Despite having one of the most progressive abortion laws in the world, access to safe abortion services is still a challenge for many people across South Africa. A variety of factors affect access to safe abortion including stigma, location, service quality, lack of trained health personnel, and lack of information on the law or where to access services. In partnership with the National Department of Health (NDOH), the goal of this project was to assess knowledge of the Choice on Termination of Pregnancy Act (CToP), as well as respondents’ access to, and experience with utilising sexual reproductive health (SRH) services in South Africa, as well as their experiences with unplanned pregnancy and abortion. The study followed a mixed method approach and was conducted in two phases which focused on different age groups and geographic locations.
Phase 1: National adult SRH study
The first phase of the project began in 2020 and focused on participants aged 18-49, across all nine provinces in the country. The quantitative arm of the study consisted of a survey completed by 2,700 respondents, administered either telephonically by a data collector or self-completed online. For the qualitative arm of the study, 25 in-depth interviews were conducted telephonically with a sample of respondents who reported an undesired pregnancy and/or an abortion in the quantitative survey. We carried out an additional 18 in-depth interviews virtually with key stakeholders involved in the provision of abortion services across all nine provinces, who were recruited using non-probability purposive sampling. These interviews explored the experiences of those accessing SRH services, as well as those providing abortion services in the public sector, in order to understand the factors that impact safe abortion care.
Phase 2: Provincial SRH study with younger adolescents
The second phase of the study started in 2022 and focused on young adolescents, aged 12-17, who resided in the Gauteng province. The data collection for both the survey and in-depth interviews were conducted in-person from partner offices throughout Gauteng. Quantitative data was collected from 236 participants using an interviewer administered quantitative survey. Participants who reported either an unplanned pregnancy or an abortion during the survey were recruited for in-depth interviews using non-probability convenience and purposive sampling. Interviews were conducted with 10 participants using a semi-structured interview guide to explore their perceptions and experiences with seeking SRH services and/or undergoing an abortion.
Findings from phase 1 and phase 2 of this project are forthcoming. The findings will be used to develop a locally-relevant, rigorous evidence base to inform policy change and service delivery interventions, in order to expand access to safe abortion and other SRH services in the public sector, with an emphasis on effective implementation of the CToP Act and abortion guidelines.