Vol. 28, No.

1: Suppl on Population Issues in South Africa, May, 2014

Termination of pregnancy: Perspectives of female students in Durban,

South Africa

Ashley Gresh and Pranitha Maharaj

School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, 4041,
Maharajp7@ukzn.ac.za

Abstract
Pregnancy termination among young women constitutes a public health problem particularly in South Africa
where high prevalence of abortion has been recently recorded. The primary objective of this study was to
assess the social context in which decisions about termination of pregnancy are taken. In particular, it
examines the perspectives of young women with regard to abortion and abortion methods, specifically
medical abortion. The study draws on in-depth interviews with female students at a university in Durban,
KwaZulu-Natal. The findings suggest that for the majority of women, abortion is a context-driven choice.
While women were opposed to abortion for themselves, it was seen as justifiable under certain
circumstances. There was a feeling that abortion services should be made accessible to all women that seek
them, including medical abortion. The major identified barriers to accessing abortion services were: stigma
and cultural beliefs; finances; and negative attitudes of health providers. Termination of pregnancy services
should take into account the context in which women make decisions on abortion as well as the barriers
women face in accessing abortion services in order to reduce its prevalence.

Keywords: Pregnancy termination; in depth interviews; public health; KwaZulu-Natal

Résumé
L'arrêt de grossesse parmi de jeunes femmes constitue un problème de santé publique en particulier en
Afrique du Sud où la forte présence de l'avortement a été récemment enregistrée. Le premier objectif de
cette étude était d'évaluer le contexte social dans lequel des décisions au sujet de l'arrêt de la grossesse
sont prises. En particulier, il examine les perspectives de jeunes femmes en ce qui concerne l'avortement et
les méthodes d'avortement, avortement spécifiquement médical. L'étude dessine sur des entrevues
détaillées avec les étudiants féminins à une université à Durban, KwaZulu-Natal. Les résultats suggèrent
que pour la majorité de femmes, l'avortement soit un choix contexte-conduit. Tandis que des femmes
étaient opposées à l'avortement pour elles-mêmes, on l'a vu en tant que certaines circonstances de dessous
justifiables. Il y avait un sentiment que des services d'avortement devraient être rendus accessibles à toutes
les femmes qui les cherchent, y compris l'avortement medical. Les barrières identifiées principales aux
services de accès d'avortement étaient : stigmate et croyance culturelle ; finances ; et attitudes négatives
des fournisseurs de santé. L'arrêt des services de grossesse devrait tenir compte du contexte dans lequel les
femmes prennent des décisions sur l'avortement comme le visage de femmes de barrières dans des services
de accès d'avortement afin de réduire sa prédominance.

Mots-clés: Arrêt de grossesse; entrevues détaillées; santé publique; KwaZulu-Natale

Introduction interventions for preventing unintended pregnancy;

