Background: Despite proven efficacy, Manual Vacuum Aspiration (MVA) use for incomplete abortions is low in the Swaziland setting, including Raleigh Fitkin Memorial (RFM) Hospital. Uncertainty in the costs implications of introducing MVA to replace Dilatation and Curettage (D&C) is the major hindrance to change. This study aimed to evaluate the cost-effectiveness of introducing MVA as an evacuation method for first trimester incomplete miscarriages as well as assess the implications of the introduction of MVA to the entire post-abortion care budget at RFM Hospital. Methods: The methods comprised cost-effectiveness and budget impact analyses from a healthcare perspective based on a theoretical cohort. Clinical outcomes data for procedures were obtained from relevant literature. Costs were collated from prospective suppliers and then compared for the two treatment modalities. Future numbers of annual evacuations were extrapolated from previous annual figures. First trimester miscarriages were in turn extrapolated from proportions found in previous studies. Total budgets were calculated under the current scenario, as well as if MVA had to be introduced. Results: With initial capital costs of ZAR11 093.00, introduction of MVA for first trimester incomplete abortions will cut post-abortion care costs by 34.7%. MVA would cost ZAR819.86 per procedure while D&C costs ZAR1 255.40 per procedure. An estimated 26 MVA procedures done instead of D&C will compensate for the initial capital investment. Introduction of MVA into the post-abortion care programme will save the hospital about ZAR516 115.30 annually, with at least similar clinical outcomes compared to D&C. Conclusions: MVA should be considered as the first option in first trimester post abortion care. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Clinical Epidemiology / unrestricted

The primary aim of this investigation is to focus on the delivering of pre-abortion counselling from a social work perspective. The importance of delivery of pre abortion counselling with regard to the pregnant woman, who is considering the termination of a pregnancy, is accentuated on the one hand. On the other hand, the focus is on making social workers aware of becoming involved in abortion-related services. The thesis consists of five Sections: SECTION A This section indicates the actuality of the research, namely a study of pre-abortion counselling according to which four research questions are formulated. The overarching research aim and four research objectives are discussed in the section. This research takes on the intervention research model within the combined qualitative and quantitative research approach. The survey procedure was utilized in two different manners to wit the single-system design and mailed questionnaires. The data which was captured during thorough interviews was processed computer-wise as well as by hand. SECTION B This section was presented in the form of four articles in which the research finding were reported. AU four articles form part of the all-embracing research aims and objectives and of the entire research project. However, every article is a sub-project of the entire research project because it also acts independently - each with a distinctive problem statement, research aim and objectives, research methods and distinctive content. Section B consists of the following articles: Article 1 discusses abortion as a moral dilemma in South Africa and points out that there are still unanswered questions with regard to this acute subject that is as old as mankind. In Article 2 the living space of the pregnant woman who requests the termination of a pregnancy is discussed with the accent on the necessity for the understanding of such a woman who finds herself in a crisis situation, in order to deliver an effective social work service. The importance of pre-abortion counselling with crisis intervention as the proper model is discussed in Article 3. And as indicated that delivering pre-abortion counselling to the pregnant woman who requests the termination of a pregnancy is essential for the decision-making process but also with regard to her future. Article 4 discusses the opinion of social workers concerning the delivery of pre-abortion counselling. 'The social worker as a pre-abortion counsellor, and who forms part of the multi-professional team receives priority attention here. SECTION C In Section C, the conclusions and recommendations with regard to this research is explained. The limitations of this study are indicated, and recommendations are made with a view to its utilisation in theory and in practice as well as for training and research SECTION D AU addendum that are referred to in the thesis are contained in this section. SECTION E Although each article has its own source list, a combined source list of the entire research project is presented in this section. / Thesis (Ph.D. (Social Work))--North-West University, Potchefstroom Campus, 2005.

The primary aim of this investigation is to focus on the delivering of pre-abortion counselling from a social work perspective. The importance of delivery of pre abortion counselling with regard to the pregnant woman, who is considering the termination of a pregnancy, is accentuated on the one hand. On the other hand, the focus is on making social workers aware of becoming involved in abortion-related services. The thesis consists of five Sections: SECTION A This section indicates the actuality of the research, namely a study of pre-abortion counselling according to which four research questions are formulated. The overarching research aim and four research objectives are discussed in the section. This research takes on the intervention research model within the combined qualitative and quantitative research approach. The survey procedure was utilized in two different manners to wit the single-system design and mailed questionnaires. The data which was captured during thorough interviews was processed computer-wise as well as by hand. SECTION B This section was presented in the form of four articles in which the research finding were reported. AU four articles form part of the all-embracing research aims and objectives and of the entire research project. However, every article is a sub-project of the entire research project because it also acts independently - each with a distinctive problem statement, research aim and objectives, research methods and distinctive content. Section B consists of the following articles: Article 1 discusses abortion as a moral dilemma in South Africa and points out that there are still unanswered questions with regard to this acute subject that is as old as mankind. In Article 2 the living space of the pregnant woman who requests the termination of a pregnancy is discussed with the accent on the necessity for the understanding of such a woman who finds herself in a crisis situation, in order to deliver an effective social work service. The importance of pre-abortion counselling with crisis intervention as the proper model is discussed in Article 3. And as indicated that delivering pre-abortion counselling to the pregnant woman who requests the termination of a pregnancy is essential for the decision-making process but also with regard to her future. Article 4 discusses the opinion of social workers concerning the delivery of pre-abortion counselling. 'The social worker as a pre-abortion counsellor, and who forms part of the multi-professional team receives priority attention here. SECTION C In Section C, the conclusions and recommendations with regard to this research is explained. The limitations of this study are indicated, and recommendations are made with a view to its utilisation in theory and in practice as well as for training and research SECTION D AU addendum that are referred to in the thesis are contained in this section. SECTION E Although each article has its own source list, a combined source list of the entire research project is presented in this section. / Thesis (Ph.D. (Social Work))--North-West University, Potchefstroom Campus, 2005.

