M.Med. (Obstetrics and Gynaecology), Faculty of Health Sciences, University of the Witwatersrand,2008 / The aim of this study was to assess the demographic characteristics and contraceptive practices of women requesting termination of pregnancy (TOP) at Chris Hani Baragwanath Hospital (CHBH). The study will provide insight into the reasons for contraceptive „failure‟ or non-use. Methods This is a cross sectional questionnaire survey. Subjects for the study were recruited from clients requesting TOP at the Gynaecology clinic (ward 54), CHBH. They included women between 13 to 49 years, who were referred from their local clinic or General practitioner with a positive pregnancy test or a pregnancy confirmed on sonar, and were less than 20 weeks pregnant. Consenting women completed a self-administered questionnaire which assessed their demographic details, current contraceptive use, past contraceptive experience, future contraceptive plans, knowledge of emergency contraceptive pill, and the current status of the relationship, initial intention with regard to the pregnancy, and the number of sexual partners they had in the last year. The data was analysed using the Epi Info 6 software programme. Results There were 780 requests for TOP during the study period. Two hundred and twenty nine women were approached to participate in the study and 203 questionnaires were analysed, i.e. an 89% analysable response rate. The mean age of the respondents was 25 years (range 13 - 42 years), the mean parity was 1.3 (range 0 to 9), 35% were still in school, 28% were unemployed and 70% were financially dependent on their parents, partners, or other relatives. A total of 56% of the respondents reported that they were using contraception when they conceived. Only 11% of the respondents knew of the emergency contraception pill. Eighty two percent of the respondents knew where to obtain contraceptives and only 7% had experienced actual difficulty in obtaining contraception. However, 46% thought they received „too little‟ information about contraception at their local clinic and 26% said that the contraceptive method they received was the healthcare provider‟s choice. Up to 47% of the respondents were either unsure of the contraceptive method they would use or would not use any contraception following the TOP. However, 43% would use a highly reliable contraceptive method (the oral contraceptive pill, injectable contraceptive, or sterilisation). Regarding the status of the relationship which resulted in the pregnancy, 44% were no longer in a permanent relationship (41% were and 11% never were). Twenty two percent of the respondents initially wanted the pregnancy. Conclusions Twenty two percent of the respondents initially wanted the pregnancy and would not have been helped by better provision of contraception. A large number of respondents reported contraceptive failure. Knowledge of emergency contraception was poor, and its use should be better promoted for cases of contraceptive failure. It is alarming that up to 47% of the clients could not use contraception in the future. Perhaps more time should be spent on contraceptive counselling and initiation of a method on site, with referral and follow-up at primary health clinics to improve uptake of contraception. Only 2.5% of the respondents were having a repeat TOP.

