Demanding doctorability for abortion on request: a conversation analysis of pre-abortion counselling in public hospitals in the Eastern Cape, South Africa.

BACKGROUND: Research on abortion counselling generally uses retrospective interviewing regarding providers' and users' experiences. In this article we explore how requests for abortion are made and received in real time in (officially non-mandatory) pre-abortion counselling conducted by nurses and counsellors in South African public abortion clinics. METHODS: To capture turn-by-turn interactions, we recorded, using consecutive sampling, 28 sessions at three abortion clinics in 2017/2018. No researcher was present. Conversation analysis, based on an ethnomethodological paradigm, was used to understand the conversational projects of the sessions and to outline how the provider and user oriented to the request for an abortion as a conversational task. RESULTS: Establishing reasons for the abortion featured in most individual counselling sessions. Through posing directive questions, providers required users to justify their request to access abortion. Users complied by providing multiple reasons. These reasons were often followed by a provider question demanding accountability in relation to contraceptive (non)use, thus establishing poor usage as the real reason. CONCLUSIONS: As abortion is legal on request in the first trimester in South Africa, no reason for presenting for an abortion is needed. The demand for users to perform 'doctorability' - that is, to present their situation as worthy of a health professional's (in this case abortion provider's) time - served as a precursor to discipline the abortion seeker for assumed poor contraceptive usage. Providers should be trained in user-centred care that supports pregnant people's autonomy in accessing legally induced abortion. A limitation of this study is its restriction to three abortion clinics in one region of South Africa.

Primary production of the kelp Lessonia corrugata varies with season and water motion: Implications for coastal carbon cycling.

Kelp forests provide vital ecosystem services such as carbon storage and cycling, and understanding primary production dynamics regarding seasonal and spatial variations is essential. We conducted surveys at three sites in southeast Tasmania, Australia, that had different levels of water motion, across four seasons to determine seasonal primary production and carbon storage as living biomass for kelp beds of Lessonia corrugata (Order Laminariales). We quantified blade growth, erosion rates, and the variation in population density and estimated both the net biomass accumulation (NBA) per square meter and the carbon standing stock. We observed a significant difference in blade growth and erosion rates between seasons and sites. Spring had the highest growth rate (0.02 g C · blade-1 · d-1 ) and NBA (1.62 g C · m-2 · d-1 ), while summer had the highest blade erosion (0.01 g C · blade-1 · d-1 ), with a negative NBA (-1.18 g C · m-2 · d-1 ). Sites exhibiting lower blade erosion rates demonstrated notably greater NBA than sites with elevated erosion rates. The sites with the highest water motion had the slowest erosion rates. Moreover, the most wave-exposed site had the densest populations, resulting in the highest NBA and a greater standing stock. Our results reveal a strong seasonal and water motion influence on carbon dynamics in L. corrugata populations. This knowledge is important for understanding the dynamics of the carbon cycle in coastal regions.

Violence Against Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review.

Women who sell sex (WSS) are vulnerable to violence. We present a scoping review of the last decade of research on the prevalence and incidence of, factors associated with, and services regarding violence against WSS in Eastern and Southern African (ESA). A systematic search of various databases resulted in 20 papers being reviewed. Inclusion criteria, applied by the first two authors, were as follows: empirical papers, key research problem is violence against WSS, and conducted in ESA countries. The lifetime prevalence of violence revealed in the studies ranged from 21% to 82%. A pattern of generalized violence against WSS from paying clients, male partners, strangers, family members, friends/acquaintances, and the authorities emerged. Factors associated with violence included the context within which the sex work occurs, alcohol use, type of sex exchange interactions, and personal factors (low education, low income, marriage, youth, high client volume, time in sex work, forced sexual debut, and internalized sex work stigma). WSS seldom access services after violence. Evaluations of two programs, a woman-focused HIV intervention, and the Diagonal Interventions to Fast-Forward Reproductive Health project, showed improvements in gender-based violence services. Findings suggest that targeted programmes should be paired with improving general health services and focus on promoting collective agency among WSS.

Comparative situational analysis of comprehensive abortion care in four Southern African countries.