Abortion remains one of the most controversial however approximately 45 million pregnancies per
sexual health issues, and yet despite the long- year end up in abortion, and an estimated 20 million
standing stigmas and opposition to its practice; of these are conducted in unsafe environments or
termination of pregnancy remains a common performed by unskilled individuals, putting more
experience for some women around the world. women at risk every year (Glasier et al., 2006).
There are many inexpensive and effective There is a growing realization that abortion is a
social reality which is often practiced despite legal
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restrictions, and is an integral part of women’s Akinsooto, 2003). In addition, there is often
sexual and reproductive health rights (Glasier et al., confusion over the fee status of abortion in South
2006; Singh et al. 2009). In Africa, an estimated 92% Africa as most women are unaware that the service
of women of childbearing age live in a country with is provided for free in public facilities. (Varga, 2002)
restrictive abortion laws (Singh et al., 2009). Studies While abortion services are provided for free,
suggest that legal access to abortion services poverty still limits access to health services and
improves sexual and reproductive health (Grimes et family planning (Knudsen, 2006). In addition, the
al., 2006). Ensuring access to safe abortion could provision of abortion services around the country
reduce unintended pregnancies, births, maternal ill- has been severely curtailed by the general lack of
health and mortality as well as reduce HIV infections abortion facilities and shortages of trained health
in infants (Orner et al., 2010). care providers (Cooper et al., 2005). A lack of
Abortion was legalized in South Africa with the confidentiality is another barrier (Jewkes et al.,
Choice on Termination of Pregnancy Act in 1996 2005) The lack of privacy and health providers’
(Mhlanga, 2003). This Act gives women the right to negatives attitudes have been cited in numerous
request termination of pregnancy (TOP) up to and studies as a deterrent for using public, safe abortion
including the 12th week of pregnancy and under services (Knudsen, 2006; Morroni et al., 2006;
certain circumstances between the 13th and 20th Varga, 2002). Most health workers supported
week of pregnancy, to be provided by a certified abortion in the case of rape or incest, or if it would
nurse practitioner or medical doctor (Mhlanga, endanger a woman’s health, but few supported it for
2003). In 2004, an amendment was added in order social or economic reasons. (Harrison et al., 2000;
to make termination of pregnancy services more Harries et al., 2009). Providers may also assert
available for women. This amendment allows for any conscientious objection and ignore the legal
health facility that has a 24-hour maternity service to obligation to refer women to other facilities,
offer first trimester abortion services (Hoffman et creating a barrier to care (Cooper et al., 2004). This
al., 2006). It also allows registered nurses that have leads women with no other option but to either
completed a TOP training course to provide first patronize unqualified practitioners or resort to self-
trimester terminations, expanding the base of induced abortion (Jewkes et al., 2005).
providers for abortions. As a result of this legislation Despite the health implications and risks
studies suggest that there has been a reduction in associated with abortion particularly when it is not
maternal deaths from unsafe abortions, although carried out by a certified professional, methods for
they are still occurring (Mhlanga, 2003; Jewkes et al., abortion have received less priority and have not
2005). Despite the encouraging statistics on been fully addressed. In the 1980s, medical abortion
decreased mortality and morbidity rates for abortion was developed as an alternative to surgical abortion,
related complications, the number of legal abortions which is essentially a combination of two drugs that
performed each year make up only a small number induce a miscarriage. Advocates suggest that medical
of abortions done in South Africa (Knudson, 2006). abortion has the potential to reach more women,
Studies have found that even after the legalization of particularly in developing countries, where
abortion, many women were still aborting outside of approximately 97% of deaths from unsafe abortion
health facilities in South Africa (Jewkes et al., 2005). take place, because no surgical procedures are
The continuing high rate of unsafe abortions is required (Sedgh et al., 2007). In 2001, the Medicines
