An abortion, be it induced or spontaneous, can be a traumatic experience in the life of a woman and her family. Women can use abortion as a method of family planning or to end an unwanted pregnancy. On the contrary there are women who wish to have children of their own, but experience spontaneous abortion or recurrent abortion. When women go through an abortion they may experience different dimensions of side effects and symptoms. The women may experience physical symptoms such as blood loss, pain and sepsis as well as psychological symptoms such as despair, depression and grief. Studies indicate that women who have abortions do not receive the care that they require and are in need of high quality care. There is a need for a systematic synthesis of the best available evidence regarding interventions for nursing practitioners. This can be used to inform practice. This research study aim to critically review and synthesise best available evidence regarding the best nursing practices for women who have an abortion. This was done by conducting a thorough step-by-step systematic review with the following objectives: to critically review available research evidence on abortion care and to synthesise best practices for abortion care provided by nurses. This study can provide nursing practitioners with the necessary information about the best available evidence regarding abortion care provided by nurses. The information can be used to increase and improve the nursing practitioner’s knowledge and to promote and enhance future questions and research. Through the step-by-step use of the systematic review after a thorough search and screening of potentially relevant studies on nurses providing abortion care according to the inclusion and exclusion criteria, the critical appraisal and data extraction of nine final relevant studies could be used for data analysis and synthesis. Conclusion statements were drawn and later combined and synthesised, graded and evaluated to provide the current best available evidence. The research was evaluated, limitations identified and recommendations made for nursing practice, nursing education and nursing research. The overall conclusion that can be drawn is there is not enough sufficient evidence to demonstrate that abortion care such as contraceptive counselling and/or psychological follow-up care provided by nurses and/or midwives before and after an induced or spontaneous abortion is sufficient and effective in reducing recurrent abortions, reducing despair, depression and grief and improving psychological consequences and increasing contraceptive usage. More research must be done on abortion nursing care. / MCur, North-West University, Potchefstroom Campus, 2014

An abortion, be it induced or spontaneous, can be a traumatic experience in the life of a woman and her family. Women can use abortion as a method of family planning or to end an unwanted pregnancy. On the contrary there are women who wish to have children of their own, but experience spontaneous abortion or recurrent abortion. When women go through an abortion they may experience different dimensions of side effects and symptoms. The women may experience physical symptoms such as blood loss, pain and sepsis as well as psychological symptoms such as despair, depression and grief. Studies indicate that women who have abortions do not receive the care that they require and are in need of high quality care. There is a need for a systematic synthesis of the best available evidence regarding interventions for nursing practitioners. This can be used to inform practice. This research study aim to critically review and synthesise best available evidence regarding the best nursing practices for women who have an abortion. This was done by conducting a thorough step-by-step systematic review with the following objectives: to critically review available research evidence on abortion care and to synthesise best practices for abortion care provided by nurses. This study can provide nursing practitioners with the necessary information about the best available evidence regarding abortion care provided by nurses. The information can be used to increase and improve the nursing practitioner’s knowledge and to promote and enhance future questions and research. Through the step-by-step use of the systematic review after a thorough search and screening of potentially relevant studies on nurses providing abortion care according to the inclusion and exclusion criteria, the critical appraisal and data extraction of nine final relevant studies could be used for data analysis and synthesis. Conclusion statements were drawn and later combined and synthesised, graded and evaluated to provide the current