M.A. / This dissertation evaluates the concept of a third alternative surrounding abortion which focuses on making abortion rare by addressing contemporary arguments. This third alternative recognises abortion as morally problematic but contends that it should be both legal and rare. Its aim is to address the overly narrow focus of the usual debate on either just the foetus or just the maternal body. In doing this it evaluates some of the current contemporary arguments surrounding abortion to show how these arguments are simply not enough. This includes questioning the social and political dimensions of the dilemma of abortion, and in particular, questions about the conditions that should be in place that will help make abortion rare. This should show how the current debate has created a clear division which has done very little to help women who are considering an abortion. Therefore the argument of making abortion rare should be supported by both Pro-Life and Pro-Choice arguments because if abortion became rare, it would mean that not only would there be fewer abortions, which is exactly what Pro-Life is arguing for, but it would also mean that women would be given more options, which is what Pro-Choice is arguing for.

M.Tech. / Homoeopathy is considered to be a safe and effective modality of treatment for various ailments commonly encountered during pregnancy, such as constipation, exhaustion, pyrosis, backache, haemorrhoids, and varicose veins (Castro, 2004; Rothenberg, 2004). Pyrosis is defined as a burning sensation in the epigastric and sub-sternal region, which may radiate to the neck, throat, back and even the face, with rising of acid liquid from the stomach (Beers & Berkow, 1999; O’Toole, 2003). Pyrosis affects up to 85% of pregnant woman, the aetiology being complex and multi-factorial (Broussard & Richter, 1998; Page & Percival, 2000; Richter, 2005). The aim of the study was to determine the effect of homoeopathic similimum treatment on the frequency and severity of pyrosis during pregnancy, and also on the frequency which other antacid medication was taken. A qualitative, interventive, and descriptive study was conducted monitoring twelve participants over a period of five weeks. Non-probability purposive sampling was employed to select twelve pregnant women between 12-34 weeks gestation, suffering from pyrosis, and met the inclusion criteria for the study. Participants were recruited through referrals from midwives and advertisements placed in pharmacies and health stores. The participants evaluated their own symptoms on a daily questionnaire, recording how often they suffered from pyrosis, and also rating the severity of their discomfort. The questionnaire was completed for one week prior to treatment, and then for four weeks during which the participant received homoeopathic similimum treatment. The researcher interviewed each participant during three consultations. A thorough homoeopathic case history was taken during the initial consultation, capturing the totality of the participants’ symptoms on a case study form. After evaluation of the symptoms and repertorisation, a homoeopathic similimum remedy was prescribed. The choice of dosage and potency was individualized to the participant according to homoeopathic principles. A follow-up consultation was conducted after two weeks of treatment. During the follow-up consultation the participants’ symptoms were recorded on a follow-up sheet and their response to the treatment was evaluated. Where indicated the treatment was continued as before, the similimum remedy changed if indicated by a change in symptoms, or treatment stopped when no longer necessary. A final consultation was conducted after another two weeks. The symptoms were again recorded on a follow-up sheet, and the effectiveness of the similimum treatment was then evaluated. The data from the consultations were used to write in-depth case studies representing a qualitative evaluation of the study, based on the subjective experience of symptoms by the participants. Quantitative data was obtained from the daily questionnaires, and represented graphically. The means for all twelve cases, relating to the frequency and severity of pyrosis during the time of the study, were obtained from this data, and represented on bar graphs. From the case studies and questionnaires it was determined that there was an improvement in all twelve of the cases studied. All the participants, except for case five, eight, and nine, experienced improvement in the frequency that pyrosis was experienced. There was improvement of the severity of the symptoms in all twelve case studies. In case five, eight, and nine, the frequency of the symptoms of pyrosis didn’t decrease, but there was amelioration of the severity of the symptoms. In several cases there was also improvement of other concomitant symptoms and participants reported an overall improvement of their health. In case three the symptoms were no longer present after the first two weeks of treatment. No further treatment was required, and the participant remained symptom free for the remainder of her pregnancy. In all of the other cases the participants still continued to experience symptoms, but less frequently and suffered less discomfort. The symptoms were typically ameliorated when the prescribed remedy was taken. Provisional findings suggest that homoeopathic similimum treatment may be effective in managing pyrosis during pregnancy.

