Study project (BCur)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: Problem statement: The abortion regulation was implemented in 1997 before the necessary infrastructure was in place. The shortage of educated healthcare providers in abortion facilities led to uninformed women. Aims for this research was exploratory-describing of nature and was aimed on pre-abortion counselling to women with unwanted pregnancies in the state facilities in the Western Cape metropole to be evaluated from a nursing perspective. Methodology: Two samplings was done namely a 50% randomized, proportional stratified sampling from the State Health facilities in the Western Cape Metropole which offer abortion care service, as well as the non-randomized convenient sampling of pregnant women that received pre-abortion counselling. Data was gathered with the help of self compiled questionnaires. Quantitative data was analyse with the help of Statistika 7 and qualitative data according to Tesch’s approach. Results: Of the respondents 79% was between the age 16 and 30 and 72% was single. Although the Department of Health strives that abortion care services should be offered by a level 1 health facility, only 43% have been counselled through a registered nurse. While 49% consider preabortion counselling as important, 39% of the respondents received no, or information in groups regarding the termination of the pregnancy, 77% received information with regarding to the procedure and 50% was informed when they could go forth with normal activities. Approximately 54% received no information regarding post-abortion complications and 59% did not received a follow-up date. Approximately 68% of the respondents received information regarding family planning. Conclusion: It seems that pre-abortion counselling is not done according to guidelines and there is many gaps in the existing counselling methods in the different health facilities. Recommendations: Counselling should be based on the WHO and the Department of Health’s guidelines for abortion care. Nurses should be more involved in education programs. Abortion care facility’s should promote the total spectrum of abortion care and counsellors should receive special training and annually be re-evaluated. / AFRIKAANSE OPSOMMING: Probleemstelling: Die aborsiewetgewing is in 1997 geïmplementeer voordat die nodige infrastruktuur in plek was. Die tekort aan doeltreffend-opgeleide gesondheidswerkers in aborsiesorgdienste het tot gevolg gehad dat vroue oningelig is met betrekking tot aborsiesorgdienste. Doelwitte vir hierdie navorsing was ondersoekend-beskrywend van aard en daarop gerig om preaborsie berading aan vroue met ongewenste swangerskappe in staatsaangewysde fasiliteite in die Wes-Kaapse metropool te evalueer vanuit ‘n verpleegkundige perspektief. Metodologie: Twee steekproefnemings is gedoen, naamlik ‘n 50% ewekansige, proporsionele, gestratifiseerde steekproefneming van die staatsgesondheidsfasiliteite in die Wes-Kaapse metropool wat aborsiesorgdienste aanbied, sowel as ‘n nie-waarskynlike, gerieflikheidssteekproefneming van swanger vroue wat pre-aborsie berading ontvang. Data is met behulp van selfopgestelde vraelyste ingesamel. Kwantitatiewe data is ontleed met behulp van Statistica 7 en die kwalitatiewe data deur middel van Tesch se benadering. Resultate: Van die respondente was 79% tussen die ouderdom van 16 en 30 jaar en 72% was enkellopend. Alhoewel die Departement van Gesondheid strewe dat aborsiesorgdienste by ‘n vlak 1 gesondheidsfasiliteite aangebied word, het slegs 43% hul berading hier deur geregistreerde verpleegkundiges ontvang. Terwyl 94% pre-aborsie berading beskou as belangrik, het 39% óf geen, óf inligting in groepe ontvang betreffende die beëindiging van die swangerskappe, 77% het inligting ontvang met betrekking tot die prosedure en 50% was ingelig wanneer hul kon voortgaan met normale aktiwiteite. Sowat 54% het geen inligting ontvang betreffende post-aborsie komplikasies nie en 59% het nie ‘n opvolgdatum gekry nie. Sowat 68% van die respondente het wel inligting ontvang oor gesinsbeplanning. Slotsom: Dit blyk dus dat pre-aborsie berading nie volgens riglyne gedoen word nie en dat daar baie leemtes is in die bestaande beradingsmetodes in die verskillende gesondheidsfasiliteite. Aanbevelings: Berading moet gebaseer word op die WGO en die Departement van Gesondheid se riglyne vir aborsiesorg. Verpleegkundiges moet meer betrokke raak by voorligtingsprogramme. Aborsiesorgfasiliteite moet die totale spektrum van aborsiesorg kan behartig en aborsiesorgberaders moet spesiale opleiding ontvang en jaarliks her-evalueer word.