best available evidence. The research was evaluated, limitations identified and recommendations made for nursing practice, nursing education and nursing research. The overall conclusion that can be drawn is there is not enough sufficient evidence to demonstrate that abortion care such as contraceptive counselling and/or psychological follow-up care provided by nurses and/or midwives before and after an induced or spontaneous abortion is sufficient and effective in reducing recurrent abortions, reducing despair, depression and grief and improving psychological consequences and increasing contraceptive usage. More research must be done on abortion nursing care. / MCur, North-West University, Potchefstroom Campus, 2014

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 (MPhil)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: Perhaps one of the most talked about subjects worldwide and in South Africa these days is the abortion issue. A growing number of women admit to having had one. Basically there are two opposing views and values on the question of abortion. We normally hear people referring to the 'abortion issue'; my understanding of this is that there is a dialogue going on at the moment concerning abortion. In South Africa before the current Choice of Termination of Pregnancy (TOP) Bill, some activists' women and the ever-growing 'feminists' movements were lobbying and demanding that abortion be decriminalised. As we may all be aware, up until 1 February 1997, abortion or termination of pregnancy (TOP) in South Africa was conceivable under very restrictive atmosphere. Before the introduction of the current Termination of Pregnancy Bill, a majority of women had no access to abortion services in the country, hence the growing number of back-street job. By implication this means that most women given the choice, would not seek the experience of abortion, but if they do, it would be available to the in safe, legal, accessible and affordable service. Not only does the Act conceal that terminating pregnancy that occurred through criminal acts such as rape and incest is justifiable. The current liberal Termination of Pregnancy Bill also gives pregnant women the 'right' or 'freedom' to abort whenever and for whatever reason they deem fit. Part of the ethical dilemma of the abortion issue is that there are those who holds a view that always where there is a conflict of rights and interests, the foetus' rights must give way to, or that the foetus' rights must be overridden by those of a pregnant women. Pro-choice advocates maintain that a woman's choice to terminate her pregnancy is her own business and hers alone, in other words, this for them is a private decision. Well, I argue that this is not necessarily the case, ethically, the father of the unborn child should also be considered in such a decision. Given that virtually every abortion has risks, the parents of the aborting woman and to some extent the society at large are involved. Therefore, to solely talk of the 'mother's right to choose' is basically suggest that morality is "relative" and such relativism is conceived from the idea of privatisation of abortion and life in general. In the following pages I will look at the arguments in support of abortion and against it, and these are criticised. Also discussed are the ethical implications of the new South African Termination of Pregnancy Act. Broadly speaking, technology advancement has made it possible to detect the unborn baby's physical condition (sometimes even its mental state) while the mother is still pregnant. The ethical implications of this medical intervention are used to decide whether the unborn child should live or die. Given this, if the purpose of these prenatal diagnosis were for the destruction of the unborn, therefore, advocates of the movements such as 'the right to life', and 'pro-lifers' would argue that because of particularly twisted purpose, prenatal diagnosis must be abolished. Furthermore, I will acknowledge that the Termination of Pregnancy Bill as we have it, is appraised by feminists movements and others who are not necessarily feminists as allowing increased and unrestricted access to 'free' and 'safe' abortion in the government hospitals and clinics. However, I argue that this was rather prematurely introduced. I argue that a number of pregnant women claiming to be poor still present themselves to private doctors and private clinics for abortion and they pay anything between R 600- 800 or more depending where these services are provided. On the other hand, for one reason or another, other women still choose to terminate their pregnancies back street way although the risks are high in such servicing stations. In the