M.Med. in Community Health, Faculty of Health Sciences, University of the Witwatersrand, 2011 / Introduction Three public health interventions well known to decrease the risks associated with pregnancy and child birth are access to maternity care, family planning and contraception, and safe abortion. Worldwide, the African region has the highest case fatality rate associated with unsafe abortion 750 per 100 000, largely as a result of restrictive abortion laws. South Africa (SA) legalised abortion in 1996 with the “Choice on Termination of Pregnancy” (CTOP) Act. It sought to improve the quality and access to termination of pregnancy (TOP) services in SA. Since its enactment there has been a 91% decrease in deaths due to unsafe abortions. There have been some experienced challenges associated with the implementation of the Act, limited number of functional TOP facilities, prolonged waiting times, and negative attitudes of TOP providers to clients. After more than a decade of liberalised law in SA, what are TOP providers’ perceptions, clients’ experiences and the overall quality of TOP services? Main Aim The evaluation of TOP services in the urban Johannesburg Metropolitan Municipality (JHB), Gauteng Province, and two rural municipalities Bela-Bela Municipality, Limpopo Province and Mangaung Municipality, Free State Province. Methodology A mixed methods approach was adopted; both quantitative and qualitative data were collected in three sections. Included were all primary health care facilities offering first trimester TOPs in the Johannesburg Metropolitan, Mangaung, and Bela-Bela Municipalities. Section I the analysis of district health information management system (DHIS) data for JHB. Section II, TOP providers and TOP clients completed self-administered questionnaires. Section III the TOP clients from JHB were questioned again after eighteen months. Various parametric and non-parametric tests were conducted on the data, based on the data distribution. The statistical software used for quantitative data analyses was Stata release 10.0 and qualitative data MAXQDA release 10.0. Results The DHIS showed a 61% increase in TOP requests from 2006 to 2009 (Chi-square for trend; P=0.08). The number of first trimester procedures performed only addressed 40% of total requests in 2006 and 33% of total requests in 2009. Section II demonstrated that all the TOP providers reported not coping with their duties, only two (15%) providers were comfortable with administering TOPs. One hundred and fifty-two TOP clients were recruited into the study. The mean age was 26.00 (±6.03) years. One hundred and sixteen (76%) women were not using contraception. Clients from JHB had prolonged waiting times 14 days (IQR; 6-28) compared to Bela-Bela clients’ 3 days (IQR; 1-6) (Post-hoc Wilcoxon- Ranksum; P<0.0001). Hence clients from JHB had TOPs at later median gestational ages of 9 weeks (IQR; 8-11) and Bela-Bela clients at 7.5 weeks (IQR;4-8) (Post-hoc Wilcoxon Ranksum; P<0.0001). Knowledge of the CTOP Act exceeded seventy percent across all three municipalities (Pearson Chi-square; P=0.83). Section III identified that 39% (n=9) of interviewed clients experienced a TOP-related complication. The odds of experiencing a complication was decreased if client received a follow-up appointment (OR 0.12; 95% CI 0.02-1.51; P=0.02), if client was aware of the CTOP Act (OR 0.11; 95% CI 0.01-2.08; P=0.06), and clients that had attended Lenasia South CHC had odds of complication 8 times higher than clients who had presented to Bophelong clinic (OR 8.68; 95% CI 3.47 -21.7; P<0.0001). The qualitative analysis identified themes of an association with intra-procedural pain and perceived inadequate counselling with those reporting emotional distress. Discussion The prevalence of contraceptive use during the month of conception was low, and the majority of clients were unaware of the correct gestational age for termination of pregnancy according to the CTOP Act. This suggests that the pre-TOP services required strengthening. The TOP services in the public sector may not to be addressing the number of TOP requests; this affects the availability of the service. TOP providers in different South African settings report similar challenges associated with delivering TOP services. The clients from JHB are waiting longer for the TOP and hence having the abortion at later gestational ages which are associated with increased complications rates. The study estimated a complication rate of approximately 26 per 100 abortion clients, higher than acceptable global rates which approximate 3 per 100. The improvement of pre and post-TOP counselling was highlighted. Conclusion This study introduces the importance of passive surveillance in improving the quality of service delivery. Though this is only achieved when data collected are analysed and used to inform policy and service. The studies conducted in South Africa since the CTOP Act enactment has demonstrated various challenges and areas for improvement. These findings have ensured that issues of public health importance continue to be studied and relevant findings disseminated to stakeholders for and consideration and action where appropriate.

Thesis (MDEV) --University of Limpopo, 2007. / The study sought to develop guidelines that are aimed at improving Termination of Pregnancy (TOP) services that are rendered by public hospital based midwives. The researcher applied a qualitative and descriptive design. The study targeted midwives in the Bohlabela District, which has three hospitals. A non-probability purposive sampling was used to 6 midwives who are currently conducting TOP services in the hospitals. Data collection was both in-depth and conducted in face-to-face interviews with each participant. The findings of the study were analyzed, categorized into sub-themes, and revealed that midwives who conduct TOP services experience the following challenges, namely: inadequate human resource, poor infrastructure, lack of equipments, poor management support, and lack of support from doctors. Based on the findings of the study, it is imperative that all hospitals be designated centres for TOP services, so as to reduce the workload in the few hospitals that currently are inundated. The infrastructure needs to be improved, information about TOP services to the public has to be disseminated through awareness campaigns, and scarce skills allowances must be introduced. In addition, more staff members need to be employed. The study further recommends that the TOP policy guideline be reviewed in terms of allowing other competent health professionals to perform TOP. Chapter two discusses the literature review regarding the challenges that affect midwives who conduct TOP. In this study, theresearch compares the practice of TOP by the developing and developed countries, looks at related to laws at on TOP; gives an overview of sterilization Act in South Africa; mentions the amendments of laws on TOP; considers other legal restrictions; presents mandatory counseling for TOP clients; focuses on religious, cultural and traditional beliefs. The researcher has consulted different literatures, journals articles and website on challenges that affect midwives in rendering TOP in Limpopo, South Africa and world wild. Chapter three presents research methodology that consists of research design; area of study; population; sampling method; data collection method and procedure; ensuring trust worthiness; and ethical consideration, to be followed by limitation of the study. Chapter deals with data analysis and interpretation. Chapter five presents the researcher’s conclusions and recommendations. / Not listed

