Making care more accessible in South Africa: The introduction of medical abortion

Wednesday, August 27, 2014

young women

South Africa’s national abortion guidelines say women are entitled to accessible, equitable abortion care at state facilities. But many women aren’t able to get care because fewer than 50 percent of the public-health facilities licensed to provide abortion care are actually providing services.

Against this backdrop, Ipas began working with South Africa’s National Department of Health to introduce medical abortion, or abortion with pills, in the provinces of Eastern Cape, Northern Cape, North West and Free State. Because medical abortion (using a regimen of mifepristone and misoprostol) can be started at a clinic and then completed in a woman’s own home or other setting of her choosing, health facilities with limited space and staffing can increase the number of women they serve and still provide high-quality, respectful care.

“Before [medical abortion], there were a lot of women [wanting services] and some would find that they would go over their designated dates and then we couldn’t help them,” says one of the Eastern Cape providers who received Ipas training. “We are now able to help more people.”

To facilitate the introduction of medical abortion, Ipas provided extensive training and support for providers at 26 selected public facilities, using a provider support model designed to ensure continuous and individualized technical and emotional support both during and after the training. From 2012-2014, Ipas clinically trained almost 250 providers, who in turn were able to provide almost 12,000 women with medical abortion services.

An Ipas-trained provider at a clinic in Eastern Cape recalls that she had little in the way of support before Ipas arrived. “The support I received was from my immediate supervisor, but the facility management knew nothing about abortions even though they were offered here. Now that Ipas is involved, they have picked up the standard.”

Research affirms women’s satisfaction with medical abortion

From 2009-2011, Ipas, Ibis Reproductive Health and the University of KwaZulu-Natal introduced medical abortion in public facilities in KwaZulu-Natal Province and assessed the impact on providers and on women’s abortion care choices.

During the two-year period, 923 women presented for early abortion at the facilities included in the study. Nearly all of the eligible women (94 percent) chose medical abortion, while only six percent chose manual vacuum aspiration—illustrating clearly the popularity of this method. In addition, more women in the medical abortion group said they would choose that method again if needed, and said they’d recommend it to a friend.

“Abortion providers in this study also reported that offering medical abortion allowed them to serve more women and eased their workload,” explains Tamara Fetters, Ipas senior research and evaluation advisor. “Introducing this method clearly helps improve women’s access to safe abortion.”

SMS text messages help women access medical abortion

In 2012, Ipas conducted a baseline survey and focus group discussions with women in South Africa to see how they preferred to access information about sexual and reproductive health, including safe abortion. Many of the women, especially young women, said that abortion was highly stigmatized in their communities and they felt ashamed to ask questions about sexual and reproductive health issues.

To help overcome this barrier to care, Ipas collaborated with other partners to host a mobi-site (a website optimized for viewing on mobile phones) called “I Choose When.” The site provides detailed information on a range of sexual and reproductive health issues including contraceptive methods, abortion, sexually transmitted infections, and where to access health services. Since the mobi-site launched in March 2012, almost 600,000 users have visited the site. More than 80,000 of these visits were related to abortion information, making it the second-most popular topic on the site.

To support women who chose to use medical abortion, Ipas created a system for sending informational text messages to South African women who desired this service. Upon starting the medical abortion at a health facility, women received a series of text messages timed to tell them when to take the pills, what to do in the event of complications, and how to access family planning. Since January 2013, almost 1,700 women have signed up to receive these supportive text messages. In a follow-up survey with 67 women who had signed up for the messages, 100 percent said they were helpful, 63 percent said the information was well timed, and 50 percent said the messages answered a question they had.

Note: Ipas is now closing its South Africa office, but will continue to work collaboratively with South African partners to advance the cause of safe, accessible and affordable abortion care.