The thesis deals with the issue of spontaneous abortion as well as induced termination of pregnancy and its potential negative impacts on woman's mental and physical health. The theoretical part summarizes the findings about particular kinds of pregnancy loss and defines the possibilities of psychological adaptation to this loss. The author paid the close attention to Post-abortion syndrome (PAS), which is regarded as a special form of Post- Traumatic Stress Disorder. The thesis is further focused on the emotional, social, psychological and physical effects following abortion, the most threatened group of women with a higher probability of having PAS and finally the way of medical treatment. In the empirical part, the main symptoms of PAS were detected by means of the Helpline database analysis. Detection of these syndromes enabled to compile the questionnaire related to pregnancy loss. The main task was to discover the perceived changes in a woman's life after the pregnancy loss. In the final part of the work, the questionnaire regarding pregnancy loss had been tested and finally the main benefits together with limits had been critically evaluated.

Bakgrund: Barnmorskor och sjuksköterskor världen över möter och vårdar kvinnor som av olika skäl genomför en inducerad abort. Det kan vara en utmaning som kräver både kunskap och stöd för dem som arbetar inom abortvården. Syfte: Syftet med studien var att belysa barnmorskors och sjuksköterskors erfarenheter av att vårda kvinnor i samband med inducerad abort. Ordet erfarenheter innefattar upplevelser och åsikter baserat på erfarenheter. Metod: Studien genomfördes som en kvalitativ metasyntes med metaetnografi som analysmetod. Tjugosju (27) artiklar inkluderades i resultatet. Resultat: Tre huvudkategorier och tio mönster belyser barnmorskors och sjuksköterskors erfarenheter av att vårda kvinnor i samband med inducerad abort. Dessa var att göra ett bra arbete genom att vara ett stöd, att åsidosätta egna värderingar och att skapa goda upplevelser för kvinnan. Barriärer för kvalitativ abortvård i form av negativa attityder från omgivningen, brister i verksamheten, bristande preventivmedelsanvändning, egna känslor och ta emot fostret. Behov hos vårdgivarna i form av stöd och kunskap. Slutsats: Den abortsökande kvinnan är i behov av stöd och icke dömande attityder från vårdgivare. Barnmorskor och sjuksköterskor behöver ha kunskap och få stöd i arbetet med abortvård. Brist på stöd och kunskap hos barnmorskor och sjuksköterskor kan påverka attityder om kvinnors rätt till inducerad abort inom kollegiet på en arbetsplats, vilket i sin tur kan ha en inverkan på den abortsökande kvinnans omvårdnad. / Background : Midwives and nurses all over the world meet with and care for women who, for various reasons, are undergoing induced abortion. It may be a challenge that requires both knowledge and support for those working in abortion care.Objective: To describe midwives and nurses’ experiences of caring for women who undergo induced abortion. The word experience includes perceptions based on experiences. Method: The study was conducted as a qualitative metasynthesis using meta-ethnography as analysis of data. Twenty-seven (27) peer-reviewed scientific articles were included in the result. Result: Three main categories and ten different patterns highlighted the midwives and nurses' experiences of caring for women undergoing an induced abortion. These were doing a good job by being supportive, putting own values aside and with the goal to create good experiences for the woman. Barriers to qualitative abortion care included negative attitudes from the surroundings, own feelings, receiving the fetus and various issues at the abortion care clinics. The third category was the caregivers’ needs which included support and knowledge. Conclusion: The abortion-seeking woman is in need of support and non-judgmental attitudes from caregivers. Midwives and nurses need knowledge and support in the work of abortion care. Lack of support and knowledge can affect midwives and nurses’ attitudes towards induced abortion as a woman’s right, which in turn can affect the women in need of abortion care.

Abortion can be a significant event in a woman's life. Some women are found to be affected by severe negative psychological complications following abortion. A synthesis of the current research on post abortion grief and support implications was conducted for this literature review. Those women who have ineffective coping post abortion were described to have dysfunctional grief. The uniqueness of the loss and the stigma attached to abortion, which has prevented women from seeking help, contributes to the dysfunctional grief. Screening and assessment of women have been found to be beneficial in identifying those who were suffering. Validation of the feelings that women ' express has been cited in the literature as one of the most significant supportive interventions that can be provided to women who are coping ineffectively. Education can be helpful in guiding nurses, practitioners, and students to evaluate, and provide support for women who are grieving ineffectively, thus initiating healthy grieving in this population. The implications for nurses to assess for pregnancy loss, educate and promote healthy grieving in women are supported by this literature review.