Thesis (MA. (Clinical Psychology)) -- University of Limpopo, 2013 / The current study aimed at investigating the relationship between attitudes towards termination of pregnancy (TOP) and family structure and functioning, religiosity, and death anxiety. Participants of this study consisted of 330 school-going, adolescent, female participants aged 12 to 19 years. The results indicated that no relationship exists between attitudes towards TOP and the type of family structure from which an individual stems. The relationship between attitudes towards TOP and the Family Assessment Device (FAD) general family functioning scale did not reach statistical significance either. When attitudes towards TOP were correlated with the more specific family functioning subscales, the FAD problem-solving subscale was negatively associated with attitudes towards TOP. Additionally, the relationship between attitudes towards TOP and death anxiety was not statistically significant. However, analysis indicated that there is a statistically significant, negative relationship between attitudes towards TOP and intrinsic religiosity among school-going adolescents. Final analysis involved the regression of variables of FAD problem-solving and intrinsic religiosity on attitudes towards TOP. Both intrinsic religiosity and FAD problem-solving scores were predictors of attitudes towards TOP.

Thesis (MPH.) -- University of Limpopo, 2022 / Background: Termination of pregnancy among young women is a public health issue, particularly in South Africa where high prevalence of pregnany terminations has lately been reported. It is estimated that 260000 terminations of pregnancy take place in South Africa every year. Studies in South Africa have reported that risk factors associated with termination of pregnancy such as financial problems, being poorly educated, being young, unemployed, dependent on parents, widowed or single and other relationship problems were most common. Approximately 1200 pregnancies were terminated in the District Hospital of Limpopo Province between 2017 and 2018. There is also an increased rate of unintended pregnancy among HIV positive women which suggest that women with HIV may be more likely to terminate pregnancy but chooses not to terminate due to fear of being judged. Therefore, the primary objective of this study was to investigate the risk factors associated with termination of pregnancy at a District Hospital in Limpopo Province. Methodology: A cross-sectional descriptive retrospective review study in which convenience sampling of the records of women who terminated pregnancies was used in this study. A self-constructed data extraction tool was used to extract the data from patients records. The tool covered variables such as the age of the women, educational status, marital status, year and month of termination of pregnancy, gestational age, parity, and gravidity, HIV status and circumstances leading to termination of pregnancy. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). The independent t-test was used for variables having two categories as it assesses whether the difference between means of two groups are statistically significant. This test was performed at the 95% confidence level. The p-value of less than 0.05 in the study results was used for statistical significant difference in means between the categories which were investigated. vi Results: The mean age was 27.9 years (standard error [Std. Err.] =0.37) and majority of women who terminated pregnancies were in the age group 20 – 24 years, single and had a secondary educational level. There was a statistical significance difference between age groups and the gestational age, parity and gravidity at p=0.004 and p<0.001 respectively. The proportion of women who were at gestational age of 1 to 8 weeks decreased with increasing maternal age from 22.4% in age ≤20 years to 13% in age group 30 – 34 years. There was again a statistical significance difference (p<0.001) in relation to number of pregnancies that have each resulted in the birth of an infant capable of survival (parity) and similarly to gravida. The prevalence of HIV amongst women who terminated pregnancy in the current study was found to be 21.3% and the risk of women who terminated pregnancies being HIV positive increased significantly with age as older women (age 20 years and above) were 6.5 times more likely to be HIV positive as compared to younger ones (p<001). Low educational level, gestational age of more than 13 weeks and parity of 1 – 2 were significantly associated with termination of pregnancy. The association of gravida of women who terminated pregnancies and HIV revealed that women who were in their second or third pregnancies (gravida) while HIV positive were 3.9 times more likely to terminate pregnancies as compared to those who were first pregnancy (p<0.001). Marital status was not significantly associated with termination of pregnancy. Conclusion: Termination of pregnancies among adolescents and youth is a major public health issue and the findings of this study highlight the need to address the structural socio-economic drivers of family planning which results in high number of termination of pregnancy amongst the youth. Structural interventions, such as increasing contraceptive use which may be useful for reducing the burden of unplanned pregnancies. These findings suggest the need for targeted interventions for women of child-bearing age to access reproductive health interventions to prevent unintended pregnancies and the associated risk of termination.