No description available.

Doctor Legum - LLD / The issue of child motherhood remains a key challenge, especially in developing countries such as Zimbabwe. Despite bearing the worst of its effects, Zimbabwe looks largely to have fallen short of answers to solve this problem. The focus has been on legal solutions to prevent and ban child marriages, which leaves the plight of child mothers and/or motherhood often forgotten. Interestingly, the 2016 landmark case of Mudzuru and another v Minister of Justice, Legal and Parliamentary Affairs which declared child marriages illegal serves as an eye opener to the challenges of how to legally protect child mothers in Zimbabwe. Though dealing with child marriages, the importance of the case is the fact that child marriages are the major contributor of adolescent motherhood in that married girls become predominantly child-bearers. According to provincial statistics in Zimbabwe, Manicaland and Mashonaland Central provinces have the highest number of child mothers averaging 27 and 30 per cent, respectively. The Zimbabwe Demographic and Health Survey reported that nine out of 10 teens aged 15 to 19 are sexually active, and two out three first have had sex before the age of 15. Therefore, girls are at risk of becoming child mothers, without necessarily being married. Consequently, the need to protect girls from early motherhood, and give effect to the rights of girls who are already child mothers becomes a pressing issue. Zimbabwe has made several international commitments to the realisation of children’s rights. It is a signatory to the Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, which contain provisions that protect girls against child motherhood and the rights of child mothers. In 2013, Zimbabwe adopted a new Constitution. It espouses a regime of justiciable children’s rights. It has also promulgated subsidiary laws that are also relevant to children’s rights. Therefore, the main purpose of this study is to critically analyse legal and policy measures towards the protection of girls against child motherhood and the rights of child mothers in Zimbabwe.

ABSTRACT Teenage pregnancy is a health and social problem in Malawi as a result of physical, psychological and socio-economic consequences on the teenage mother, family and the society as a whole. Although studies have been conducted on the prevalence and risk factors that cause teenage pregnancy in Malawi before, detailed reports are scanty, especially for Zomba district. In spite of studies and interventions that have been and are being implemented, the prevalence of unplanned teenage pregnancy in Malawi is still high, suggesting that more efforts are required to achieve effective preventive measures. The aim of this study was to explore risk factors such as cultural issues, non-use of contraceptives, lack of knowledge on sexual and reproductive health, circumstances of first sex, gender power dynamics, sexual and physical violence, age difference between teenage girls and their partners and socio-economic status for unplanned teenage pregnancy in Zomba district of Malawi. A cross-sectional analytic design was used. Five antenatal clinics were selected using a stratified and simple random sampling technique. Data were obtained from 505 participants under the age of 20 years using a questionnaire administered through face-to-face interviews. Descriptive statistics were used to analyse data and comparisons between planned and unplanned teenage pregnancy were conducted using the Chi-squared (P ≤ 0.05) and logistic regression model to predict factors for unplanned pregnancy. Findings reveal that unplanned pregnancy accounted for 76.4% of teenagers attributable to early sex and marriage, low contraceptive use, educational levels and socio-economic status, lack of knowledge of reproductive and sexual health, physical and sexual violence and substance abuse, transactional sex due to poverty, early school dropout, misleading counselling causing a lack of knowledge on sexual and reproductive health and gender inequalities. Recommendations made are aimed at eliminating myths and misconceptions surrounding the use of contraceptives and condoms, empowering teenagers economically and in decision making, promoting career guidance, awareness on human rights, including sexual and reproductive rights and implications of early marriage and training of traditional counsellors. A multisectoral approach, including government, Non-Governmental Organisations (NGOs) and communities, is required to implement these recommendations.