due to a variety of interconnected factors. Women Control Council (MCC) of South Africa approved
may lack awareness of the availability of safe the use of mifepristone in conjunction with
abortion services. A study done in the Western misoprostol for termination of early pregnancy up to
Cape found that 32% of women did not know that 56 days from the last menstrual period (LMP) (8
abortion is legal (Morroni et al., 2006). Another weeks) (NAF, 2009). To our knowledge, there is no
study found that 54% of women presenting at a formal national policy that allows for the provision of
hospital for incomplete abortions had not used legal medical abortion in public health facilities. Research
services because they did not know about the law is ongoing assessing the feasibility of integrating
(Jewkes et al., 2005). Not only are women unaware medical abortion into public health services.
of the abortion legislation, a study done in KwaZulu
Natal found that 68% of participants were not
aware of any existing facility for TOP (Moodley &
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The main aim of this study was to explore the open-ended to allow respondents to share their
influences on young women’s decision-making, personal experiences. Interviews began by assessing
specifically with regard to abortion in Durban, South the demographic profile and reproductive history of
Africa. It focuses on awareness of medical abortion each participant. Questions covered topics such as:
and whether or not women find it to be an partner history; contraceptive use; pregnancy
acceptable method for termination of pregnancy. In history; religious beliefs; knowledge of abortion
addition, it investigates the barriers that women face legislation; and abortion methods.
accessing abortion services. The study draws on Respondents were recruited through chain
interviews with university students in Durban, South referral sampling through various sources including:
Africa. Students, of course, are far from typical of student associations, email list servers and referrals.
young people but they are of special importance All the respondents were informed about the
because they are often agents of social change, and purpose of the study and asked if they would be
can serve as an indicator as to whether or not there willing to participate in the study. Informed consent
will be a demand for medical abortion. In South was obtained before each interview. Interviews
Africa fertility levels have declined but unwanted were conducted onsite at the university, and lasted
pregnancies among young women remains high. on average about one hour. Interviews were
Among young women less than 30 years of age conducted in English by the principal investigator.
approximately 55% reported unintended English was used because it is the main medium of
pregnancies (SADHS, 2003). Focusing on this age instruction at the university. All interviews were
group is critical in order to tailor effective digitally recorded with consent from each
interventions to prevent the occurrence of unsafe participant. All respondents were assured of
abortions and ensure that services are provided for anonymity, and confidentiality was maintained at all
the population that is most at risk. times. Ethical approval was obtained from the Ethics
Methodology Committee at the Faculty of Humanities,
The study was conducted at a university in Durban, Development, and Social Sciences at the University
South Africa. Durban is located in the province of of KwaZulu-Natal before the commencement of the
KwaZulu-Natal. The study site was selected because study. All participation was voluntary and
over the past ten years KwaZulu-Natal has one of respondents were free to withdraw at any time
the highest rates of termination of pregnancy and after having signed the informed consent sheet.
lowest rate of functioning abortion facilities (Health The digital recordings were transcribed and key
Systems Trust, 2009). The province also has the concepts and themes were identified to create a
highest HIV prevalence in the country, at almost coding framework to base the analysis and organize
37% and is confronting major sexual and the data. The data was drawn, coded into analytic
reproductive health problems (Department of themes, and then translated into designated themes
Health, 2012.). and synthesized to carry out a thematic analysis
The study draws on in-depth, open-ended using Nvivo.
interviews conducted among female university Results
students aged less than 30 years. In Africa, in Background information of the respondents