This research seeks to contribute to the debate on the state infringing upon the responsibilities and rights of parents with regards to the reproductive health of their children. The qualitative method of research is used. The researcher analysed the right of the child to participate in conjunction with best interests of the child, as well as the reproductive rights of children. Furthermore, the argument is based on the provisions of the South African legislation that deals with the reproductive rights of children. This legislation includes the Children's Act 38 of 2005 and the Choice on Termination of Pregnancy Act 92 of 1996. The crux of the discussion is on access to contraceptives provided to children without parental consent, as it is provided for in section 134 of the Children's Act 38 of 2005, as well as the lack of consent needed in the Choice on Termination of Pregnancy Act 92 of 1996 for a girl with no specification of age. The debate is on the fact that the responsibilities and rights that parents have towards their children are not considered. They are not involved in the major decisions that the children who are under their care and guidance have to make. Due to this finding, it has been recommended that it is very imperative to allow the parents to be involved in matters that pertain to their children's reproductive rights. This means that as children are informed about their reproductive rights, the parents must be involved as well, so as to make informed decisions relevant to the issues that their children encounter. / LLM (Comparative Child Law), North-West University, Potchefstroom Campus, 2015

The purpose of the study was to explore and describe factors influencing termination of pregnancy and describe measures that can be implemented to reduce the high rate of Termination of pregnancy (TOP). A qualitative, exploratory, descriptive and contextual research design was followed, in order to explore and describe factors influencing termination of pregnancy in Mafikeng North West Province. Purposive sampling was utilized to identify participants who met inclusion criteria for the study. The sample size was determined by data saturation, which was reached after twenty five in-depth individual interviews with women requesting TOP was done. In-depth individual interviews were utilized to gather data after written approval from the Human research Ethics committee as well as the Research Ethics Committee of the North West University (Mafikeng Campus), North West Provincial Department of Health, Operational manager of Montshioa Stadt Health Centre, and Hospital Manager of Mafikeng Provincial Hospital where data was collected, and consent was also obtained from women who requested TOP. The findings of this study indicated that factors influencing termination of pregnancy were economic factors, the need for self development, health factors and social factors. From the results, women requesting termination of Pregnancy think that effective use of contraceptives and correct use of condom can reduce the high rate of termination of pregnancy. Conclusion reached were that, non-use of contraceptives and incorrect use of condoms influenced TOP, as it was their common problem, hence the researcher suggested that health education on different methods of contraceptives should be given to teenage girls and other older women by health care providers. Recommendations in the field of nursing practice, nursing education, as well as nursing research were made. / Thesis (M.Cur) North-West University, Mafikeng Campus, 2012

This research seeks to contribute to the debate on the state infringing upon the responsibilities and rights of parents with regards to the reproductive health of their children. The qualitative method of research is used. The researcher analysed the right of the child to participate in conjunction with best interests of the child, as well as the reproductive rights of children. Furthermore, the argument is based on the provisions of the South African legislation that deals with the reproductive rights of children. This legislation includes the Children's Act 38 of 2005 and the Choice on Termination of Pregnancy Act 92 of 1996. The crux of the discussion is on access to contraceptives provided to children without parental consent, as it is provided for in section 134 of the Children's Act 38 of 2005, as well as the lack of consent needed in the Choice on Termination of Pregnancy Act 92 of 1996 for a girl with no specification of age. The debate is on the fact that the responsibilities and rights that parents have towards their children are not considered. They are not involved in the major decisions that the children who are under their care and guidance have to make. Due to this finding, it has been recommended that it is very imperative to allow the parents to be involved in matters that pertain to their children's reproductive rights. This means that as children are informed about their reproductive rights, the parents must be involved as well, so as to make informed decisions relevant to the issues that their children encounter. / LLM (Comparative Child Law), North-West University, Potchefstroom Campus, 2015

