Expanding women’s options: Scaling up medication abortion in public sector facilities in KwaZulu-Natal, South Africa

South Africa’s 1996 Choice on Termination of Pregnancy Act legalized abortion on request through 12 weeks’ gestation and for social, economic, or psychological reasons from 13-20 weeks. Legal abortion has reduced abortion-related morbidity and mortality, but barriers to access to legal services remain. Availability of medication abortion in free, public sector services might improve access, encourage women to attend services sooner, and increase the number of providers willing to provide abortion. In this study, we introduced medication abortion services in public sector facilities in KwaZulu-Natal Province, South Africa, and assessed the impact on abortion-seeking behavior and provision. Women who were eligible for medication abortion were given the choice of either medication or surgical termination of pregnancy (TOP). We collected data from clients and providers on their experiences with both surgical and medication abortion and the quality of the service, and we also monitored changes in demographic characteristics and the gestational ages of women seeking abortion in order to assess the impact of introducing medication abortion. Additionally, we asked providers about their attitudes toward medication abortion and impact of medication abortion on their decisions to provide abortion services. Finally, we tracked changes in TOP-related policy and/or practice at the facilities level.

In 2011, the National Department of Health told provinces they may begin rolling out medication abortion services in public sector clinics. We hope our results will help provinces seeking to introduce this service in the public sector.