Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal
Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal
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DOI：
10.1093/heapol/15.4.424
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发表时间：
2000-12-01
影响因子：
3.2
通讯作者：
Wilkinson, D
中科院分区：
文献类型：
--
作者：
Harrison, A;Montgomery, ET;Wilkinson, D
引言：南非的《终止妊娠法》是非洲最自由的堕胎法，于1997年初生效。然而，尽管预期对妇女健康有好处，公众的反应却褒贬不一。在该国人口最多的省夸祖鲁/纳塔尔省，反对势力很强，大多数保健提供者拒绝提供这项服务。本研究探讨了农村地区初级保健护士和社区成员对堕胎和终止妊娠法的态度和信念，以便更好地了解实施新法律的障碍。方法：作为妇女生殖健康社区调查的一部分（n = 138），询问了有关堕胎的知识、态度和信仰以及对《终止妊娠法》条款的了解情况。为了更好地了解卫生保健工作者的观点，对值班的初级保健护士（n = 25）也进行了调查。我们与护士和社区妇女进行了深入访谈，以进一步探讨两次调查中提出的问题。结果：社区成员和护士对该法案的支持率都很低（11%），很少有人支持堕胎（分别为18%和6%）。然而，在每个群体中，都观察到明确的支持等级：大多数护士（56%）和社区成员（58%）支持在强奸或乱伦的情况下堕胎，或者如果继续怀孕会危及妇女的健康（分别为61%和56%），但很少有人支持出于社会或经济原因堕胎。深度访谈显示，堕胎被视为违反普遍的社区规范；护士对终止妊娠法知之甚少，对自己的职业责任感到困惑。结论和建议：仅靠合法化不能确保堕胎服务的实施。在南非，在通过该法律之前，媒体进行了广泛的报道，确保了几乎人人都了解该法案，但与此同时很少进行公共教育。然而，尽管普遍反对这项法律，但在某些情况下对堕胎的支持程度令人鼓舞。这些发现表明，即使在保守的农村地区，堕胎服务也可以实施，但在实施之前，信息传播和社区同意的过程至关重要。将堕胎纳入更广泛的生殖健康服务可能是改善获得和可接受性的有效途径。
Introduction: South Africa's Termination of Pregnancy Act, the most liberal abortion law in Africa, took effect early in 1997. in spite of the anticipated benefits to women's health, however, public reaction has been mixed. In the country's most populous province, KwaZulu/Natal, opposition is strong and most health care providers have refused to provide the service. This study explored attitudes and beliefs about abortion and the Termination of Pregnancy Act among primary care nurses and community members in a rural district in order to better understand barriers to implementation of the new law.Methods: As part of a community survey on women's reproductive health (n = 138), questions on knowledge, attitudes and beliefs about abortion were asked, as well as awareness of the provisions of the Termination of Pregnancy Act. To better understand the perspectives of health care workers, a survey among primary care nurses on duty (n = 25) was also conducted. In-depth interviews were conducted with both nurses and women in the community to further pursue issues raised in the two surveys.Results: Support for the Act was low (11%) among both community members and nurses, and few supported abortion on request (18 and 6%, respectively). Within each group, however, a clear hierarchy of support was observed: a majority of nurses (56%) and community members (58%) supported abortion in the case of rape or incest, or if the continued pregnancy would endanger a woman's health (61 and 56%, respectively), but few supported abortion for social or economic reasons. In-depth interviews revealed that abortion is seen as contrary to prevailing community norms; nurses were poorly informed about the Termination of Pregnancy Act and felt confused in their professional responsibilities.Conclusions and recommendations: Legalization alone cannot ensure implementation of abortion services. In South Africa, extensive media coverage prior to passage of the law ensured almost universal awareness of the Act, but little public education took place at the same time. In spite of general opposition to the law, however, there is an encouraging level of support for abortion in some circumstances. These findings suggest that abortion services can be implemented, even in conservative rural areas, but that a process of information dissemination and community consent prior to implementation is essential. Locating abortion within broader reproductive health services could be an effective way to improve access and acceptability.