Thesis (MA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: An exploratory study of the extent and nature of adolescent pregnancy resolution and pre-abortion counselling was undertaken. Little research has been done on pre-abortion counselling in South Africa since the Choice of Termination of Pregnancy Act (92 of 1996) was passed in February 1997. This study emphasised pre-abortion counselling since this is a new field for most counsellors. A literature study was conducted on adolescent pregnancy, focussing on the factors and possible consequences of the choice to carry the pregnancy to term or to terminate it. Adolescents, more than adults, need assistance to make this decision. Crisis intervention was explored as a possible counselling model for pregnancy resolution and pre-abortion counselling. The preliminary investigation included interviews with social workers and nursing professionals in Mossel Bay. Nursing professionals were included in the study since they administer the pregnancy tests and are therefore the first professionals with whom the pregnant adolescent comes into contact. This investigation revealed that nurses, not social workers, do most of the preabortion counselling in Mossel Bay. The Choice on Termination of Pregnancy Act emphasises the importance of supplying pre and post-abortion counselling at the facility providing the termination of pregnancy. The Act also envisages this as primarily a medical concern, with the implication that nursing professionals should do the counselling. The role of professional counsellors such as social workers is not mentioned in the Act. The Act lays down that training will be provided to equip nursing professionals with necessary skills to render this service. The empirical study examined the training and skills of nursing professionals and social workers to determine whether they were adequately qualified to render these services. The respondents' attitude towards pregnant adolescents who choose abortion was also investigated, since this would influence their counselling skills. The investigation revealed that many of the nurses did not seem confident in their counselling although they felt that they were adequately qualified to counsel pregnant adolescents. The nurses explained that they did not feel that they had enough knowledge of the different options, especially foster care and adoption and therefore referred patients to a social worker or Options Pregnancy Centre (a volunteer based counselling centre). The social workers felt confident in counselling adolescents who decided to carry pregnancy to term. The counselling model used was crisis intervention, which is most appropriate for pre-abortion counselling as well. However they felt that they did not have enough information of abortion procedures and emotional consequences of abortion to counsel a pregnant adolescent requesting an abortion effectively. The study showed that respondents felt empathy and understanding for the adolescents' situation and the seriousness of the decision needing to be made. The study also found that social workers and nurses were willing to attend further training in order to improve their knowledge and their counselling skills. The training should therefore not focus on attitudes but simply on improving counselling skills. Training should focus on the nature of a crisis and the steps of crisis intervention. / AFRIKAANSE OPSOMMING: 'n Studie is gedoen om die aard en omvang insake die besluitneming ten opsigte van tienerswangerskappe en berading voor 'n aborsie te ondersoek. Sedert die Wet op Beëindiging van Swangerskap (92 van 1996) in Februarie, is weinig navorsing in Suid-Afrika gedoen oor berading voor 'n aborsie. Hierdie studie beklemtoon voorafgaande berading aangaande aborsie, aangesien dit 'n onbekende terrein vir baie beraders is. 'n Literatuurstudie oor tienerswangerskap is geloods met die fokus op faktore en moontlike gevolge van die keuse om die volle termyn van die swangerskap te voltooi of die beëindiging daarvan. Adolessente het meer ondersteuning nodig as volwassenes om so 'n keuse uit te oefen. Krisis-ingryping is ondersoek as 'n moontlike model vir die beslissing van 'n swangerskap en berading wat 'n aborsie voorafgaan. Met die voor-ondersoek is onderhoude met maatskaplike werkers en verpleegkundiges in Mosselbaai gevoer. Verpleegkundiges was deel van die studie aangesien hulle die eerste kundiges is met wie die swanger tiener in aanraking kom, omdat hulle die swangerskaptoetse uitvoer. Dié navorsing toon dat verpleegsters in Mosselbaai (nie maatskaplike werkers nie) grotendeels die berading voor 'n aborsie hanteer. Die Wet benadruk hoe belangrik dit is om beradingsdienste vir voor- en na-aborsie te voorsien by die plek waar die aborsie toegepas word. Dié Wet beskou dit ook primêr as 'n mediese aangeleentheid, gevolglik behoort verpleegkundiges die berading te doen. Daar word egter nie melding gemaak van die rol van professionele beraders soos maatskaplike werkers, in dié verband nie. Die Wet bepaal ook dat verpleegkundiges opleiding sal ontvang om hulle met vaardighede toe te rus om so 'n diens te lewer. Die opleiding en vaardighede van verpleegkundiges en maatskaplike werkers is dus getoets aan die hand van studies, gegrond op praktiese ervaring, om te bepaal of hulle bevoegd is om die dienste te lewer. Daar is ook ondersoek ingestel na die respondente se houding teenoor die swanger adolessent wat 'n aborsie verkies, aangesien hul vermoë om die berading te hanteer, beïnvloed kan word. Die ondersoek toon dat baie verpleegsters onseker voorgekom het tydens berading, hoewel hulle gevoel het dat hulle bekwaam is om swanger adolessente te adviseer. Hulle verklaar dat hulle nie genoeg kennis oor die verskillende opsies, veral pleegsorg en aanneming, gehad het nie, en dus pasiënte na 'n maatskaplike werker of Options Pregnancy Centre verwys het. Maatskaplike werkers het berading aan swanger adolessente wat die termyn van die swangerskap wou voltooi, met sekerheid hanteer. In die proses is krisis-ingryping uitgeoefen wat dan ook gepas is vir berading voor 'n aborsie. Die maatskaplike werkers het egter gevoel dat hulle nie genoeg inligting oor die aborsieproses en die emosionele gevolge daarvan gehad het om die swanger adolessent wat 'n aborsie verlang, effektief voor te lig nie. Die studie het getoon dat respondente die adolessent se situasie en die erns van die besluit wat gemaak moes word, met empatie en begrip hanteer het. Met die studie is ook bevind dat maatskaplike werkers en verpleegsters bereid was om verdere opleiding te ontvang en sodoende hul kennis en vaardighede te verbeter. Die opleiding moet dus nie op houdings fokus nie, maar eerder die ontwikkeling van vaardighede. Dit behoort te fokus op die aard van die krisis en die stappe van krisis-intervensie.

