Ibis Reproductive Health

Improving second trimester abortion services in South Africa

With a grant from the International Planned Parenthood Federation-managed Safe Abortion Action Fund (SAAF), we are investigating women’s and providers’ knowledge and attitudes about second trimester abortion in South Africa. We are collecting data about the procedures used for second trimester abortion in several public hospitals and are working with the clinical and administrative staff of these facilities to improve services. In particular, we aim to introduce dilation and evacuation (D&E) and medical induction with mifepristone and misoprostol into these public sector hospitals.

There is very little evidence directly comparing surgical and medical methods of abortion, and biases about the methods frequently create additional barriers to safe abortion in settings that permit second trimester abortion for at least some indications. In addition, women’s opinions about which method is preferable have not been adequately explored. As part of the SAAF-supported work, we are conducting a pilot study of women seeking abortion after 13 weeks of gestation in South Africa to see if they would be willing to join a study where they would be randomized to a medication or surgical method. We expect that this pilot data will support our hypothesis that a randomized trial of medical versus surgical methods in the second trimester is feasible in South Africa. This is a critical clinical question that will have broad-reaching implications for policy, advocacy, and service activities in the future.

Expanding access to earlier abortion services (including medication abortion) can help to reduce the need for later abortion. But it is also critical that we work to improve access to high-quality second trimester services in South Africa. Limited access to poor-quality services forces women to obtain more dangerous abortions later in pregnancy or to use unsafe techniques, both of which contribute to maternal morbidity and mortality. We are currently exploring the barriers that prevent high-quality surgical second trimester abortion services from being widely provided in the public sector in two provinces in South Africa: Gauteng and the Western Cape. We are collecting qualitative information from current providers to understand the barriers that public and private sector providers face. We are also working to better understand barriers that affect government policy makers and staff managing public sector pregnancy termination services.

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