light of these facts, one wonders whether it is appropriate to legislate for the termination of pregnancy or would it have been a worthwhile decision to delay the legislation of abortion for a while and thoroughly make a research and relevant preparation for it. I also argue that ideology plays an important part in the abortion debates. Besides, the abortion debate is also characterised by indoctrination, the purpose of which is to leave other confused. In both cases facts are misrepresented or false statements are made, and this for me is ethically unacceptable. I will also comment on the importance of linguistics, that is, the proper understanding of normal English terms and what I refer to as 'deceptive language' used by campaigners. Inthe last part of this thesis, I will outline some basic approaches to ethics and which belong to what is referred to as postmodernism. The Postmodern worldview deconstructs metanarratives so that no one particular belief is more believable than another. This worldview bring with it ethical relativism, which is a theory which holds that morality is relative to the individual. Three movements are given as an example of this move toward ethical relativism, they are: (a) Emotivism, (b) Subjectivism, and (c) Situationalism While I will argue that rape and incest are evil acts, and support abortion in cases involving such acts, however, I also believe that abortion is not the answer to the problem of rape and incest. I will propose a number of recommendations the South African government should have made before legislating for abortion. For instance, by creating separate abortion service facilities even in the hospital premises, with properly trained staff; so that people who came to seek advice for abortion are not intimidated by those who go to full terms with their pregnancy. Included in this thesis is a case study to demonstrate the complexity of the abortion issue to everyone involved. Some psychological and emotional symptoms following abortion will be outlined and this according to women who do share their abortion story is a reality they have to live with every day of their lives. / AFRIKAANSE OPSOMMING: Aborsie is moontlik een van die mees veelbesproke kwessies van ons tyd, sowel in Suid- Afrika as wêreldwyd. 'n Groeiende aantal vroue erken dat hulle al een gehad het. Basies is daar twee opponerende gesigspunte en waardes betrokke by die twispunt rondom aborsie. Aborsie was voor die aanvaarding van die jongste wetgewing (d.w.s. voor 1 Februarie 1997) in Suid-Afrika slegs moontlik onder streng beperkings. Voor die huidige wet ( die "Termination of Pregnancy Bill") in werking gekom het, het die meerderheid vroue geen toegang tot aborsie gehad in Suid-Afrika nie, wat gelei het tot 'n toename in agterstraat aborsies. Die nuwe wet gee nie slegs die reg om te aborteer aan vroue wat swanger is as gevolg van kriminele optrede soos verkragting of bloedskande nie. Die huidige, buitengewooon liberale wet gee ook vir alle praktiese doeleindes aan die vroue die reg om aborsie op versoek te ondergaan tot op 20 weke van swangerskap. Die doel van hierdie werkstuk is om hierdie nuwe liberale wet aan 'n krities ondersoek te onderwerp. Deel van die etiese dilemma rondom die kwessie van aborsie spruit voort uit die feit dat daar diegene is wat reken dat, indien daar enige konflik tussen regte en belange is, die regte van die fetus ondergeskik is aan die regte van die swanger vrou. Diegene ten gunste van aborsie voer aan dat die keuse gemaak moet word deur die betrokke vrou, en dat so 'n keuse uitsluitlik haar eie is. Ek argumenteer dat dit nie noodwendig die geval is nie. Die vader van die ongebore kind behoort ook 'n sê te hê in hierdie saak. Gegee dat elke aborsie sekere risiko's insluit, het die ouers van die betrokke vrou en die samelewing ook 'n belang by so ,'n situasie. Dus is om slegs te praat van die 'vrou se reg om te Ides' om te suggereer dat moraliteit "relatief' is, en sulke relativisme word afgelei van die idee van die privatisering van aborsie en die lewe in die algemeen. In die volgende bladsye sal ek die argumente vir en teen aborsie analiseer en kritiseer. Die etiese implikasies van die nuwe Termination of Pregnancy Act word veral bespreek. Tegnologiese vooruitgang het dit moontlik gemaak dat die ongebore baba se fisiese (en soms selfs mentale) kondisie bepaal kan word voor geboorte. Die etiese implikasies van die mediese intervensie word gebruik om te besluit of die ongebore baba moet lewe of sterf Dus, indien die doel van prenatale diagnose die moontlike vernietiging van die ongeborene insluit, sal diegene wat teen aborsie is, argumenteer dat so 'n verwronge doel veroorsaak dat sulke ondersoeke gestaak behoort te word. Ek