particular, almost 80% of unsafe abortions are The ages of the women interviewed ranged from 21
happening among women under 30 (Shah and to 28 years. The mean age of the sample was 23
Ahman, 2004). In addition, studies have found that years. In the sample, 11 women were black African,
for developing regions as a whole unsafe abortions 6 white, and 3 Indian. The students included both
peak among women aged 20-29 years old (Grimes undergraduates and postgraduates. Just under half of
et al., 2006; Shah and Ahman, 2004). Twenty the women claimed religious affiliation- the majority
interviews were conducted with female students being Christian. Over half of the women had a
under the age of 30 over a three-month period from regular partner. However, only one of the women
October to December 2009. Due to the sensitivity reported that she was married. In the total sample,
of studying abortion, qualitative methods were three stated that they had children, while one
deemed most appropriate in order to discover the woman reported having experienced a miscarriage.
complex factors that influence perspectives on and There was only one woman who reported two
experiences with abortion. The interviews were
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previous abortions. All of the women who had “If I got raped, I would not want that baby because I
previous pregnancies reported that they were know it is not it’s [the baby’s] fault, but it is the
unplanned and unexpected. product of hate.” (P3)
Awareness and attitudes towards abortion
The majority of women (90%) were aware that “If you think of women that are raped…what could
abortion is legal in South Africa, however they had they do? It [abortion services] was not available, and
inadequate knowledge of the legislation. In addition, that is why they resort to illegal abortions in some
they reported that they did not know where to cases.” (P11)
access services, the cost of services and whether or
not TOP services are available at public facilities. A Women expressed a desire to finish their studies
few women (2) were unaware of the legality of and establish a career before commencing
abortion in South Africa, of which one of them had childbearing. Many women’s aspirations for the
an abortion outside of a health facility through an future were dependent on finishing their university
illegal provider. degree, and having a child was seen as a barrier to
Overall, a substantial number of the respondents this success.
expressed negative attitudes to abortion and claimed
that they would not have an abortion if they were to “…I was a student, so I knew that if I do not have
become pregnant. However, a few of the women the abortion then it will be over for me…so I had to
(5) reported they would have an abortion if they do the abortion, even though I did not like it. For
became unexpectedly pregnant. While on the one me, I had no choice.” (P8)
hand the women were against abortion, there was
an ambivalent attitude when imagining different Without resources to support a child, many
circumstances in which one becomes unexpectedly women said they would most likely resort to having
pregnant. The respondents said that under certain an abortion. Two women, who already have a child,
circumstances, namely rape or dangerous medical said they were not in a financial position to support
conditions, they would consider terminating the an additional child. Women commented that many
pregnancy. families in South Africa struggle on a daily basis to
survive and maintain the basic necessities for their
“Although I am against abortion in principle, there children.
are circumstances, look even if abortion is not
legalized; people are still going to do it. And then it “If it [abortion] is not available then it increases
raises the question should you rather have it where people…children coming to this world in poverty
they can do it in a safe environment? Or do it in the and unemployment. (P17)
toilets where they are at risk as well.” (P20)
Women who were experiencing problems in
The reports from this study suggest there is a gap their relationship would consider terminating the
between ideals and real life practices in relation to pregnancy. Some women said that if their partner
abortion. On the one hand women say they are was not supportive of the pregnancy, they would
against abortion; but on the other hand, when an rather choose to terminate than go ahead with the
unexpected pregnancy occurs, the reality might be pregnancy.
different.
Reasons Why Women Induce Abortion “I had this boyfriend, so I did not use the condom.
The most common reason reported for seeking So I got pregnant, and then we were no longer in