The introduction of abortion legalisation in South Africa during 1997 gave rise to the need for pre- and post-abortion counselling. Two dominant counselling groups came to the fore namely pro-choice and pro-life, reflecting the respective stances of society on abortion. In order to answer the following research questions: "What value-challenges do abortion counsellors experience, if any?" and "What ways have they found in negotiating these challenges?" A narrative conversation was used to come to an understanding of these research questions in practice. Research was undertaken with counsellors from both pro-life and pro-choice stances. The influence of capitalism, patriarchy and religion on role players confronted with making decisions on abortion was explored. Pro-choice counsellors negotiated their values in terms of forgiveness based on the unconditional forgiveness they would expect from God and pro-life counsellors in terms of God's forgiveness for the client, accepting her own responsibility for the consequences of the abortion. / Practical Theology / M. Th. (Pastoral Therapy)

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 introduction of abortion legalisation in South Africa during 1997 gave rise to the need for pre- and post-abortion counselling. Two dominant counselling groups came to the fore namely pro-choice and pro-life, reflecting the respective stances of society on abortion. In order to answer the following research questions: "What value-challenges do abortion counsellors experience, if any?" and "What ways have they found in negotiating these challenges?" A narrative conversation was used to come to an understanding of these research questions in practice. Research was undertaken with counsellors from both pro-life and pro-choice stances. The influence of capitalism, patriarchy and religion on role players confronted with making decisions on abortion was explored. Pro-choice counsellors negotiated their values in terms of forgiveness based on the unconditional forgiveness they would expect from God and pro-life counsellors in terms of God's forgiveness for the client, accepting her own responsibility for the consequences of the abortion. / Philosophy, Practical and Systematic Theology / M. Th. (Pastoral Therapy)