sal erken dat die nuwe wet waardeer word deur feministe, en andere wat nie noodwendig feministe is nie, as 'n wet wat dit moontlik maak dat daar toenemende en onbeperkte toegang is tot 'gratis' en 'veilige' aborsies in regeringshospitale en klinieke. Maar ek wil argumenteer dat die wet te vroeg aangeneem is. Ek argumenteer dat 'n groot aantal verwagtende vroue voorgee dat hulle arm is en poog om 'n aborsie te kry by private dokters en klinieke, en dan tussen R600 - R800 of meer betaal vir so 'n diens, afhangende van waar dit geskied. Aan die ander kant, om een of ander rede, kies sommige vroue steeds om hulle swangerskappe te termineer deur agterstraat-aborsies, ten spyte van die risiko's. Gegewe hierdie feit, wonder mens of dit gepas was on 'n wet in te stel aangaande die terminasie van swangerskap, en of dit nie beter sou wees om die wetgewing uit te stel tot volledige navorsing gedoen is en voorbereiding getref is nie. Ek argumenteer ook dat ideologie 'n belangrike rol speel in die aborsie-debat. Die aborsie-debat word ook gekenmerk deur indoktrinasie ten einde mense te verwar. In beide gevalle is daar die wanvoorstelling van feite of word valse stellings gemaak, wat eties onaanvaarbaar is. Ek salook kommentaar lewer oor die belangrikheid van taal, dws die korrekte verstaan van normale (Engelse) terme en wat ek na verwys as die 'misleidende taal' wat gebruik word deur sekere kampvegters betrokke by die debat. In die laaste deel van die werkstuk sal ek sekere basiese benaderings tot etiek ondersoek, veral dié wat na verwys word as "postmodernisme". Die Postmoderne gesigspunt dekonstrueer metanarratiewe sodat geen spesifieke oordeel langer meer geloofwaardig is as 'n ander nie. Hierdie gesigspunt word dan ook vergesel deur etiese relativisme, wat huldig dat moraliteit relatief is tot die individu. Drie bewegings word genoem as voorbeelde van hierdie beweging na etiese relativisme, nl: (a) Emotivisme, (b) Subjektivisme, en (c) Situasie-etiek Alhoewel ek argumenteer dat verkragting en bloedskande morele verkeerd is, en alhoewel ek aborsie in sulke gevalle voorstaan, glo ek nie dat aborsie 'n antwoord bied op die probleem van verkragting en bloedskande nie. Ek sal 'n aantal voorstelle maak aangaande wat eintlik moes gebeur het voor die regering die huidige aborsiewet aanvaar het. Byvoorbeeld, dat aparte aborsie-fasiliteite, selfs by die hospitaal en met opgeleide personeel, geskep moes word ten einde te voorkom dat diegene wat advies vra aangaande aborsie nie geïntimideer word deur persone wat nie wil aborteer nie. Ingesluit in hierdie studie is 'n gevallestudie wat die kompleksiteit van die kwessie rondom aborsie, vir al die rolspelers, demonstreer. Sekere emosionele en sielkundige simptome, veroorsaak deurdat 'n persoon besluit het om te aborteer, sal geskets word. Vir vroue wat 'n aborsie ondergaan het is hierdie 'n realiteit waarmee hulle elke dag moet saamleef

This study explored how nurses in acute and nurse-led gynaecology wards prioritised patient caseloads ranging in diversity and number of patient conditions. Statistics show that since the introduction of medical termination of pregnancy (MTOP) procedures into the National Health Service (NHS) in 1991, the number of women having this procedure is increasing year on year. To date very little is known about the impact this procedure may have had on nursing practice. The focus of this study was to explore the nursing care when this included, and did not include, caring for women having MTOP. The study was conducted in two parts. The first qualitative study employed non-participant observation and semi-structured interviews of nurses in gynaecology and surgical wards at two hospital sites to examine the external context in which nursing decisions were made. This found that nurses in gynaecology focused on emotional or psychosocial aspects more so than surgical nurses who focused on physical aspects of patient care. The second quantitative study involved a cross-sectional survey of nurses from both ward types in two hospitals sites in Scotland. Internal constructs were examined using personality and thinking styles measures. Nurses were assessed on their emotionality, that is, the numbers of times an emotional care aspect was prioritised. This found that nurses who prioritised the emotional aspects of the task tended to be more conscientious and elected preference for a ‘people-centred’ thinking style. The context in which women have TOP is also important since the findings suggest women may benefit from being cared for in nurse-led rather than in acute wards. Knowing how a person thinks about emotional and physical aspects of care also has implications for those involved in education, and career planning.