abortion services was in the case of being a victim of love; so I thought I cannot have the baby for him, if
rape. If a pregnancy resulted from such an act of we were not in love. So I did not want to have
violence, the majority of women would have an another baby [and had an abortion].” (P8)
abortion, and would be supportive of other women
making the same decision. Many women mentioned Women reported having friends who had
that rape is a serious problem in South Africa. abortions because their partners either physically or
emotionally abused them. In addition, if they found
themselves in situations where their partner is
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abusing them, they would not want to risk the It is not uncommon for women to report that
health of a child as well. In the case of dangerous their family was opposed to abortion. One woman
medical conditions that posed a risk for the mother said when she became pregnant for the first time
or the child; some women felt that the risk of a child her family persuaded her to not have an abortion
being born with birth defects or another serious when she wanted to have one.
disability was an acceptable reason for opting for an Barriers to Abortion Services
abortion. The women admit that abortion is something that is
Reasons for Opposing Abortion not often talked about in communities, within
As stated earlier, the majority of women were families, or even among friends. They reported that
generally opposed to abortion. Many regard abortion was socially unacceptable. A few women
abortion as “murder” and are “morally opposed” to said that there are serious social consequences for
it. Religious affiliations were reported to greatly having an abortion because of the stigma attached to
affect women’s reproductive decision-making. the act, women face being outcast from their
communities. Due to the stigma, women do not
“It is religious beliefs themselves, and just moral, discuss abortion and seek alternative methods,
killing someone, a human being; you are killing a which perpetuates the cycle of unsafe and illegal
human being.” (P14) methods. Cultural beliefs against abortion also deter
women from using health facilities for abortion
“Under the circumstances I was scared to do an services.
abortion. I am always scared because of many things,
religion and everything, and you are thinking to kill “I think that there are a lot of cultural
this thing that is your baby. So I decided to keep it complications. Abortion in general being socially
and something happened [a miscarriage].” (P19) taboo…I know that traditional healers have some
sort of plant that you can take that terminates
For some, abortion is equivalent to murder. Their pregnancy.” (P16)
families and the churches they attend influenced
many of these women’s beliefs. Some women “I think that they [cultures] limit women…from
attended religious schools, which influenced their going to the hospitals, because there is always those
attitudes toward abortion. ways that they say to abort…you know different
cultures have different ways, methods that they
“I went to a Catholic school that was very anti- think you can use to abort.” (P13)
abortion actually. They would show you a picture of
a baby at one week, or a fetus…I think we learnt According to the black respondents that were
abortion was evil, number one.” (P10) interviewed, Zulu culture does not accept abortion,
which deters women from seeking safe services.
Women said they would not have an abortion They mentioned the annual reed dance, or virginity
because of the attitudes of their male partner. Men testing, that is still practiced in some areas idolizing
were perceived as holding negative attitudes toward women’s chastity and purity.
abortion.
“And there is the whole reed ceremony thing, they
“The thing that prevented me from doing that thing go for virginity testing and what not. And if you are
[abortion] was my boyfriend suspected that I was having sex you are going to be isolated from the
pregnant. So he prevented everything because I whole community, so you are going to keep quiet.
could not go on…with the abortion because he And if you are pregnant also, everyone would
knew that I was pregnant.” (P8) know…But there are these crazy things, because
they [communities] scare them [women] from going
“Some [men] ask a woman to keep the baby; even to hospitals or clinics.” (P19)
though they know themselves that they won’t
support that baby. They run away, and women will The women also made reference to the attitudes
be left alone to raise the child.” (P19) of health care workers as a major deterrent in

