Introducing medication abortion into public sector facilities in KwaZulu-Natal, South Africa: an operations research study.

OBJECTIVES: Examine the feasibility of introducing mifepristone-misoprostol medication abortion into existing public sector surgical abortion services in KwaZulu-Natal, South Africa. STUDY DESIGN: Cohort study of women offered medication or surgical abortion in a larger medication abortion introduction study. The sample included 1167 women seeking first-trimester abortion at four public sector facilities; 923 women at ≤9 weeks' gestation were eligible for medication abortion. Women who chose medication abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe abortion guidelines. Women who chose surgical abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete abortion and proportion reporting adverse events. RESULTS: Ninety-four percent of eligible women chose medication abortion. No adverse events were reported by women who chose surgical abortion; 3% of women in the medication abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their abortion, with no difference based on procedure type. Medication abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, p<.001) and recommend the method to a friend (98% vs. 84%, p<.001). CONCLUSIONS: Medication abortion was successfully introduced with low and acceptable rates of adverse events; most women at study facilities chose this option. IMPLICATIONS: Mifepristone-misoprostol medication abortion was successfully integrated into public sector surgical abortion services in South Africa and was chosen by a large majority of women who were eligible and offered choice of early termination method; access to medication abortion should be expanded in South Africa and other similar settings.

Abortion in a progressive legal environment: the need for vigilance in protecting and promoting access to safe abortion services in South Africa.

The importance of South Africa as a model for reproductive self-determination in Africa cannot be underestimated. Abortion has been legal since 1996, and the country has some of the most developed government systems for the provision of abortion care on the continent. Yet in the same way opponents of abortion in the United States have whittled away at access with increased bureaucracy, South Africa faces similar assaults that leave women without safe care and threaten to turn back achievements made during the past 16 years. I explore the history of the law, subsequent legal challenges, and new threats to women's access to abortion services, including service delivery issues that may influence the future of public health in the country.

Building alliances from ambivalence: evaluation of abortion values clarification workshops with stakeholders in South Africa.

A retrospective evaluation of attitudinal, behavioural and knowledge change among diverse stakeholder groups was conducted in Limpopo Province of South Africa to assess the effectiveness of a series of values clarification (VC) interventions. Telephone and face-to-face interview (193) results revealed that over two-thirds (70.2%) reported behavioural changes and 93.2% reported increased compassion for women who seek and providers who render termination of pregnancy. Behaviours supportive of the law were more likely among those initially undecided about their opinion of termination of pregnancy (p < 0.05) than among those initially opposed or supportive to it. When combined with supportive follow-up, three-day VC workshops may be effective at increasing CTOPA knowledge, changing attitudes and spurring advocacy behaviour to support reproductive choice. Research studies with pre-post and case-control designs are needed to confirm these preliminary results.