The study sought to assess the knowledge of adolescents regarding abortion in a selected area in Lagos Nigeria. The researcher used a non-experimental, exploratory, descriptive research design for the study. One hundred adolescents participated in the study. The study found that many adolescents will not admit to having had an abortion. Moreover, the respondents gave different meanings for abortion, had inadequate knowledge of abortion and sexual and reproductive health. Cultural taboos and religious beliefs have a great impact on adolescents’ sexual behaviour. Most adolescents would not access abortions services because they regard it as killing an innocent baby. Efforts should be strengthened to make contraceptives and family life education available and accessible to the adolescents. / Health Studies / Thesis (M.A. (Health Studies))

In 1996 the South African government legalised the termination of pregnancy (TOP) services, allowing women to choose to terminate unplanned pregnancies at designated facilities. Although TOP services are available, pregnant women continue to use illegal abortion services, with potentially life-risking consequences. The purpose of this study was to identify challenges encountered by women requesting TOP services, and to make recommendations for improved policies and practices, enabling more women in the North West Province (NWP) to access TOP services. This was a non-experimental, exploratory, descriptive and quantitative study. Structured interviews were conducted with 150 women who had used TOP services in phase 1, with 50 women who were unable to access TOP services in phase 2 and with 20 professional nurses providing TOP services in the NWP in phase 3. In phase 1, 96.0% (n=144) of the women needed transport to access TOP services, and 73.2% (n=109) indicated that nurses put women’s names on waiting lists, posing barriers to such access in the NWP. In phase 2, 92.0% (n=46) of these respondents had reportedly requested TOPs for the first time, but 89.0% (n=44) could not access TOP services. In phase 3, only 14 out of 19 designated facilities in the NWP, and only 20 nurses, provided TOP services during the study period. Out of the 20 interviewed nurses, 74.0% (n=14) regarded the Choice on Termination of Pregnancy Act, Act 92 of 1996 (CTOP Act) was being unclear requiring a revision. These professional nurses provided TOP services in NWP, by choice. Unless more facilities and more nurses can provide TOP services to the women of the NWP, these services will continue to remain inaccessible, necessitating the continued utilisation of illegal abortion services, in spite of the TOP Act’s prescriptions. It is also recommended that management will provide sufficient support and training opportunities for professional nurses working in TOP services in the NWP. / Health Studies / (D. Litt. et Phil. (Health Studies))

The study sought to assess the knowledge of adolescents regarding abortion in a selected area in Lagos Nigeria. The researcher used a non-experimental, exploratory, descriptive research design for the study. One hundred adolescents participated in the study. The study found that many adolescents will not admit to having had an abortion. Moreover, the respondents gave different meanings for abortion, had inadequate knowledge of abortion and sexual and reproductive health. Cultural taboos and religious beliefs have a great impact on adolescents’ sexual behaviour. Most adolescents would not access abortions services because they regard it as killing an innocent baby. Efforts should be strengthened to make contraceptives and family life education available and accessible to the adolescents. / Health Studies / Thesis (M.A. (Health Studies))

In 1996 the South African government legalised the termination of pregnancy (TOP) services, allowing women to choose to terminate unplanned pregnancies at designated facilities. Although TOP services are available, pregnant women continue to use illegal abortion services, with potentially life-risking consequences. The purpose of this study was to identify challenges encountered by women requesting TOP services, and to make recommendations for improved policies and practices, enabling more women in the North West Province (NWP) to access TOP services. This was a non-experimental, exploratory, descriptive and quantitative study. Structured interviews were conducted with 150 women who had used TOP services in phase 1, with 50 women who were unable to access TOP services in phase 2 and with 20 professional nurses providing TOP services in the NWP in phase 3. In phase 1, 96.0% (n=144) of the women needed transport to access TOP services, and 73.2% (n=109) indicated that nurses put women’s names on waiting lists, posing barriers to such access in the NWP. In phase 2, 92.0% (n=46) of these respondents had reportedly requested TOPs for the first time, but 89.0% (n=44) could not access TOP services. In phase 3, only 14 out of 19 designated facilities in the NWP, and only 20 nurses, provided TOP services during the study period. Out of the 20 interviewed nurses, 74.0% (n=14) regarded the Choice on Termination of Pregnancy Act, Act 92 of 1996 (CTOP Act) was being unclear requiring a revision. These professional nurses provided TOP services in NWP, by choice. Unless more facilities and more nurses can provide TOP services to the women of the NWP, these services will continue to remain inaccessible, necessitating the continued utilisation of illegal abortion services, in spite of the TOP Act’s prescriptions. It is also recommended that management will provide sufficient support and training opportunities for professional nurses working in TOP services in the NWP. / Health Studies / (D. Litt. et Phil. (Health Studies))