July 15, 2008 – Ibis Reproductive Health, in collaboration with the Women’s Health Research Unit (WHRU) at the University of Cape Town, will soon finish the first phase of data collection in a research project that could reveal important information about abortion services in the Western Cape Province of South Africa. Funded by the Safe Abortion Action Fund managed by the International Planned Parenthood Federation, Ibis and WHRU are investigating ways to improve second trimester abortion services in South Africa.
Though South Africa has a model abortion law, barriers to access, including a shortage of providers, provider opposition, stigma associated with abortion, and a lack of providers trained to perform abortions and facilities certified to provide abortions, can result in women resorting to unsafe abortion. Additionally, these barriers lead to a high proportion of second trimester terminations, which are inherently more risky. In South Africa 30% of abortions are performed at a gestational age of greater than 12 weeks, while in the United States approximately 10% of abortions are performed in the second trimester. The high rate of second trimester abortion in South Africa is a public health concern, given that every additional week of gestational age increases the risk of serious complication or death.
In the first phase of the project, which is currently underway and scheduled to finish in July, Ibis and WHRU are collecting baseline data on women's knowledge and attitudes about second trimester abortion. We are interviewing women who have undergone second trimester abortion procedures in five public hospitals in the Western Cape Province; two of the facilities involved in the study use medical induction, and three use a surgical technique called dilation and evacuation to perform second trimester abortions. The interviews explore women's experiences with referrals, barriers to obtaining the procedure, women's experience with counseling, support, and pain management available before, during, and after the procedure, and the specifics of the procedures the women undergo. So far, we have completed 219 interviews of a target of 250. In this first phase we will also interview staff at all five facilities to assess their opinions and attitudes regarding current service provision and the possibilities for expanding or improving second trimester abortion services.
These interviews are the first part of a larger project with an overall goal to improve access to high-quality second trimester termination services in the Western Cape Province of South Africa and create a model of care that could be scaled up on a national level. Eventually, Ibis also hopes to use this project as a stepping stone to a study which would randomize women seeking abortion in the second trimester in South Africa to a medication or surgical method. This research is crucial because there is very little clinical and acceptability evidence directly comparing surgical and medical methods of second trimester abortion.
Ibis's office in Johannesburg is uniquely situated to lead groundbreaking research like this study on second trimester abortion. We are also involved in a number of other projects in South Africa, including participating in a coalition of partners working to increase access to medication abortion and a project to improve sexual and reproductive health services for young women in Soweto, South Africa.