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 (MPA.) -- University of Limpopo, 2014 / The aim of the study was to determine whether Members of the Limpopo Provincial Legislature misrepresented members of the public in the policy and decision making process. The Choice on Termination of Pregnancy Amendment Act, No. 213 of 2008, when passed in Parliament, might have had good intensions, but has instead led to unintended consequences. Both qualitative and quantitative research methods were used in this study. Questionnaires were used to collect the primary data from MPLs, staff of the Limpopo Legislature and members of the public in districts of the Province while the secondary data was collected from online databases and through literature reviews. A random sampling method was used to collect primary data for this research by using various data collection methods such as questionnaires, face to face and telephone interviews. The collected data was captured in Ms Excel 2007, and then analysed and presented using graphs and tables. Results of this study indicate that the majority of people in Limpopo were not in favour of the bill in question. This was evident in the video recording that was taken at the public hearing held in the Vhembe District where the emotions and expressions including the language used by members of the public was witnessed. The Committee Report that was tabled in the House by the Chairperson of the Committee stated that all districts in the Province were not in favour of the bill. It also became evident that indeed MPLs did not debate the report in the House and also did not consider inputs of the masses made during public hearings before a provincial mandate was given to Permanent delegates at the National Council of Province (NCOP) to vote in favour of the bill. It can thus be concluded that MPLs can take a decision on a bill even if the masses are against it. This clearly indicates that the voices of the people are indeed heard since public hearings are conducted, but all is merely done to comply with the Constitutional mandate.

Abortų problema yra prieštaringai vertinama daugelyje pasaulio valstybių. Dažniausiai diskusijų sukelia tokios temos kaip vaisiaus ir motinos teisės, tačiau tėvo teisės sulaukia mažiau dėmesio, nors šis klausimas yra ne mažiau aktualus. Jei tėvas prisideda prie gyvybės sukūrimo, tai kodėl neturėtų dalyvauti sprendžiant ir jos nutraukimo klausimą? Vyro teisės priimant aborto sprendimą ne visada buvo vienodos ir keitėsi su laiku. Jeigu senovėje nutraukiant nėštumą lemiamą sprendimą priimdavo vyras, tai dabar ši teisė priklauso moteriai. Tačiau vyrai toliau kovoja už teisę turėti palikuonį, remdamiesi vaisiaus teisės į gyvybę teorija, moterų ir vyrų lygių teisių įstatymais, Konstitucija ir kitais teisės aktais. Atlikus tarptautinių dokumentų, Jungtinių Amerikos Valstijų, Jungtinės karalystės ir Lietuvos nacionalinių teisės aktų bei tarptautinių ir nacionalinių teismų praktikos analizę vyro teisės priimant aborto sprendimą klausimu, prieita prie išvados, kad tarp būsimųjų tėvų iškilus nesutarimui dėl nėštumo nutraukimo sprendimo priėmimo, lemiamas žodis atitenka motinai, o tėvui tenka susitaikyti su moters priimtu sprendimu, kadangi jis neturi jokių įstatymuose garantuotų teisių uždrausti moteriai darytis abortą, nesvarbu ar jis būtų moters sutuoktinis ar ne. Šiomis dienomis, kai visur yra pabrėžiamos vyrų ir moterų lygios teisės, kai moterys ir vyrai atrodo, kad visose srityse pasiekė lygybės, liko bent viena sritis, kurioje vyrai turi mažiau teisių negu moterys – tai priimant... [toliau žr. visą tekstą] / Abortion is a very controversial issue in various countries. The discussion it arises is mainly concerned with mother’s and unborn fetus’s rights but father’s rights are rarely discussed. The aim of this thesis is to analyze father’s rights in abortion decision. The attitude towards father’s rights has been changing with time. The first law against abortion appeared in ancient times protecting the father's right to have an offspring and the woman’s opinion was not important. But nowadays the situation has changed – the abortion decision is left for the mother. In most countries men have no right to stop a woman from having an abortion with a small exception of some mostly Muslim countries. The thesis analyzes international documents and jurisprudence of the European Court of Human Rights (ECtHR); national laws, related to abortion decision and father’s rights and case law in the United States of America, the United Kingdom (UK) and Lithuania. The analysis of international and national laws and jurisprudence shows that when a woman becomes pregnant, the man who impregnated her has few legal rights with respect to that pregnancy. He can neither require the woman to remain pregnant if she chooses to have an abortion nor force her to have an abortion if she wants to give a birth. Furthermore, if the woman chooses to bear a child, the father is legally liable for child support. The question arises – if men have financial responsibilities for their children, should not they have... [to full text]