Abstract not on disk

Submitted in partial fulfilment of the requirements for the degree of Master of Public Health, in the field of Maternal and Child Health, to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, September 2014 / Introduction: Nevirapine (NVP) is used in combination antiretroviral treatment especially for pregnant HIV infected women. NVP has been shown to be inferior and more toxic than other similar drugs, but continues to be used in developing countries due to cost. Aim: This study aimed to determine the prevalence of NVP toxicity and associated factors among 478 pregnant women from three public health facilities in inner city Johannesburg. Materials and methods: We employed a cross-sectional retrospective record review study design to analyse the records of 478 pregnant women in the above mentioned public health facilities. Variables including demographic (age, weight, gestational age) and clinical (CD4 cell count, WHO HIV clinical stage, prior ART experience) characteristics were extracted and the association between these characteristics and the development of toxicity post NVP exposure was explored. Results: The study found that approximately nine out of ten women (89.5%) were ART naïve at the time of NVP initiation. When compared with ART naïve women, ART experienced women had a slightly higher mean CD4 cell count, however, for both groups of women, mean CD4 cell count was less than 250 cells/mm3. Overall, 85.1% of women had a CD4 cell count less than 250 cells/mm3. More than half (55.3%) of the women were in the third trimester of pregnancy and the majority (82%) classified as WHO HIV clinical stage one. At least one adverse event was reported in 63 (13.2%) women. Mild skin rash was the most prevalent adverse event, occurring in 9.6% of women. Hepatotoxicity occurred in 5.3% of women and severe skin rash occurred in 1.5% of women. Almost 85% of adverse events occurred in women with CD4 cell counts <250 cells/mm3. WHO HIV clinical stage II and IV were significantly associated with the overall development of toxicity (ρ <0.01). Conclusions: Whilst the overall prevalence of mild and severe skin rash in this sample was less than that demonstrated in earlier studies, a higher overall prevalence of hepatotoxicity was found. When compared with ART naïve women, ART experienced women were found to have a higher prevalence of mild skin rash. Hepatotoxicity and severe skin rash only occurred in ART naïve women. In this sample, CD4 cell count ≥250 cells/mm3 was not associated with the development of NVP adverse events. Recommendations: Our findings support the continued use of NVP as part of combination ART regimens in women of African descent. In contrast with previously published data, our study showed a significant association between WHO HIV clinical stage and NVP toxicity, our study also included relatively few women with higher CD4 cell counts. Further research including predominantly healthy HIV infected pregnant African women as well as women with higher CD4 cell counts is required in order to fully explore the association between these variables and the development of NVP post-exposure toxicity.

Background and objectives There has been a steady annual increase in the number of deliveries performed at Chris Hani Baragwanath Hospital in recent years. A 2004 audit found that approximately one third of deliveries conducted at the hospital were of women who had referred themselves and were low risk and as such did not require delivery at a specialist centre. A triage down-referral system back to midwife obstetric units was implemented in 2008 to address the problem of low-risk self-referrals at the hospital. This study was conducted after the establishment of the triage system to find out whether the establishment of the triage system had been accompanied by a decrease in the proportion of self-referred women presenting to Chris Hani Baragwanath Hospital in labour, and to assess delivery outcomes in these patients. Literature review The literature review was conducted using Pubmed and MDConsult using the key words self referral, triage, gatekeeper, low-risk pregnancy, maternity / labour and referral systems. Relevant references were accessed via the University of the Witwatersrand eJournal portal. Appropriate articles cited by other authors were also reviewed. Appropriate websites were also used and referenced. Methods This was a retrospective descriptive study which included all women presenting in labour to the hospital maternity admissions area. The study population was clinical case-files of all births that were admitted in labour from 1 May to 31 May 2010. A simple random sample of these files was drawn. Results One hundred and eighty two intra-partum admissions were sampled. Thirty-five (19%) of these women were self-referred. Seven out of the 35 (20%) required caesarean sections. Five more (14%) needed oxytocin augmentation of labour, and one more (3%) had a vacuum delivery. Twenty women (57%) did not develop any complications during labour and could have been delivered at their midwife obstetrics units. During the month of the study, the triage down-referral system attended to 171 women and down-referred 83 (49%). Conclusion The establishment of a triage down- referral system has been accompanied by a curtailment in the number of low-risk pregnancies presenting self-referred at the referral hospital labour ward, compared with the audit in 2004.

Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg / Background and objectives Prelabour rupture of the membranes (PROM) is a major obstetric problem affecting about 20% of pregnancies. Complications include preterm labour, ascending intrauterine and perinatal infections, and neonatal mortality. Standard guidelines are formulated and continually reviewed to improve the clinical management of PROM and to reduce poor perinatal outcomes associated with this condition. The objectives of this study, conducted using women in Johannesburg as a sample population, were: 1) to audit the implementation of the standard protocol on management of PROM, and 2) to determine the maternal and fetal outcomes of this condition. Methods A cross-sectional descriptive study was done on women admitted to the antenatal wards of Chris Hani Baragwanath Academic Hospital with PROM. Inclusion criteria were that PROM was the main reason for admission, gestation ≥24 weeks, and maternal age 18 years or more. Hospital clinical files were studied for obstetric and clinical characteristics, adherence by doctors to the management protocol, and final outcome including latency period, induction rate, mode of delivery, and neonatal outcome. Results Ninety-seven women participated in the study. Their mean age was 27.0 years, and 37 (38%) were nulliparous. Eighty-five (87%) had attended antenatal clinic. Twenty-nine (30%) were HIV-infected, 23 (79%) of them on highly active antiretroviral treatment. 6 The mean gestational age on admission was 32.8 weeks, with 78 (80%) women having preterm PROM at GA<37 weeks and 52 (54%) at GA <34 weeks. The most frequent methods of diagnosis were visual inspection in 77 (79%), speculum examination in 49 (51%) and ultrasound scan in 81 (84%) of the women. Antibiotics were given to 96 women (99%), and antenatal corticosteroids were used in all women <34 weeks pregnant. No cases of clinical chorioamnionitis were detected. The mean latency from PROM to delivery for women <37 weeks pregnant was 15 days, and for those <34 weeks, it was 19 days. Twenty-nine women (30%) required induction of labour, and 25 (25.8%) had caesarean sections. There were 12 perinatal deaths (with the exclusion of three late neonatal deaths), resulting from prematurity (n=4), congenital anomalies (n=2), neonatal jaundice (n=2), respiratory distress syndrome (n=2) and perinatal asphyxia / hypoxic ischaemic encephalopathy (n=2). There were no recorded cases of either neonatal or puerperal sepsis. Conclusion The study may have under-represented term PROM, so the findings are most applicable to preterm PROM. The condition was mostly managed appropriately within the local protocol, especially in terms of corticosteroid and antibiotic use. Overt or clinically evident chorioamnionitis was not detected. However, the perinatal mortality rate was high, and whatever the causes of perinatal death in this group, it is clear that PROM is a high-risk condition deserving of close clinical attention.

Background: This study examined the association between gender-based violence and unintended pregnancy in Zimbabwe. Various studies have identified factors associated with unintended pregnancy but the role of gender-based violence in unintended pregnancy has not been fully investigated. Gender-based violence is identified as a global public health concern and has reproductive health consequences. METHODS: This study used the Zimbabwe Demographic and Health Survey (ZDHS) of 2005/ 2006 to explore the relationship between gender-based violence and unintended pregnancy. A total of 1 516 women were included in ZDHS. For the purpose of this study only women aged 15-49 who participated in the Domestic Violence Module and who reported to have given birth in the five years before the survey were selected. The outcome variable was pregnancy intent. The predictor variables were physical, emotional and sexual violence. These were recoded into binary variables. The responses for these were “yes” for women who reported that they had experienced a form of violence and “no” for those who had not. Data analysis consisted of three stages; univariate frequency distributions and, bivariate and multivariate analysis using logistic regression. RESULTS: The study found that the experience of gender-based violence was prevalent in Zimbabwe. As 33.25% of women reported having experienced some form of physical violence and 33.71% suffered a form of emotional abuse. In the case of sexual violence, about 15.37% of women reported an experience thereof. Unintended pregnancies were reported by 30.67% respondents. An association between gender-based violence and unintended pregnancy was found to exist. This is evident in both the bivariate and multivariate analyses. Women who have experience gender-based violence are 1.53 times more likely to report unintended pregnancy.