We report on a comparative situational analysis of comprehensive abortion care (CAC) in Botswana, Eswatini, Lesotho and Namibia. We conducted systematic literature searches and country consultations and used a reparative health justice approach (with four dimensions) for the analysis. The following findings pertain to all four countries, except where indicated. Individual material dimension: pervasive gender-based violence (GBV); unmet need for contraception (15-17%); high HIV prevalence; poor abortion access for rape survivors; fees for sexual and reproductive health (SRH) services (Eswatini). Collective material dimension: no clear national budgeting for SRH; over-reliance on donor funding (Eswatini; Lesotho); no national CAC guidelines or guidance on legal abortion access; poor data collection and management systems; shortage and inequitable distribution of staff; few facilities providing abortion care. Individual symbolic dimension: gender norms justify GBV; stigma attached to both abortion and unwed or early pregnancies. Collective symbolic dimension: policy commitments to reducing unsafe abortion and to post-abortion care, but not to increasing access to legal abortion; inadequate research; contradictions in abortion legislation (Botswana); inadequate staff training in CAC. Political will to ensure CAC within the country's legislation is required. Reparative health justice comparisons provide a powerful tool for foregrounding necessary policy and practice change.

The Binary Order of Things: A Discursive Study of Nursing Students' Talk on Providing, and Learning About, LGBT Patient Care.

Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers' prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and "scientifically" supported through binary, deterministic views of sexuality and gender. Such "expert" views accord with Foucault's notion of "grotesque discourse." We conclude with a discussion of the findings' implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives.

Integrating child rights standards in contraceptive and abortion care for minors in Africa.

Minor girls in Africa face challenges in accessing high-quality contraceptive and abortion services because laws and policies are not child-friendly. Many countries maintain restrictive laws, policies, or hospital practices that make it difficult for minors to access contraception and safe abortion even when the pregnancy would risk their life or health. Further, the clinical guidelines on contraceptive and abortion care are silent, vague, or ambiguous regarding minors' consent. African states should remedy the situation by ensuring that clinical guidelines integrate child rights principles and standards articulated in child rights treaties to enable health providers to facilitate full, unencumbered access to contraceptive and abortion care for minor girls. A sample of clinical guidelines is analyzed to demonstrate the importance of explicit, consistent, and unambiguous language about children's consent to ensure that healthcare workers provide sexual and reproductive health care in a manner that respects child rights.

Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion.

Objectives: There is a need to hone reproductive health (RH) services for women who sell sex (WSS). The aim of this review was to collate findings on non-barrier contraception, pregnancies, and abortion amongst WSS in Eastern and Southern African (ESA). Methods: A scoping review methodology was employed. Inclusion criteria were: 1) empirical papers from 2) ESA, 3) published since 2010, and 4) addressing WSS in relation to 5) the identified RH issues. Results: Reports of rates of non-barrier contraceptive usage varied from 15% to 76%, of unintended pregnancy from 24% to 91%, and of abortion from 11% to 48%. Cross-cutting factors were alcohol use, violence, health systems problems, and socio-economic issues. Pregnancy desire was associated with having a non-paying partner. Barriers to accessing, and delaying, antenatal care were reported as common. Targeted programmes were reported as promoting RH amongst WSS. Conclusion: Programmes should be contextually relevant, based on local patterns, individual, interpersonal and systemic barriers. Targeted approaches should be implemented in conjunction with improvement of public health services. Linked HIV and RH services, and community empowerment approaches are recommended.

Connecting to the oceans: supporting ocean literacy and public engagement.

Improved public understanding of the ocean and the importance of sustainable ocean use, or ocean literacy, is essential for achieving global commitments to sustainable development by 2030 and beyond. However, growing human populations (particularly in mega-cities), urbanisation and socio-economic disparity threaten opportunities for people to engage and connect directly with ocean environments. Thus, a major challenge in engaging the whole of society in achieving ocean sustainability by 2030 is to develop strategies to improve societal connections to the ocean. The concept of ocean literacy reflects public understanding of the ocean, but is also an indication of connections to, and attitudes and behaviours towards, the ocean. Improving and progressing global ocean literacy has potential to catalyse the behaviour changes necessary for achieving a sustainable future. As part of the Future Seas project (https://futureseas2030.org/), this paper aims to synthesise knowledge and perspectives on ocean literacy from a range of disciplines, including but not exclusive to marine biology, socio-ecology, philosophy, technology, psychology, oceanography and human health. Using examples from the literature, we outline the potential for positive change towards a sustainable future based on knowledge that already exists. We focus on four drivers that can influence and improve ocean literacy and societal connections to the ocean: (1) education, (2) cultural connections, (3) technological developments, and (4) knowledge exchange and science-policy interconnections. We explore how each driver plays a role in improving perceptions of the ocean to engender more widespread societal support for effective ocean management and conservation. In doing so, we develop an ocean literacy toolkit, a practical resource for enhancing ocean connections across a broad range of contexts worldwide.

Reproductive health systems analyses and the reparative reproductive justice approach: a case study of unsafe abortion in Lesotho.

