This study utilized a qualitative research methodology to examine the perspectives of six subjects, three married couples, choosing abortion to terminate unwanted pregnancies. The subjects were interviewed a few days after the abortion and six weeks after the abortion for a total of 12 hours. The researcher transcribed the interviews and observer's comments written throughout the interview process. The data were qualitatively analyzed to gain an understanding of (a) the factors which contributed to the unwanted pregnancies; (b) the process by which the couples Chose abortion to terminate the unwanted pregancies, (c) factors which contributed to the decision; (d) factors surrounding the abortion procedure; and (e) factors which predisposed the couples to different kinds of post-abortion reactions. This analysis indicated that inconsistent birth control usage was but one factor in the unwanted pregnancy. decision to abort the unwanted pregnancy created relationship conflicts because each subject had different ideas and needs in regard to managing the unwanted pregnancy. Although all of the subjects expressed relief after the abortion procedure was completed, they also expressed feelings such as guilt, sadness, and a sense of loss. All of the couples in the study experienced relationship stress, and discussed relationship issues in the interviews. More concern was verbalized about the relationship than the abortion for the couples in the study. Two of the couples expressed a commitment to making personal changes to improve the marital relationship. For the married couples in this study, the decision to terminate the unwanted pregnancy and abortion mirrored the decision-making and conflict resolution process utilized by the couples in other situations.

