOP diensvoorsiening op 'n persoonlike, gesins- en beroepsvlak, sowel as hul behoeftes met betrekking tot ondersteuning. 'n Belangrike aspek van die behoeftebepaling was om 'n vraelys saam te stel wat as basis vir toekomstige navorsingsdoeleindes sou kon dien. 'n Kwalitatiewe, eksploratiewe, beskrywende en kontekstuele navorsingsontwerp is toegepas ten einde hierdie loodsstudie uit te voer. Deelnemers is gewerf by 'n gesondheidsorgfasiliteit in die Wes-Kaap en die klein steekproef (sewe uit 'n moontlike vyftien) het bestaan uit 'n geselekteerde groep verpleegpersoneel wat tans betrokke is by die uitvoering van terminasie van swangerskappe, sowel as verpleegsters wat betrokke is in pre- en/of post-prosedurele versorging van pasiente. Elke respondent het 'n selfgeadministreerde biografiese en semi-gestrulctureerde vraelys voltooi, wat spesifiek vir die doel van die loodsstudie saamgestel is. Spesifieke riglyne op grond van vorige navorsingsbevindinge is geinkorporeer. Die resultate van die loodsstudie het aan die lig gebring dat die meeste van die respondente een of ander kognitiewe, emosionele en/of gedragsreaksie ervaar voor, tydens en na die uitvoering van TOP prosedures. Gevoelens van angs, hartseer, woede, depressie en skuld is gerapporteer in sornmige gevalle, sowel as moreel-etiese konflikte. Wat betref die effek op 'n persoonlike, gesins- en beroepsvlak, is dit ook bevestig dat die werk 'n effek blyk te he op respondente se persoonlike en beroepslewe tot 'n sekere mate, alhoewel dit geblyk het dat gesinslewe nie beduidend bemvloed word nie. Dit het ook uit die resultate van die studie geblyk dat die meerderheid van verpleegsters die impak van hul werk met TOP as anders as die van hul ander verplegingstake ervaar. Daar is bevind dat deelnemende verpleegpersoneel 'n behoefte het aan een of ander tipe ondersteuningsdiens en dat die praktiese aspekte van die dienste wat tans voorsien word, verder ondersoek behoort te word. Alhoewel die veralgemeenbaarheid van die resultate deur die klein steekproef beperk word, is waardevolle inligting bekom met betrekking tot verpleegpersoneel se behoeftes aan ondersteuning, soos bevestig deur ander Suid-Afrikaanse navorsingsbevindinge. Aanbevelings vir verbeteringe aan die vraelys, sowel as verdere navorsingsmoontlikhede word gemaak.

The purpose of this study was to explore and describe the contributory factors to the high teenage pregnancy rate within a district hospital in the Ehlanzeni district of the Mpumalanga Province, South Africa. Quantitative, non-experimental, descriptive and exploratory research was conducted to explore the contributory factors to the high teenage pregnancy rate. Data collection was done using a self-designed structured interview schedule. The findings of the study supported the assumptions that there are factors related to biography, individual perceptions, knowledge and awareness of; and practices, perceptions regarding the use of contraception. Perceived seriousness and barriers to the use of safeguards that could have prevented pregnancy contribute to the high teenage pregnancy rate thus emphasise the need to develop strategies to prevent teenage pregnancies / Health Studies / M. A. (Health Studies)