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seeking abortion services because of the negative Women are often forced to travel long distances
judgment and disapproval from staff at clinics and to reach hospitals where abortion services are
hospitals. available, and because of the limited number of
patients taken per day they are often unable to
“They [nurses] are so hostile down there [clinics]. access these services.
They would not allow a young person to come for Women who fall unexpectedly pregnant and are
contraceptives, even for your condoms. They will be unaware of the abortion legislation, specifically the
asking what, you are having sex at this age?” (P19) fact that abortion services are free in public
hospitals, or face barriers in accessing abortion
“Some nurses are judgmental, you know that? I services often turn to methods outside of health
know because I know so many people who have facilities.
done abortion…It is the belief that abortion is
murder.” (P7) “Especially for the teenagers who do not have
money...Private consultations fees are so high.
Women say that nurses and other health care Because most of the people who are falling pregnant
workers are deeply judgmental and often impose now are teenagers, those ones who are at school,
their own views of abortion on to their patients, that is why they prefer to do the other route, the
which makes women uncomfortable. Women then R300 written all over town.” (P19)
seek providers outside health facilities that will be
less judgmental. In addition, the perception that Many women voiced concerns about the
public medical facilities do not provide quality care abortion advertisements that are posted throughout
was cited as a reason why women would seek care the city of Durban promoting “safe abortion”
in either the private sector or services from illegal services for women. They felt that many of these
providers. private providers are exploiting women in vulnerable
situations.
“I do not trust the public system. And I would rather
go to a private doctor…There are too many “…I think the people that are involved are making
patients. There is an insufficient amount of doctors. I good bucks [money] out of women in troublesome
think the standard of care is substandard.” (P20) situations, they are trying to capitalize on it…they
[women] have no options.” (P11)
It was also mentioned that hospitals take a
limited amount of patients per day, making it very
difficult for the majority of women to access The following is a description of a woman’s
abortion services. The following is one woman’s personal experience with having an abortion outside
description of her experience of the abortion of a health facility after she was turned away at the
services in a public hospital in Durban: hospital for being too far along in her pregnancy at
13 weeks:
“And the first time I went there [abortion clinic]
they take 10 people a day, so you have to wake up “It was this old lady, like when we were there in the
early in the morning, maybe about five o’clock you hospital, maybe a lot of girls talk, ‘so and so is doing
have to be there. And it was not easy, waking up at an abortion’, and so you take numbers and so I go to
that time…I go there, and then I come back, it was that [place]…it is an old lady. She is the one that
so full. They have their 10 people, so I have to come inserts the pills in me, and then you go, and that is it
back…I slept on the hospital bench, so that I could for her…for me it did not take too long, maybe it
wait there, wake up early, instead of going was like five hours...After the baby comes out, you
home…You sign some papers about doing the are just thinking and bleeding.” (P8)
abortion, and then they do not give you the pills that
day, you have to come another day to take the pills Women reported a variety of unsafe methods
and then come back another day for cleaning.” (P8) that are often used for induced abortion such as:
pills (oral and vaginal insertions); coat hangers;
drinking sodas, laxatives and detergents; and
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traditional methods, umuthi. These methods may categories. The most common advantage mentioned
sometimes lead to life-threatening complications but was privacy associated with medical abortion.
women prefer to take the risk instead of using public
facilities. “…you can do it [medical abortion] without many
people knowing, without having the stress of going
“She told me they put the pills there [in her vagina], in to be almost operated on.” (P20)
and told her to go home, and then eventually that
[the fetus] will come out, eventually dead. And she “…medical abortion- the advantage is you can do it
almost died. And we wanted to take her to the on your own. You get the pill and you just take it.”
hospital, and she refused, she was like, no…I would (P4)
rather die here, I am not going to hospital.” (P19)
Women would prefer an abortion method that
Medical Abortion can be done discretely without revealing their
In the interviews women highlighted that in addition actions to people in their community. It can be done
to the barriers that deter women from seeking safe at home versus a clinic, which reinforces the privacy
abortion services, they seek alternative unsafe aspect of the method. Avoiding surgery was another
methods perhaps because of a lack of options of advantage mentioned by multiple women. Some
methods to choose from. So the interviews then women felt that medical abortion was a method that
explored attitudes toward different abortion appeared “easier” and “simpler” than surgical
methods and investigated awareness and abortion.
acceptability of medical abortion among this sample
of women. The findings suggest that acceptability of “I just think it seems easier to do a medical abortion.
medical abortion was high among participants. It is a lot easier to get a pill than to find a surgical
Almost 30% of participants had some knowledge of procedure.” (P6)
medical abortion as a method, but those that had
heard of it before had limited knowledge. “Also I do feel that is easier, and it feels more like a
All of the women in this study discussed the miscarriage. So I think you think to yourself well it is
unsafe abortions happening around South Africa, and more acceptable doing it this way.” (P20)
some women thought that medical abortion had the
potential to reduce the prevalence of these unsafe A few women said medical abortion would be
methods. Some women mentioned that medical easier psychologically, one can think of it as a
abortion provides an alternative to surgical abortion, miscarriage, as it is more similar to a woman’s
which would improve the sexual and reproductive menstrual cycle. Some women also felt they would
health of women by allowing them to make a choice have a greater sense of control with medical
based on their preferences and individual contexts. abortion as opposed to surgical abortion. In addition
some women mentioned that psychologically it
“It [medical abortion] needs to be available, again would be easier to terminate earlier in gestation
you cannot say there is one right way to have an because the fetus seems less lifelike.
abortion.” (P16) Although there were many women with
favorable attitudes and who accepted medical
“I think it should [be made available] because there abortion, there were also concerns and reservations
are different women with different backgrounds, if about the method. The most common concern was
this could help women, like those people that are the fear of adverse side effects and complications.
doing abortion, unsafe abortion, I think it could There was a worry expressed by some women that
work…” (P14) they would not be able to reach health services
either because they did not want to disclose what
The majority (65%) of women would choose they were doing to others, or because they were
medical abortion as a method if it were available, unable to readily access health facilities. They were
accessible, and affordable. Reasons women afraid of what would happen if there were
preferred medical abortion fell into several broad