Thesis (MPH.) --University of Limpopo, 2015 / Background: There are a high number of teenagers seeking Termination of Pregnancy (TOP) at Maggys Hope Clinic in Polokwane Municipality in Capricorn District in Limpopo Province after the Termination of Pregnancy Act was passed in 1997. The numbers have doubled since the inception of the Children's Act no 38 of 2005 and the Sexual Offences Bill in 2008. The report by Stats SA and Department of education also indicated that the numbers have also doubled. Objective: The aim of the study was to determine the factors contributing to termination of pregnancies amongst teenagers at Maggys Hope Clinic in Polokwane Municipality, Limpopo Province. Methods: An exploratory, descriptive qualitative research design was used to identify and describe the factors contributing to termination of pregnancies among teenagers in Maggys Hope Clinic in Capricorn district Limpopo Province South Africa, in April 2014. Results: The results of the study revealed that CTOP legislation is one of the reasons why teenagers terminate. All the twenty participants indicated age and marital status as the motivation as the contributing factor. Looking at the age and educational level the most pushing factor is that thirteen of the participants are still at school. Eleven of the participants have no knowledge of contraceptives. This is a serious concern. Participants indicated that they had very little knowledge on reproductive health issues. The rest of the pushing factors are parental pressure, contraceptive failure, fear of parental disappointment and unpreparedness to raise a child as well. Conclusion: It can thus be concluded that teenage termination of pregnancies is a major health concern in South Africa, Africa and globally. Teenagers’ health is in danger due to engaging in unprotected sex banking on TOP as a solution. The study found that age and fear from dropping out of school, lack parental involvement in sexual matters, family economic status and marital status, including lack of knowledge and information on reproductive health issues, were the main factors contributing to termination of pregnancies among teenagers in Maggys Hope Clinic in Capricorn District, Limpopo Province.

Background: Abortion implies that the pregnancy is interrupted. According to the World Health Organization approximately 46 million induced abortions are carried out each year. Different methods of abortion can be used such as medical and surgical methods. The medical method especially affects a nurse’s experience of the procedure. Most likely, a woman undergoes the abortion process only once in her lifetime, while the nurse may face the experience several times a week. Induced abortion can be morally difficult for nurses and can generate ethical dilemmas between the woman´s right and the fetus value of protection. Aim: The aim of this literature review was to describe nurses experiences when they participate in the implementation of induced abortion. Method: A literature review has been conducted, where ten caring sciences articles were studied. The articles were all of qualitative design. Results: The analyses of the results were divided into two themes: nurses approaches to abortion. Feelings that could occur in relation to abortions were guilt, shock, fear, anger and sadness.  Most nurses used self-preservation to shut out emotions. The most demanding and challenging situations. All nurses were affected emotionally, especially in relation to repeated and late abortions. It could also occur an ethical conflict between a woman´s right and the fetus value of protection. It was therefore important for the nurses to have the opportunity to discuss and reflect on their experiences. Discussions: The discussion addressed: feelings associated with late and repeated abortions as the nurses need support to care for women undergoing an abortion. The results were discussed in relation to Jean Watson theory of nursing. / Bakgrund: Abort innebär att havandeskapet avbryts. Enligt World Health Organization genomförs cirka 46 miljoner inducerade aborter årligen. Det kan användas olika tillvägagångssätt vid abort så som medicinska och kirurgiska metoder. Den medicinska metoden har en påverkbar faktor på sjuksköterskors upplevelser. Kvinnan kanske genomgår denna abortprocess endast en gång under sin livstid, medan sjuksköterskorna genomgår det flertalet gånger i veckan. Dessa situationer kan vara moraliskt svåra för sjuksköterskorna och kan skapa ett etiskt dilemma mellan kvinnans rättigheter och fostrets skyddsvärde. Syfte: Syftet med denna litteraturöversikt var att beskriva sjuksköterskors upplevelser när de medverkar vid genomförandet av inducerad abort. Metod: En litteraturöversikt har genomförts, där tio vårdvetenskapliga artiklar har använts. Samtliga av dessa var av kvalitativ design. Resultat: Analysen av resultatet delades in i två teman: sjuksköterskors förhållningssätt till abort. Känslor som kunde uppstå i relation till aborten var skuld, chock, skräck, ilska och sorg. Flertalet sjuksköterskor använde sig av självbevarelsedrift för att utestänga känslor. Särskilt påfrestande och utmanande situationer. Alla sjuksköterskor påverkades känslomässigt, särskilt vid återkommande och sena aborter. Det kunde även uppstå en etisk konflikt mellan kvinnans rättighet och fostrets skyddsvärde. Det var viktigt för sjuksköterskorna att få möjlighet att diskutera och reflektera sina erfarenheter sinsemellan. Diskussion: Det som togs upp i diskussionen var känslor förknippat med sena och återkommande aborter samt sjuksköterskors behov av stöd när de vårdar kvinnan som genomgår abort. Resultatet diskuterades i relation till Jean Watsons omvårdnadsteori.