New studies show benefits of increasing women’s access to medical abortion in South Africa

Tuesday, April 25, 2017

image of pills and South African flag

Even though abortion is legal in South Africa for a broad range of indications, many women still encounter barriers when trying to access safe abortion care. Medical abortion, or abortion with pills, is not available in all areas of South Africa and has the potential to greatly improve women’s abortion access.

Two new articles by researchers from Ibis Reproductive Health, Ipas, the University of Cape Town, King Dinuzulu Hospital, and the University of KwaZulu-Natal add to the growing body of evidence on abortion in South Africa in support of making medical abortion more accessible. 

The first study, “The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa,” published in PLOS ONE, estimates the costs to South Africa’s public health system of offering medical abortion with a combined regimen of mifepristone and misoprostol. The conclusion: Scaling up medical abortion access would not result in increased costs.

“There are concerns in South Africa about what is thought to be the high price of mifepristone,” says study lead author Naomi Lince-Deroche. Yet the study found that medical abortion with mifepristone was not more expensive than manual vacuum aspiration services, and because women preferred medical abortion, offering it alongside manual vacuum aspiration services might even result in cost savings to the public health system. 

“We should be offering women a choice of abortion method wherever possible,” Lince-Deroche says.

A companion study, “Accessing medical and surgical first-trimester abortion services: Women's experiences and costs from an operations research study in KwaZulu-Natal Province, South Africa,” published in Contraception, examines the experiences of women from the same cohort who accessed either first-trimester manual vacuum aspiration or medical abortion in public health facilities in KwaZulu-Natal. Findings reveal the many cost barriers to care: Women seeking abortion services had to pay for child care, transportation, a pregnancy test, sanitary pads, and/or pain medication. Some also missed work and lost income as a result of having their abortion.

The study’s authors determined that women’s costs could be lowered by:

  • Improving availability of pregnancy tests and other supplies, such as pain medication, in public health facilities
  • Allowing for telephone booking prior to arrival to reduce required travel to facilities
  • Reducing the number of required visits to reduce transportation costs
  • Providing manual vacuum aspiration on the same day rather than booking for a later date 
  • Eliminating the follow-up visit for medical abortion (The World Health Organization does not recommend a follow-up visit so long as the woman has received information about when to seek care for complications and had her contraceptive needs addressed.)
  • Increasing the number of facilities offering abortion services

“Addressing these barriers could reduce the persistence of unsafe abortion still prevalent in many parts of the country,” says author Tamara Fetters, senior research scientist at Ipas.