PDF(Pubmed)
Abstract：
BACKGROUND: Pregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18-28 years, and ii) factors characterising the decision to terminate.
METHODS: In-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach.
RESULTS: An application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants\' decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants\' decisions through detrimental changes in interpersonal support and financial situation.
CONCLUSIONS: Amongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women\'s needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.
In South Africa, where the number of unintended pregnancies is high, we need an improved understanding of the main reasons why women terminate their pregnancies and what factors characterise this decision. Aside from individual factors, this should also be seen within the context of their environment, including relationships, community, and institutions. We therefore aimed to explore women’s reasons for choosing to terminate their pregnancy through semi-structured in-depth interviews with participants. We included ten participants from Soweto, South Africa, who had undergone a pregnancy termination. The main reasons for terminating a pregnancy had to do with personal factors and reasons related to their social relationships and support. These included financial insecurity, not feeling ready to have a child (again), and lack of support from family or partners. We also found factors that characterised how the participant experienced the decision, such as barriers to getting a safe (legal) pregnancy termination. We found that amongst South African women, the decision to terminate is made in the context of their complex (social) environment. Insight into the reasons why women choose to terminate helps to better align legal termination services with women’s needs, for example by reducing judgement within healthcare settings and improving access to social and mental health support.
METHODS: In-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach.
RESULTS: An application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants\' decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants\' decisions through detrimental changes in interpersonal support and financial situation.
CONCLUSIONS: Amongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women\'s needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.
In South Africa, where the number of unintended pregnancies is high, we need an improved understanding of the main reasons why women terminate their pregnancies and what factors characterise this decision. Aside from individual factors, this should also be seen within the context of their environment, including relationships, community, and institutions. We therefore aimed to explore women’s reasons for choosing to terminate their pregnancy through semi-structured in-depth interviews with participants. We included ten participants from Soweto, South Africa, who had undergone a pregnancy termination. The main reasons for terminating a pregnancy had to do with personal factors and reasons related to their social relationships and support. These included financial insecurity, not feeling ready to have a child (again), and lack of support from family or partners. We also found factors that characterised how the participant experienced the decision, such as barriers to getting a safe (legal) pregnancy termination. We found that amongst South African women, the decision to terminate is made in the context of their complex (social) environment. Insight into the reasons why women choose to terminate helps to better align legal termination services with women’s needs, for example by reducing judgement within healthcare settings and improving access to social and mental health support.
摘要：
背景：终止妊娠是生殖保健的重要组成部分。在南部非洲,估计有23%的妊娠终止妊娠,在意外怀孕和不安全终止妊娠率很高的背景下，这有助于孕产妇发病率和死亡率。如果从人际关系（包括家庭，同行,andpartner),社区,机构,和公共政策因素。因此，本研究旨在利用社会生态框架进行定性探索，在索韦托,南非,i）18-28岁女性终止妊娠的原因，和ii)终止决定的特征因素。
方法：在2022年2月至3月之间对10名不同均等的参与者进行了深入访谈，自从参加Bukhali试验以来，他已经终止了妊娠，设置在索韦托，南非。半结构化，深度采访指南，基于社会生态领域，被使用。使用反身性主题分析对数据进行了分析，和演绎的方法。
结果：社会生态框架的应用表明，终止妊娠的直接原因属于社会生态框架的个人和人际领域。主要原因包括财政依赖和不安全，感觉没有准备好有一个孩子（再次），以及缺乏家人和伴侣对参与者及其怀孕的支持。除了这些原因,在所有社会生态领域中确定了表征参与者决策经验的因素，包括社会支持的可用性和（缺乏）获得终止服务的机会。COVID-19大流行和由此产生的封锁政策也通过人际支持和财务状况的不利变化间接影响了参与者的决策。
结论：在这项研究中包括的南非妇女中，终止妊娠的决定是在复杂的结构和社会背景下做出的.深入了解女性选择终止服务的原因有助于更好地将法律终止服务与多个部门的女性需求保持一致。例如，通过减少医疗保健环境中的判断力，改善获得社会和心理健康支持的机会。
在南非,意外怀孕的数量很高，我们需要更好地了解妇女终止妊娠的主要原因以及这一决定的特征是什么。除了个别因素，这也应该在他们的环境背景下看待，包括关系，社区,和机构。因此，我们旨在通过与参与者的半结构化深入访谈来探索女性选择终止妊娠的原因。我们包括了来自索韦托的十名参与者,南非,经历过终止妊娠的人。终止妊娠的主要原因与个人因素以及与其社会关系和支持有关的原因有关。其中包括金融不安全，不准备有一个孩子（再次），缺乏家人或伴侣的支持。我们还发现了表征参与者如何体验决定的因素，例如获得安全（合法）终止妊娠的障碍。我们发现在南非女性中,终止的决定是在他们复杂的(社会)环境中做出的。深入了解妇女选择终止合同的原因有助于使合法终止合同服务更好地符合妇女的需求，例如，通过减少医疗保健环境中的判断力，改善获得社会和心理健康支持的机会。
方法：在2022年2月至3月之间对10名不同均等的参与者进行了深入访谈，自从参加Bukhali试验以来，他已经终止了妊娠，设置在索韦托，南非。半结构化，深度采访指南，基于社会生态领域，被使用。使用反身性主题分析对数据进行了分析，和演绎的方法。
结果：社会生态框架的应用表明，终止妊娠的直接原因属于社会生态框架的个人和人际领域。主要原因包括财政依赖和不安全，感觉没有准备好有一个孩子（再次），以及缺乏家人和伴侣对参与者及其怀孕的支持。除了这些原因,在所有社会生态领域中确定了表征参与者决策经验的因素，包括社会支持的可用性和（缺乏）获得终止服务的机会。COVID-19大流行和由此产生的封锁政策也通过人际支持和财务状况的不利变化间接影响了参与者的决策。
结论：在这项研究中包括的南非妇女中，终止妊娠的决定是在复杂的结构和社会背景下做出的.深入了解女性选择终止服务的原因有助于更好地将法律终止服务与多个部门的女性需求保持一致。例如，通过减少医疗保健环境中的判断力，改善获得社会和心理健康支持的机会。
在南非,意外怀孕的数量很高，我们需要更好地了解妇女终止妊娠的主要原因以及这一决定的特征是什么。除了个别因素，这也应该在他们的环境背景下看待，包括关系，社区,和机构。因此，我们旨在通过与参与者的半结构化深入访谈来探索女性选择终止妊娠的原因。我们包括了来自索韦托的十名参与者,南非,经历过终止妊娠的人。终止妊娠的主要原因与个人因素以及与其社会关系和支持有关的原因有关。其中包括金融不安全，不准备有一个孩子（再次），缺乏家人或伴侣的支持。我们还发现了表征参与者如何体验决定的因素，例如获得安全（合法）终止妊娠的障碍。我们发现在南非女性中,终止的决定是在他们复杂的(社会)环境中做出的。深入了解妇女选择终止合同的原因有助于使合法终止合同服务更好地符合妇女的需求，例如，通过减少医疗保健环境中的判断力，改善获得社会和心理健康支持的机会。