The field of prenatal screening and diagnosis has developed rapidly over the past half-century, enabling possibilities for detecting anomalies in reproduction that were never before contemplated. A simple blood sample can aid in the identification of several conditions in the fetus early in the pregnancy. If a fetus is found to be affected by Down syndrome, anencephalus, spina bifida, or Edward's syndrome, a decision must then be made whether to continue or terminate the pregnancy. As prenatal screening becomes increasingly commonplace and part of routine maternal care, researchers are faced with the challenge of understanding its effects at the level of the population and monitoring trends over time. Greater uptake of prenatal screening, when followed by prenatal diagnosis and termination, has important implications for both congenital anomaly surveillance and infant and fetal mortality indicators. Research in Canada suggests that this practice has led to reductions in the congenital-anomaly specific infant mortality rate and increases in the stillbirth rate.(1, 2) The current study is a population-based, epidemiological exploration of demographic predictors of maternal serum screening (MSS) and amniocentesis uptake, with special attention to variations in birth outcomes resulting from different patterns of use. To accomplish our objectives, multiple data sources (vital statistics, hospital and physician services, cytogenetic and MSS laboratory information) were compiled to create a comprehensive maternal-fetal-infant dataset. Data spanned a six-year period (2000-2005) and involved 93,171 pregnancies. A binary logistic regression analysis found that First Nations status, rural-urban health region of residence, maternal age group, and year of test all significantly predicted MSS use. Uptake was lower in women living in a rural health region, First Nations women, and those under 30 years of age. The study dataset identified ninety-four terminations of pregnancy following detection of a fetal anomaly (TOPFA), which led to a lower live birth prevalence of infants with Down syndrome, Trisomy 18, and anencephalus. While a significant increasing trend was observed for the overall infant mortality rate in Saskatchewan between 2001-2005, a clear trend in one direction or the other could not be seen in regards to infant deaths due to congenital anomaly. First Nations status and maternal age were important predictors of both MSS and amniocentesis testing, and appeared to influence the decision to continue or terminate an affected pregnancy. The fact that First Nations women were less likely to screen (9.6% vs. 28.4%) and to have diagnostic follow-up testing (18.5% vs. 33.5%), meant that they were less likely to obtain a prenatal diagnosis when the fetus had a chromosomal anomaly compared to other women (8.3% vs. 27.0%). This resulted in a lower TOPFA rate compare to the rest of the population (0.64 vs. 1.34, per 1,000 pregnancies, respectively) and a smaller difference between the live birth prevalence and incidence of Down syndrome and Trisomy 18 for First Nations women. Women under 30 years of age were much less likely to receive a prenatal diagnosis when a chromosomal anomaly was present (18.4% vs. 31.8%). While risk for a chromosomal anomaly is considerably lower for younger mothers, 53.5% of all pregnancies with chromosomal anomalies and 40.7% of DS pregnancies belonged to this group. Consistent with other studies pregnancy termination rates following a prenatal congenital anomaly diagnosis are high (eg. 74.1% of prenatally diagnosed Down syndrome or Trisomy 18 cases), but these rates may be misleading in that they are based on women who chose to proceed to prenatal diagnosis. The fact that two-thirds (67.3%) of Saskatchewan women who received an increased-risk result declined amniocentesis, helps to put this finding into context. Strong surveillance systems and reasonable access to research datasets will be an on-going challenge for the province of Saskatchewan and should be viewed as a priority. Pregnancies and congenital anomalies are two particularly challenging outcomes to study in the absence of perinatal and congenital anomaly surveillance systems. Still pregnancies that never reach term must be accounted for, in order to describe the true state of maternal-fetal-infant health and to study its determinants. While our study was able to identify some interesting trends and patterns, it is only a snapshot in time. Key to the production of useful surveillance and evaluation is timely information. The current system is not timely, nor is it user-friendly for researchers, health regions or governments. Data compilation for the current study was a gruelling and cumbersome process taking more than five years to complete. A provincial overhaul is warranted in both the mechanism by which researchers access data and in the handling of data. The Better Outcomes Registry & Network (BORN) in Ontario is an innovative perinatal and congenital anomaly surveillance system worthy of modelling.