Thesis (PhD (Education)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Before the implementation of abortion legislation in South Africa in February 1997, illegal abortions were the only way out for women with unwanted pregnancies. Because of the high morbidity and mortality rate of the women concerned, abortion legislation was implemented with the aim of ending illegal abortions in South Africa by having abortions carried out legally on request in designated health care facilities. The abortion legislation stipulates that registered nurses who have undergone the proposed abortion care training may terminate a pregnancy upon request of a woman during the first twelve weeks of the gestation period of her pregnancy. Although legislation authorises registered nurses to carry out first trimester abortions, an inadequate number of nurses are being trained in the Western Cape to provide pregnant women with guidance and counselling services, carry out the abortions and/or refer problem cases. Since the implementation of the abortion legislation no real attempts have been made by higher education institutions in the Western Cape to offer abortion care training for nurses. A need has therefore been identified to develop a comprehensive training framework for higher education institutions in the Western Cape for the training of nurses in abortion care. The case study was used as research design and the specific unit of analysis on which the researcher focused were the registered nurses who had received training in abortion care and the context in which they provide abortion care at the various levels of service provision in the different regions of the Western Cape. A random, stratified sample (non-proportional) was taken of the designated state health care facilities in the Western Cape, as well as a non-probability purposive sampling of registered nurses who provide abortion care, a non-probability convenience sample of women who have received abortion care and a non-probability purposive sampling of final-year pre-registration nursing students. Data was generated by means of questionnaires to the women who received abortions and/or counselling, the registered nurses who carried out abortions as well as final-year preregistration nursing students. A checklist was used to observe the abortions that were carried out by registered nurses in an objective and non-participatory manner and semi-structured interviews were conducted with various role-players in abortion care and training. The main findings of this study indicate that the necessary infrastructure within which the services could be provided according to the abortion legislation was adequate, but that the ongoing shortage of trained health care practitioners hampers the abortion care services. Only 10 (n=10) of the 15 certified nurses employed in state health care facilities actively offered abortion care services in the various designated facilities in the Western Cape. Deficiencies were identified in the existing provincial protocol and it was clear that some of the guidelines are either not in use or have become obsolete in the light of new research findings. It was found that midwives with appropriate and effective training are the ideal category of health practitioner for the provision of abortion care. The certified nurses who have been trained by the various regional offices of the Department of Health: Western Cape are skilled in carrying out the abortion procedure, but the other aspects of abortion care, that are mainly carried out by other categories of nurses, will probably require greater attention. The recommendations, which are based on a thorough literature study as well as on the findings and conclusions that arose from the empirical part of this study, have been included in a training framework. The researcher recommends that the training framework provide the basis for the development of a formal programme or programmes for the training of nurses in abortion care at higher education institutions. The purpose of the proposed framework is therefore to determine the context within which curriculation ought to take place, and to provide a focus or format for those who develop the curriculum for prospective students. / AFRIKAANSE OPSOMMING: Voor die implementering van aborsiewetgewing in Februarie 1997 was onwettige aborsies die enigste uitweg vir vroue met ongewenste swangerskappe in Suid-Afrika. Weens die hoë morbiditeit- en mortaliteitsyfer van die betrokke vroue is aborsiewetgewing geïmplementeer met die doel om onwettige aborsies in Suid-Afrika te beëindig en aborsies op versoek wettiglik in aangewysde gesondheidsorgfasiliteite uit te voer. Die aborsiewetgewing stipuleer dat verpleegkundiges wat die voorgestelde aborsiesorgopleiding ondergaan het, ‘n swangerskap kan beëindig op versoek van ‘n vrou gedurende die eerste 12 weke van die draagtyd van haar swangerskap. Ten spyte van wetgewing wat verpleegkundiges magtig om eerste trimester aborsies uit te voer, word daar om verskeie redes onvoldoende aantal verpleegkundiges in die Wes-Kaap opgelei wat voorligting en berading aan swanger vroue gee, die aborsies uitvoer en/of probleemgevalle moet verwys. Geen daadwerklike pogings is sedert die inwerkingstelling van die aborsiewetgewing deur hoëronderwysinstellings in die Wes-Kaap aangewend om aborsiesorgopleiding vir verpleegkundiges aan te bied nie. Derhalwe is ’n behoefte geïdentifiseer om ’n omvattende opleidingsraamwerk vir hoëronderwysinstellings in die Wes- Kaap te ontwikkel vir die opleiding van verpleegkundiges in aborsiesorg. Die gevallestudie is as navorsingsontwerp gebruik en die spesifieke eenheid van analise waarop gefokus is was die verpleegkundiges wat opleiding in aborsiesorg ontvang het en die konteks waarbinne hulle aborsiesorg lewer by die onderskeie vlakke van dienslewering in die onderskeie streke van die Wes-Kaap. ’n Ewekansige, gestratifiseerde steekproef (nie-proporsioneel) is geneem van die aangewysde staatsgesondheidsorgfasiliteite in die Wes-Kaap, sowel as ’n nie-waarskynlike, doelbewuste steekproefneming van verpleegkundiges wat aborsiesorg verskaf, ’n nie-waarskynlike gerieflikheidsteekproefneming van vroue wat aborsiesorg ontvang het en ’n nie-waarskynlike, doelbewuste steekproefneming van finalejaar voorregistrasie verpleegstudente. Data is gegenereer met behulp van vraelyste aan onderskeidelik die vroue wat aborsies en/of berading ontvang het, die verpleegkundiges wat aborsies uitgevoer het, asook finalejaar voorregistrasie verpleegstudente. ’n Kontrolelys is gebruik om die aborsies wat deur verpleegkundiges uitgevoer is objektief en nie-deelnemend te observeer en semigestruktureerde onderhoude is met verskeie rolspelers in aborsiesorgdienste en -opleiding gevoer. Die hoofbevindings van hierdie studie dui daarop dat die nodige infrastruktuur waarbinne die dienste ingevolge die aborsiewetgewing gelewer kon word voldoende was, maar dat die voortslepende tekort aan opgeleide gesondheidsorgpraktisyns die aborsiesorgdienste kortwiek. Slegs 10 (n=10) van die 15 gesertifiseerde verpleegkundiges in diens van staatsgesondheidsorgfasiliteite het aktief aborsiesorgdienste aangebied in die onderskeie aangewysde fasiliteite in die Wes-Kaap. Leemtes is in die bestaande provinsiale protokol geïdentifiseer en dit het in die lig van nuwe navorsingsbevindings geblyk dat sommige van die riglyne óf nie in gebruik was nie, óf dat hulle intussen verouderd geraak het. Daar is bevind dat vroedvroue met toepaslike en doeltreffende opleiding die ideale kategorie gesondheidsorgpraktisyn is vir die verskaffing van aborsiesorg. Die gesertifiseerde verpleegkundiges wat deur die Departement van Gesondheid: Wes-Kaap se onderskeie streekskantore opgelei is, is vaardig in die uitvoer van die aborsieprosedure as sulks, maar die ander aspekte van aborsiesorg, wat meestal ook deur ander kategorieë verpleegkundiges uitgevoer word, sal waarskynlik groter aandag moet kry. Die aanbevelings is gegrond op ’n deeglike literatuurstudie sowel as op die bevindings en gevolgtrekkings wat uit die empiriese gedeelte van hierdie studie spruit en is vervat in ’n opleidingsraamwerk. Die navorser beveel aan dat die opleidingsraamwerk die grondslag sal bied vir die ontwikkeling van ’n formele program of programme vir die opleiding van verpleegkundiges in aborsiesorg aan hoëronderwysinstellings. Die doel van die voorgestelde raamwerk is dus om die konteks te bepaal waarbinne kurrikulering moet plaasvind, asook om ’n fokus of formaat te verskaf vir diegene wat die kurrikulum vir voornemende studente ontwikkel.

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)

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)