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Abortion Care Services Provided by Registered Midwives in South Africa

Kim Dickson-Tetteh and Deborah L. Billings
International Family Planning Perspectives
Vol. 28, No. 3 (Sep., 2002), pp. 144-150
Published by: Guttmacher Institute
DOI: 10.2307/3088257
Stable URL:
Page Count: 7
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Abortion Care Services Provided by Registered Midwives in South Africa
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Context: South Africa's Choice on Termination of Pregnancy Act, which took effect in 1997, legalized abortion and stipulated that registered midwives can perform abortions for women with pregnancies of no more than 12 weeks' gestation. A program was initiated to train registered midwives throughout South Africa to provide abortion services at primary care facilities. Methods: From October 1999 through January 2000, an evaluation was conducted at 27 public health care facilities in South Africa's nine provinces to assess the quality of care provided by midwives who had been trained and certified to provide abortion services. Data were collected by observing abortion procedures and counseling sessions, reviewing facility records and patients' charts, and interviewing patients and certified midwives. Results: Of 96 abortion procedures performed by 40 midwives, 85 involved manual vacuum aspiration. Midwives' clinical practice was rated "good" in 75% of the procedures. No complications occurred during abortion procedures or as a result of the procedures, and no abortion clients died. Midwives consistently provided women with contraceptive counseling after the abortion, and most clients (89%) received a contraceptive method before leaving the facility. The injectable was the only method that was available at all facilities; of the 90 clients who were interviewed about the contraceptive method they received after their abortion, 75% had received this method. Few had received condoms (1%). Conclusions: Midwives can provide high-quality abortion services in the absence of physicians. Training in abortion care should be systematically integrated into midwives' basic training. This training should use postabortion counseling as an opportunity to inform women about dual protection from unwanted pregnancy and sexually transmitted infections.

Notes and References

This item contains 7 references.

  • 1
    Choice on Termination of Pregnancy, Act No. 92, Nov. 12, 1996, art. 2(b).
  • 2
    Rees H et al., The epidemiology of unsafe abortion in South Africa, South African Medical Journal, 1997, 87(4):432-437.
  • 3
    Dickson-Tetteh K and Rees H, Efforts to reduce abortion-related mor- tality in South Africa, in: Berer M and Ravindran TK, eds., Safe Moth- erhood Initiatives: Critical Issues, Oxford: Blackwell Science, 1999, pp. 198-219.
  • 4
    This reference contains 2 citations:
    • Varkey SJ, Abortion services in South Africa: available yet not acces- sible to all, International Family Planning Perspectives, 2000, 26(2):87-88
    • Althaus FA, Work in progress: the expansion of access to abortion services in South Africa following legalization, International Family Plan- ning Perspectives, 2000, 26(2):84-86
  • 5
    This reference contains 2 citations:
    • Department of Health, Republic of South Africa, Termination of preg- nancy, Epidemiological Comments, 1998, 24(3):2
    • Reproductive Rights Alliance, Directory of designated services, Barometer, 1998, 2(1): 30-31
  • 6
    Marais T, Abortion values clarification workshops for doctors and nurses, HST Update, 1997, No. 21
  • 7
    Dickson-Tetteh K et al., Abortion Care Manual: A Guide for the Train- ing of Registered Midwives in Termination of Pregnancy, Management of Incomplete Abortions and Related Reproductive Health Matters, Johan- nesburg, South Africa: Reproductive Health Research Unit and Ipas, 1998.