ABSTRACTHealth systems analyses are touted as mechanisms through which health policy and planning may be implemented. An example is the WHO health systems approach that connects people (needs, rights, perspectives) with services and technologies (equitable access, quality of care, mix of interventions) and with policies and institutional capacities (laws, regulations, human/physical resources, management and financing). The approach is comprehensive and multi-faceted, which is a strength. We argue, however, that health systems analyses should be supplemented with a focus on reproductive justice. Using the WHO health systems approach as an exemplar, we show how the reparative reproductive justice approach outlined by the first author and colleagues assists with outlining comprehensive remedies to the inequities identified in the systems analysis. We argue for attention to remedies at individual and collective, material and symbolic levels. We illustrate our argument using unsafe abortion, legal abortion services and post-abortion care in Lesotho as a case study. We outline the policies, services and people components of abortion in Lesotho using the WHO systems model, followed by a reparative justice analysis of remedies.

Cleaner seas: reducing marine pollution.

In the age of the Anthropocene, the ocean has typically been viewed as a sink for pollution. Pollution is varied, ranging from human-made plastics and pharmaceutical compounds, to human-altered abiotic factors, such as sediment and nutrient runoff. As global population, wealth and resource consumption continue to grow, so too does the amount of potential pollution produced. This presents us with a grand challenge which requires interdisciplinary knowledge to solve. There is sufficient data on the human health, social, economic, and environmental risks of marine pollution, resulting in increased awareness and motivation to address this global challenge, however a significant lag exists when implementing strategies to address this issue. This review draws upon the expertise of 17 experts from the fields of social sciences, marine science, visual arts, and Traditional and First Nations Knowledge Holders to present two futures; the Business-As-Usual, based on current trends and observations of growing marine pollution, and a More Sustainable Future, which imagines what our ocean could look like if we implemented current knowledge and technologies. We identify priority actions that governments, industry and consumers can implement at pollution sources, vectors and sinks, over the next decade to reduce marine pollution and steer us towards the More Sustainable Future. Supplementary Information: The online version contains supplementary material available at 10.1007/s11160-021-09674-8.

Human Papilloma Virus infection and cervical cancer among women who sell sex in Eastern and Southern Africa: A scoping review.

OBJECTIVES: Women who sell sex have a high prevalence of human papilloma virus, which may cause cervical cancer. The objective of this review was to collate findings on prevalence, associated factors, screening, service provision and utilization of services in relation to human papilloma virus and cervical cancer among women who sell sex in Eastern and Southern Africa. METHODS: A scoping review methodology was employed. Inclusion criteria were as follows: (1) empirical papers, (2) of studies conducted in Eastern and Southern Africa, (3) published in the last 10 years, and (4) addressing women who sell sex in relation to (5) human papilloma virus and cervical cancer. A thorough search of a range of databases surfaced 66 papers. Both authors applied inclusion and exclusion criteria, resulting in 14 papers being reviewed. RESULTS: The reported prevalence of high-risk human papillomavirus virus varied between 23.6% and 70.5%. HIV sero-positivity, other sexually transmitted infections and Epstein-Barr virus were associated with human papilloma virus and high-grade cervical lesions. High-risk human papilloma virus was associated with women who reported younger age at first intercourse, non-barrier contraceptive use, and no history of condom use. For screening, there was overall agreement between physician- and self-collected samples. Contradictory results were found for visual inspection with acetic acid. Screening services utilization was associated with provider's recommendation, history of sexually transmitted infections, frequency of facility visit and history of vaginal examination. A diagonal programme led to an increase in screening, attributed to the targeted services. CONCLUSIONS: Context is important in planning cervical cancer services. There is a need for enhanced sexually transmitted infections and viral management within cervical cancer prevention. Women who sell sex should be empowered in self-collection of stored-dry specimens, especially in resource-constrained regions. Cervical cancer screening services should be honed to the needs of women who sell sex.

Alcohol use during pregnancy: prevalence and patterns in selected Buffalo City areas, South Africa.

