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 />

This study investigated the relationships among family environment, demographic measures, the decisions made by unintentionally pregnant adolescents regarding post-delivery plans (stay single, get married, adoption), and the certainty with which these decisions were made. The Information Sheet, Family Environment Scale (Moos & Moos, 1981), and Multiple Affect Adjective Check List (Zuckerman & Lubin, 1965a) were administered to 17 5 pregnant adolescents, ages 14 through 22, who intended to carry their pregnancies to term. Pearson product-moment correlations and multiple regression analyses were utilized to assess the relationships between family environment and certainty of decision and between family environment and negative affect. Greater uncertainty was associated with nonwhite racial status and living with both natural parents or mother only. Higher levels of negative affect were related to lower levels of perceived family cohesion, independence, expressiveness, and intellectualcultural orientation. The demographic variables of age, trimester of pregnancy, and family constellation were also found to be useful in predicting levels of negative affect. Subjects who were older, further along in their pregnancies, and living with both natural parents or mother only tended to report greater negative affect. Findings of greater uncertainty and negative affect associated with living with the natural mother are consistent with previous reports of disturbed mother-daughter relationships among this population. Discriminant analysis revealed that subjects choosing adoption were more likely to be older and to be white than those choosing to keep the child. They also tended to perceive higher levels of expressiveness and independence in their families. Comparisons between the present sample and "normal" families revealed differences which were statistically significant, but quite small in terms of raw score units. Indeed, these groups may be more similar than has often been assumed. The implications of these findings for the delivery of services and for future research efforts in this area were discussed. More intensive assessment of family functioning is needed. Based upon present results, further investigation of the family constellation variable is warranted.

It is a novel experience for a woman to enter into motherhood. While she may have some familiarity with basic methods of childcare, the experience of caring for her own child is a new one. Becoming a mother elicits a transformation for a woman, from a „self as a self‟ to a „self as a mother‟. When the pregnancy is unplanned, this transformation may be particularly complicated. This study explored this transformation by focusing on the stressors and supports mothers reported during pregnancy and in early motherhood, for women whose pregnancies had been unintended. The study utilized a psychoanalytic perspective, particularly object relations theory (ORT), to understand how the mother‟s object relations have been influenced by her perceptions and her stress levels, in her transition into motherhood. A qualitative approach was adopted in this study, so that the researcher could gain a “rich” description of the participants‟ experiences of pregnancy and motherhood. Five mothers, whose eldest was four years or younger and who had not intended to conceive, participated in focus groups and individual interviews. The data gained was analysed by means of thematic analysis, which brought about a list of perceived stressors and support factors. These stressors were categorized and discussed in relation to child-specific factors, factors specific to parenthood, environmental factors, and factors specific to the unintended nature of the pregnancy. The perceived supports included psychosocial support, allomaternal support, financial support, and information. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

A quantitative, descriptive, explorative, contextual study was conducted to determine pharmacists and drug vendors' level of knowledge, attitude towards and practice on Emergency Contraceptive (ECl in Addis Ababa. Forty licensed service providers in Addis Ababa were randomly selected during 2008 and interviewed using a structured interview schedule. Data were analysed using a computer software package. The findings revealed that although these service providers were knowledgeable on the purpose and dOSing schedule of EC, they lacked knowledge on side-effects, contra-indications, and types of ECs. Most respondents portrayed a subjective attitude towards easy EC access of especially adolescent girls, since they believed that it will encourage promiscuity and unprotected intercourse. Their knowledge and practice need to be improved, as it has a direct effect on potential users and reducing unwanted pregnancies among young. / Health Studies / M.P.H. (Health Sudies)

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)

A quantitative, descriptive, explorative, contextual study was conducted to determine pharmacists and drug vendors' level of knowledge, attitude towards and practice on Emergency Contraceptive (ECl in Addis Ababa. Forty licensed service providers in Addis Ababa were randomly selected during 2008 and interviewed using a structured interview schedule. Data were analysed using a computer software package. The findings revealed that although these service providers were knowledgeable on the purpose and dOSing schedule of EC, they lacked knowledge on side-effects, contra-indications, and types of ECs. Most respondents portrayed a subjective attitude towards easy EC access of especially adolescent girls, since they believed that it will encourage promiscuity and unprotected intercourse. Their knowledge and practice need to be improved, as it has a direct effect on potential users and reducing unwanted pregnancies among young. / Health Studies / M.P.H. (Health Sudies)

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)

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)