(3) Academic papers in non-ethics' journals typically focus on the technical or programmatic aspects of screening and do not effectively alert the reader to the complex and profound moral dilemmas raised by the practice. A discussion of ethics was felt necessary to ensure a well-rounded portrayal of the issue, putting findings into context and helping to ensure their moral relevance did not remain hidden behind the scientific complexities. Here I lay out the themes of the major arguments in a descriptive manner, recognizing that volumes have been written on the ethics of both screening and abortion. A major ethical tension arising within the context of population based prenatal screening is the tension between community morality and the principle of respect for personal autonomy. Prenatal screening and selective termination have been framed as a purely private or medical matter, thereby deemphasizing the social context in which the practice has materialized and the importance of community values. I consider how a broader sociological perspective, one that takes into account the relevance of community values and limitations of the clinical encounter, could inform key practice and policy issues involving prenatal screening. It is my position that the community's voice must be invited to the conversation and public engagement processes should occur prior to any additional expansion in programming. I end with a look at how the community’s voice might be better heard on key issues, even those issues that at first glance seem to be the problems of individuals. As Rayna Rapp (2000) (4) poignantly observed, women today are 'moral pioneers' not by choice, but by necessity. By elucidating the effects of prenatal screening and the extent of the practice of selective termination in the province, the true occurrence of important categories of congenital anomalies in our province can be observed. Without this knowledge it is very difficult to identify real increases or decreases in fetal and infant mortality over time as the etiologies are complex. Evidence suggests a large and increasing impact of TOPFA on population-based birth and mortality statistics nationally, whereas in Saskatchewan the effect appears to be less pronounced. Appreciation of the intervening effect of new reproductive technologies will be increasingly important to accurate surveillance, research, and evaluation as this field continues to expand.

Background The Choice on Termination of Pregnancy Act (CTOPA) No 92 of 1996 replaced the Abortion and Sterilization Act of 1975. It promotes reproductive rights and the choice on termination of pregnancy. It aims to reduce deaths resulting from illegal abortions. It designates District Hospitals and Community Health Centres to render Termination of Pregnancy (TOP). In the Free State there are 24 District Hospitals and ten Community Health Centres. Currently nine render TOP. None are in Xhariep District. Aim of the study The study investigated barriers to the implementation of the CTOPA in Xhariep District among doctors, nurses and managers in District Hospitals. Methodology It was descriptive in nature, and was divided into the quantitative and qualitative parts. The quantitative part targeted doctors and nurses, while thelatter targeted management. The response rate was 95%. Findings The findings are summarised below:-  Ninety five per cent of the respondents were nurses.  Infrastructural and human resource deficiencies are a barrier to the implementation of the act.  There are insufficient budgets to procure equipment, consumables and pharmaceuticals to render the service.  Training on reproductive health and TOP is not sufficient, except for family planning.  There is stigma towards TOP from the community, and peers. Its origin is religion and culture.  There is no psychosocial and management support for those willing to participate in TOP.  Respondents are willing to refer patients for TOP, and believe that women are entitled to choose whether to terminate unwanted pregnancies or not.  There are no incentives to for those willing to implement the Act, nor provincial support to the Districts. Recommendations  Train staff on reproductive health and TOP.  Hold management accountable by including TOP and the reproductive health package in their performance agreements.  Negotiate incentives for those willing to implement TOP, and recogniseTOP as a speciality in line with the Occupation Specific Dispensation.  Provide infrastructure and equipment for the implementation of TOP.  Develop a recruitment and retention strategy for professionals. The policy on community service for health professionals is a case in point.  Resource the District Health System as a vehicle for Primary Health Care Services. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, [2010?].