The high rate of foetal alcohol spectrum disorders, which results from alcohol consumption during pregnancy, is of concern in South Africa. The aims of this research were to establish the prevalence, patterns and factors associated with alcohol use amongst pregnant women attending antenatal clinics in two former township areas of Buffalo City, South Africa. A survey was conducted using a structured questionnaire that included socio-demographic questions, and the Alcohol Use Test (AUDIT). The questionnaire was administered in English, Afrikaans or isiXhosa by healthcare providers trained in its administration. Consecutive sampling was used, with all willing women presenting at public clinics offering antenatal care in the two townships being invited to participate. Of the 18 clinics operating in the two townships, 16 were willing to participate, resulting in a sample of 1028 women over a nine-month period. Data were analysed in Medcalc using descriptive statistics, one-way analysis of variance, independent samples t-test and a multivariable binary logistic regression analysis. Two-thirds of the sample did not drink alcohol, but results showed high levels of risky alcohol use: 20.1% on the total AUDIT scale, and 16.8% on the AUDIT-C scale. The following variables were found to be significantly associated with risky drinking: age; race; report of intimate partner violence (IPV); and other regular drinker in the home. Employment status, education status, relationship status, parity and gestation were not associated with risky drinking. Interventions aimed at reducing alcohol use during pregnancy should address: drinking youth cultures; drinking norms within the home; and intimate partner violence. Future studies should include additional mental and physical health variables.

'Bad choices': Unintended pregnancy and abortion in nurses' and counsellors' accounts of providing pre-abortion counselling.

Little research tackles healthcare providers' experiences in conducting pre-abortion counselling sessions in circumstances where pregnant persons may request an abortion. We report on a study conducted in South Africa, in which two nurses and two counsellors were asked about how they conduct these counselling sessions. Using a synthetic narrative approach, we present these health workers' micro-narratives about their motivations for providing abortion services, the purpose of the counselling, their information-giving practices, and whether and how third parties are included in the counselling. We highlight how these micro-narratives are premised on discursive resources that problematise unintended pregnancy and abortion. These resources enable and justify directive counselling that undermines pregnant peoples' reproductive autonomy. We locate such directiveness within dominant anti-abortion discourse and call for training to reframe normative understandings of abortion.

Sistering and sexual socialisation: a discursive study of Xhosa women's sisterly interactions concerning sex and reproduction.

Considerable research has been devoted to understanding and promoting parent-child sexual socialisation. Less attention has been paid to experiences of sibling interactions concerning sex. Drawing on discursive psychology, this study explores how women report interacting about sex and reproduction in their sisterly relationships. Ten in-depth interviews were conducted, using Free Association Narrative Interview technique, with five Black isiXhosa-speaking, middle-aged and working class women in South Africa. Findings show that the participants construct their sisterly interactions concerning sex drawing on three interpretative repertoires: silence; safety and secrecy; risk and responsibilisation. The silence repertoire constructs sex talk between sisters as vague and non-viable. Within the safety and secrecy repertoire, sisters are constructed as sharing sexual secrets and providing a safe space for sexual exploration. The risk and responsibilisation repertoire is deployed when understandings of 'proper' feminine behaviour and sexual purity are breached, with sisters emphasising the importance of avoiding risk and acting responsibly. Thus, alongside encouraging the expression of women's agency in relation to sexuality, sisters potentially join a patriarchal policing and the shaming of women's sexuality. These contradictory repertoires have implications for sexual health programmes and interventions targeted at family communication about sex.

The Conundrums of Counselling Women in Violent Intimate Partner Relationships in South Africa: Implications for Practice.

Little research focuses on how counsellors experience counselling encounters concerning intimate partner violence. This study reports on narrative research conducted with eight South African non-governmental organisation counsellors. Participants spoke of creating productive and caring counselling dynamics, and providing non-directive counselling. However, they also indicated providing moral guidance, particularly in cases where pregnancy or children were involved. Success was viewed rather narrowly as the women leaving the relationship, setting up 'all-or-nothing' outcomes. Such 'success' led to counsellor happiness, whilst failure in this regard led to counsellors experiencing anger and burn-out. We conclude that the conundrums evident in these data are grounded in patriarchal systems, limiting the efficacy of counselling based on a bondage and deliverance narrative. Implications for practice and training are also outlined.

Contradictions in womxn's experiences of pre-abortion counselling in South Africa: Implications for client-centred practice.

Pre-abortion counselling may play a key role in abortion seekers' understanding of their decision to terminate a pregnancy and the subsequent emotions that they feel. In this paper, we report on a study conducted in the Eastern Cape province of South Africa concerning womxn's experiences of the pre-abortion counselling offered as part of the implementation of the Choice of Termination Act that governs the provision of legal abortion in the country. Using a narrative-discursive lens, the analysis revealed four micro-narratives in which participants appreciated non-directive and empathic counselling, as well as being provided with information. They also indicated that the counselling was upsetting and hurtful, particularly when providers drew on the awfulisation of abortion discourse to suggest that abortion leads to terrible consequences, and foetal personhood discourse to intimate that terminating the pregnancy is wrong and other alternatives (adoption, parenting) are better. The connection between these broadly positive and negative responses may lie in the dominance of anti-abortion discourses coupled with the powerful positioning of healthcare providers as experts. The attendant disempowerment of clients within the health clinic setting may constrain pregnant people's ability to question such 'expert' information. The implications for feminist client-centred pre-abortion counselling are discussed.

