Harrison A, Montgomery E T, Lurie M, Wilkinson D
Centre for Epidemiological Research in South Africa (CERSA)/Hlabisa, Medical Research Council, Mtubatuba, South Africa.
Health Policy Plan. 2000 Dec;15(4):424-31. doi: 10.1093/heapol/15.4.424.
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.
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.
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.
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.
南非的《终止妊娠法》是非洲最宽松的堕胎法律，于1997年初生效。然而，尽管预计该法律会给女性健康带来益处，但公众的反应却褒贬不一。在该国人口最多的夸祖鲁-纳塔尔省，反对声强烈，大多数医疗服务提供者拒绝提供堕胎服务。本研究探讨了农村地区基层护理人员和社区成员对堕胎及《终止妊娠法》的态度和看法，以便更好地理解新法律实施的障碍。
作为一项关于妇女生殖健康的社区调查（n = 138）的一部分，询问了有关堕胎的知识、态度和看法，以及对《终止妊娠法》条款的知晓情况。为了更好地了解医护人员的观点，还对值班的基层护理人员进行了调查（n = 25）。对护士和社区女性进行了深入访谈，以进一步探讨两项调查中提出的问题。
社区成员和护士对该法律的支持率都很低（11%），很少有人支持按需堕胎（分别为18%和6%）。然而，在每个群体中，都观察到了明确的支持等级：大多数护士（56%）和社区成员（58%）支持在强奸或乱伦情况下堕胎，或者如果继续妊娠会危及女性健康时堕胎（分别为61%和56%），但很少有人支持出于社会或经济原因堕胎。深入访谈显示，堕胎被视为违背社区现行规范；护士对《终止妊娠法》了解甚少，对自己的职业责任感到困惑。
仅靠合法化并不能确保堕胎服务的实施。在南非，法律通过前的广泛媒体报道确保了几乎所有人都知晓该法律，但与此同时几乎没有进行公众教育。然而，尽管总体上反对该法律，但在某些情况下对堕胎的支持程度令人鼓舞。这些研究结果表明，即使在保守的农村地区也可以实施堕胎服务，但实施前的信息传播和社区认可过程至关重要。将堕胎纳入更广泛的生殖健康服务中可能是提高可及性和可接受性的有效途径。
