Despite South Africa having one of the most progressive abortion laws in the world, unsafe and illegal abortions remain a significant public health problem. Multiple barriers to abortion care provision exist including provider conscientious objection, stigma, healthcare provider shortages, lack of trained providers, and a lack of designated facilities providing abortion services.
In partnership with the Western Cape Department of Health (WCDOH), the RCOG Leading Safe Choices (LSC) programme seeks to improve access to abortion services within the Western Cape by increasing the number of providers willing and able to provide Comprehensive Abortion Care (CAC) services; improving the quality of post abortion family planning counselling and provision; and raising the standing of abortion care professionals. The programme trains and mentors mid-level health care providers (HCPs) in CAC.
Early on in the LSC programme it became clear that although training interventions can make a localised impact in relation to increasing skilled providers and improving quality of abortion care, the overall impact was being hindered by the prevalence of conscientious objection at senior management levels; the failure of the WCDOH to hold designated facilities accountable if they failed to provide CAC services; blockages in the referral pathway of patients and a lack of understanding of multi-disciplinary teams to provide CAC services as women’s rights enshrined in the Choice on Termination of Pregnancy Act and the constitution of South Africa.
In partnership with the WCDOH and using lessons learnt during the programme, a CAC Optimization Strategy was implemented to tackle systems barriers and to improve abortion care services. Following its implementation uptake of CAC training has tripled and 11 new CAC sites have been established in the Western Cape.
This presentation will present the different elements of the Western Cape CAC Optimization Strategy and its vital role in improving CAC services within province.
Objectives: Major barriers in accessing abortion services for women include provider opposition, stigma associated with abortion, poor knowledge of abortion legislation, lack of trained providers, and lack of fully equipped facilities. Many providers display negative and judgemental attitudes towards women, with reports of attempts to dissuade women from undergoing an abortion. The Leading Safe Choices (LSC) programme trains and mentors mid-level HCPs in comprehensive abortion care (CAC) with a focus on surgical abortion. However, recruitment of participants for CAC training proved challenging.
Methods: Values Clarification Workshops (VCWs) were conducted with multidisciplinary HCPs and facility managers.
The objectives of the VCWs included exploring assumptions, myths and realities about unwanted pregnancy; providing accurate legal information about abortion; and understanding the difference between personal views and professional responsibilities. Between March 2017 and March 2018, 18 VCWs were conducted with 272 participants.
Results: Uptake of CAC training increased with the introduction of VCWs. In the 15 months prior to the introduction of VCWs (December 2015 to February 2017), 35 providers attended CAC training with 5 being signed off as competent to provide services. In the 12 months following the introduction of VCWs (March 2017 – March 2018) the number of CAC trainees increased to a total of 81 with 19 being signed off as competent after receiving mentorship at their facilities. Since the introduction of VCWs, 11 new CAC sites have been established in the Western Cape. We suggest that VCWs have contributed to this.
Conclusion: Increased uptake of CAC training suggests VCWs have led to improvements in the provision of, and access to, abortion care services. VCWs should be conducted with multidisciplinary teams including facility managers and attendance at VCWs should be a pre-requisite for undertaking CAC training to enable health care providers to offer holistic, respectful and woman centred abortion care.