Objectifs et hypothèses :Cette thèse a pour objectif d'explorer les causes de la non observance en contraception orale qui se traduit par un nombre important d'IVG chez des femmes pourtant sous contraception. Nous avons formulé 3 hypothèses : il existe des différences significatives entre les femmes présentant des difficultés d'adhésion thérapeutique et celles qui n'en présentent pas. La 2ème hypothèse a trait à l'existence de relations significatives entre les causes de non observance et la motivation générale. La 3ème hypothèse énonce l'existence de différences significatives entre les moyennes des deux groupes concernant les causes de non observance, la motivation générale et ses différentes dimensions. Population : Elle est composée de 50 femmes âgées de 20 à 55 ans utilisatrices de la contraception orale, (soit deux groupes : 25 femmes présentant des difficultés d'observance et 25 femmes ne présentant pas des difficultés d'observance). Instruments : Deux questionnaires ont été mis au point et utilisés : 1) Un questionnaire sur l'observance en contraception orale et une échelle d'évaluation des causes de non observance en contraception orale. 2) Une échelle de Motivation Globale EMG-28 destinée à l’évaluation du degré de motivation à l'observance de la contraception orale en examinant les degrés d'auto-détermination de la motivation dans la vie en général. Résultats : Les résultats indiquent l'existence de causes de non observance liées à l'utilisatrice (oublis, fausses croyances, peur des effets indésirables, manque d'information), à la contraception orale (routine, lassitude, contrainte de la prise journalière) et à la relation entre le prescripteur et l'utilisatrice (qualité de l'information donnée, relation thérapeutique, écoute, logique de prescription). Conclusion : Le processus d'utilisation de la contraception orale se révèle très complexe. Une prise en charge motivationnelle s'avère nécessaire chez les femmes en situation d'échec de contraception, comme nous le montrons avec les deux cas cliniques présentés. / Objectives and assumptions : This thesis aims explore the causes of non adherence in oral contraception which lead to TOP among women however under contraception. We formulated 3 assumptions: there are significant differences between the women presenting adherence problems and those without problems. The 2nd assumption supposes the existence of significant relations between the causes of non adherence and the general motivation. The 3rd assumption states the existence of significant differences between the averages of the two groups concerning the causes in non adherence, the general motivation and its various components. Population : A survey was carried out based on a sample of 50 women users of oral contraception in Amiens, including a group of 25 women which exhibit adherence problems. Tools : Two questionnaires were developed within the framework of this thesis, 1) A questionnaire on adherence in oral contraception and a scale for the evaluation of the causes of non adherence in oral contraception. 2) A Scale of Global Motivation EMG28 intended to evaluate the degree of motivation for adherence to oral contraception by examining the self-determination degree of motivation in life in general. Results : Collected data confirm the assumptions posed. It reveals existence of causes of non observance related on the user (missing pills, beliefs, fear of undesirable effects, information lack, on the oral contraception (routine, lassitude, constraints …) and the relation between the prescriber and the user (therapeutic relation, quality of information given, model of prescription). Conclusion : The process of use of oral contraception appears very complex. A motivational therapy is necessary among women in situation of failure of contraception, as we show it with clinical cases presented.

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

The aim of this study was to investigate sexual activity as well as contraceptive knowledge and use among termination of pregnancy (TOP) clients at Prince Mshiyeni Memorial Hospital’s TOP clinic in the province of KwaZulu-Natal (KZN). This was a non-experimental quantitative study in the form of a cross sectional study. Self-administered questionnaires were used for collecting data from 61 respondents selected non-randomly. The majority of the respondents were single young women between 18 and 27 years of age. Sexual intercourse frequency was mostly once a month (91.8%). Most were unemployed and dependent on government grants and had heard of both contraception in general and emergency contraception. Only 44 (78.6%) had used contraceptives before and the most frequently used method of contraception was the injection (36.6%). Despite the respondents having heard of contraception, the median score of the knowledge of contraception was only 16%. The distribution of knowledge was very wide, but on the whole the level of knowledge of contraception was very low / Health Studies / M.A. (Public Health)

The aim of this study was to investigate sexual activity as well as contraceptive knowledge and use among termination of pregnancy (TOP) clients at Prince Mshiyeni Memorial Hospital’s TOP clinic in the province of KwaZulu-Natal (KZN). This was a non-experimental quantitative study in the form of a cross sectional study. Self-administered questionnaires were used for collecting data from 61 respondents selected non-randomly. The majority of the respondents were single young women between 18 and 27 years of age. Sexual intercourse frequency was mostly once a month (91.8%). Most were unemployed and dependent on government grants and had heard of both contraception in general and emergency contraception. Only 44 (78.6%) had used contraceptives before and the most frequently used method of contraception was the injection (36.6%). Despite the respondents having heard of contraception, the median score of the knowledge of contraception was only 16%. The distribution of knowledge was very wide, but on the whole the level of knowledge of contraception was very low / Health Studies / M.A. (Public Health)