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complications and they did not know how to handle Discussion

them. There is no proclaimed “best method” for
A lack of financial resources was another barrier termination of pregnancy; it is highly dependent on
reported to accessing medical abortion. individuals and various local, regional, national, and
Young women who fall pregnant are most often international contexts. Termination of pregnancy
not financially independent. Further those women services should take into account why women have
who are falling unexpectedly pregnant and are abortions, the context in which these decisions are
unaware of the abortion legislation, specifically the being made, and women’s preferences. Unlike
fact that abortion services are free in public surgical abortion, midlevel providers, which include
hospitals, often turn to methods outside of health nurses, physician assistants, family planning workers,
facilities. and midwives, can be trained to provide early
medical abortion services (Berer, 2009). It could also
Some women felt that follow-up visits would not contribute to fulfilling women’s sexual and
always be carried out, and therefore the method reproductive health rights, providing more choices
would not be effective, and as a result, unsuitable for to best suit their needs. Generalizing the findings of
women in South Africa. In addition, systemic this study must be done cautiously as the results are
concerns about the health system and transport not applicable to the general population because it is
system were raised. The public transport system based on a small sample of young women. In
makes it difficult in some areas to reach a hospital or addition, it was based on a sample of women willing
clinic easily. to talk about abortion and their experiences, which
limits the study to particular social networks. In
“But you know, the problem with public hospitals is addition, while the university setting holds a diverse
that people never do follow-ups I think I would be a population, it lacks the opinions of women from a
bit skeptical. Because people might not do the broader range of backgrounds. Despite these
follow-up or finish their medications, and that would limitations the study does give important insights
cause problems because I do not think our clinics or into the perspectives of young women with regard
our health care can actually have the capacity to deal to termination of pregnancy.
with what is going out, giving pills and making sure The findings reveal that decisions around
that people take them and come back and what termination of pregnancy are complex and involve a
not.” (P2) variety of factors. The majority of women recognize
that it is a context-driven choice and it is likely that
A few women raised concerns that medical they would have to make a decision when
abortion would end up being “too accessible” to confronted with an unintended pregnancy.
women and abortion would be made “too easy”. Consistent with other findings, women often have
The majority of women were against abortion, ambivalent attitudes toward abortion (Hessini, 2005;
except under certain circumstances, so a few of Patel & Myeni, 2008). While the majority of women
these women mentioned that if abortion methods say that they are against abortion, there are certain
were made too available to women, some would circumstances in which abortion is justifiable.
take advantage of this method and neglect other Understanding the complex nature of these
measures of preventing pregnancy. There is the decisions makes it impossible to predict women’s
concern that medical abortion would be used as a behaviors when faced with an unintended
contraceptive method to prevent an unplanned pregnancy. Therefore measures should be taken to
pregnancy. There were also concerns about the ensure that all options are available to suit women’s
regulation of the medication among providers. needs during these difficult moments when decisions
There was a fear that it could be taken outside of need to be made.
health facilities and contribute to the reported In general the barriers to accessing abortion
existing market of illegal abortion providers. noted in this study: social stigma; finances; and
However, there was a general consensus that negative attitudes of health professionals are
choices such as medical abortion should be available, consistent with findings from previous studies
accessible, and affordable for women in South (Cooper et al., 2004; Hord & Wolf, 2004; Jewkes et
Africa. al., 2005). These barriers often contribute to a high

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prevalence of unsafe abortions. Despite the fact that to be acceptable to women, so the time is now to
it is over a decade since the legalization of introduce these services.
termination of pregnancy in South Africa, attitudes References
of health providers appear to not change; women Berer, M. 2009. “Provision of abortion by mid-level
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