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 Choice on Termination of Pregnancy Act (CTOP Act 92 of 1996) is perhaps the most revolutionary piece of legislation internationally ever to have been promulgated to regulate abortion and as such women’s reproductive lives. Abortion research tends to focus on the experiences of women and thus cast abortion as solely a territory that represents women’s reproductive concerns and the power to choose to procreate. While the CTOP Act safeguards women’s right of choice and a form of determination relating to what happens to their bodies, it also fails to recognise or even make pronouncements about the role that a man plays in the choice to terminate a pregnancy as well as how abortion affects a man’s life. This therefore implies that legally, men do not have a stake to influencing the decision to terminate a pregnancy. This qualitative study was undertaken to explore how young unmarried males whose partners have undergone an abortion construct abortion and the meanings that they attach to the experience of abortion. Interviews were conducted and the data was analysed using discourse analysis. Some of the young men knew about the woman’s decision to have an abortion and others did not know. Common findings include a sense of helplessness due to feeling that the decision is ultimately that of the woman, anger for those who did not know about the decision to abort and a lack of forgiveness towards their partners. / Psychology / M.A. (Clinical Psychology)

Unintended and unwanted pregnancies are major reproductive health problems impacting negatively on women’s health globally. When faced with these pregnancies, many women choose termination of pregnancy (TOP) as their recourse. The purpose of the study was to explore and describe physical, psychological and social implications of TOP on the woman’s health. A qualitative and descriptive research design was used. The population comprised women who had TOP three months to one year before the study and were willing to participate in the study. A non-probability purposive sampling was used to select participants for the study. In-depth phenomenological interviews were used for data collection until data saturation was reached with 20 participants. The findings reveal that women had psychological, physical and social implications after TOP which impacted negatively on their health. Recommendations were made to improve the services of women choosing to terminate a pregnancy to lessen negative implications. / Health Studies / M.A. (Health Studies)

The Choice on Termination of Pregnancy Act (CTOP Act 92 of 1996) is perhaps the most revolutionary piece of legislation internationally ever to have been promulgated to regulate abortion and as such women’s reproductive lives. Abortion research tends to focus on the experiences of women and thus cast abortion as solely a territory that represents women’s reproductive concerns and the power to choose to procreate. While the CTOP Act safeguards women’s right of choice and a form of determination relating to what happens to their bodies, it also fails to recognise or even make pronouncements about the role that a man plays in the choice to terminate a pregnancy as well as how abortion affects a man’s life. This therefore implies that legally, men do not have a stake to influencing the decision to terminate a pregnancy. This qualitative study was undertaken to explore how young unmarried males whose partners have undergone an abortion construct abortion and the meanings that they attach to the experience of abortion. Interviews were conducted and the data was analysed using discourse analysis. Some of the young men knew about the woman’s decision to have an abortion and others did not know. Common findings include a sense of helplessness due to feeling that the decision is ultimately that of the woman, anger for those who did not know about the decision to abort and a lack of forgiveness towards their partners. / Psychology / M. A. (Clinical Psychology)

Contraceptives are available free of charge throughout South Africa. Nevertheless the number of requests for termination of pregnancy (TOP) services continues to increase. This research investigated challenges preventing women from using contraceptives effectively. Structured interviews were conducted with 47 women who requested TOP services. Gender and financial issues posed challenges for some women to access contraceptives as well as their reported inability to access contraceptives. Most (85,5%) of the respondents used contraceptives. They discontinued using contraceptives because they experienced side-effects, necessitating them to request TOPs. Knowledge about, access to, nor the actual use of contraceptive enabled these women to prevent unwanted pregnancies. More effective counselling about the side-effects of contraceptives and enhanced accessibility of contraceptives during weekends and lunch breaks could enable more women to prevent unwanted pregnancies and reduce the number of requests for TOPs in the Gert Sibande District (Mpumalanga). / Health Studies / M.A. (Health Studies)