Resisting abortion stigma in situ: South African womxn's and healthcare providers' accounts of the pre-abortion counselling healthcare encounter.

Abortion providers and pregnant people who undergo abortion potentially face significant stigma. Researchers have started to explore how womxn respond to abortion stigma, usually focusing on individual strategies in managing or reducing stigma effects. Drawing on narrative data from research conducted on womxn's and healthcare providers' experiences of the pre-abortion healthcare encounter in the South African public health sector, we highlight how stigma may be resisted in social ways within this context. Everyday chatter and informal social support amongst womxn in the waiting room provided a counterpoint for health service providers' ascription of shame to the womxn, and a sense of solidarity amongst the womxn. Health service providers narrated their decision to do abortion work through the socially affirming hero canonical narrative, and womxn described their counselling as helpful. These social and discursive practices resist the awfulisation of abortion and provide relief for the womxn and the healthcare providers in particular contexts.

Psychological knowledge production about abortion: the politics of location and representation.

BACKGROUND: Despite considerable psychology research being conducted on abortion, there has been no study of the history of psychological knowledge production on the topic. The aim of our research was to analyse journal articles published in English language psychology journals using a politics of location and of representation analytical lens. STUDY DESIGN: A systematic search for articles published on abortion in psychology journals from 1960 to 2015 was conducted. A mixed-method approach (content analysis and narrative review) was used to analyse the dataset. Articles were coded according to: decade of publication, region, types of research conducted, and main issues focused on. A narrative review of the dominant issue researched - psychological consequences - in two decades (the 1970s and 2000s) was conducted. RESULTS: Knowledge production began in the 1970s in most regions featured in the dataset and in the 1990s in South Africa. Research is dominated by quantitative studies conducted in North America and Europe concerning the demarcation of psychological consequences of abortion performed under safe conditions. In the 1970s, abortion was viewed as leading to benign psychological consequences, but by the 2000s traumatology talk was firmly entrenched. Only one article, emanating from South Africa, addressed the question of unsafe abortion. CONCLUSIONS: Knowledge production in psychology needs to move beyond a narrow focus on the psychological consequences of abortion and attitudes to abortion. Nuanced, contextualised research of the psychology of both safe and unsafe abortion is necessary.

Autonomous adaptation to climate-driven change in marine biodiversity in a global marine hotspot.

While governments and natural resource managers grapple with how to respond to climatic changes, many marine-dependent individuals, organisations and user-groups in fast-changing regions of the world are already adjusting their behaviour to accommodate these. However, we have little information on the nature of these autonomous adaptations that are being initiated by resource user-groups. The east coast of Tasmania, Australia, is one of the world's fastest warming marine regions with extensive climate-driven changes in biodiversity already observed. We present and compare examples of autonomous adaptations from marine users of the region to provide insights into factors that may have constrained or facilitated the available range of autonomous adaptation options and discuss potential interactions with governmental planned adaptations. We aim to support effective adaptation by identifying the suite of changes that marine users are making largely without government or management intervention, i.e. autonomous adaptations, to better understand these and their potential interactions with formal adaptation strategies.

Expanding reproductive justice through a supportability reparative justice framework: the case of abortion in South Africa.

Theoretical refinement of the concept of reproductive justice has been called for. In this paper, I propose the use of a supportability reparative justice approach. Drawing on intra-categorical intersectionality, the supportability aspect starts from the event of a pregnancy to unravel the interwoven embodied and social realities implicated in women experiencing pregnancy as personally supportable/unsupportable, and socially supported/unsupported. The reparative justice aspect highlights the need for social repair in the case of unsupportable pregnancies and relies on Ernesto Verdeja's critical theory of reparative justice in which he outlines four reparative dimensions. Using abortion within the South African context, I show how this framework may be put to use: (1) the facilitation of autonomous decision-making (individual material dimension) requires understanding women within context, and less emphasis on individual-driven 'choice'; (2) the provision of legal, safe state-sponsored healthcare resources (collective material dimension) demands political will and abortion service provision to be regarded as a moral as well as a healthcare priority; (3) overcoming stigma and the spoiled identities (collective symbolic dimension) requires significant feminist action to deconstruct negative discourses and to foreground positive narratives; and (4) understanding individual lived experiences (individual symbolic dimension) means deep listening within the social dynamics of particular contexts.