OBJECTIVE: To investigate whether the free availability of contraception affects the need for termination of pregnancy (TOP). DESIGN: Case-control study. SETTING: South African rural hospital. POPULATION: Three thousand and ninety-five TOP seekers and 439 non-pregnant controls. METHODS: Structured questionnaire followed by ultrasonography. MAIN OUTCOME MEASURES: Current use or recent discontinuation of contraception and the reason for discontinuation. RESULTS: Less than one-third (28.6%) of TOP seekers claimed to be using contraception versus 85.0% of controls. Injectable contraception (IC) was preferred by the controls and oral contraception (OC) by TOP seekers (chi 2 = 48.5, p < 0.0001, OR 0.34 (95% confidence interval 0.25, 0.46)). The percentage of discontinuation of hormonal contraception was higher in controls (chi 2 = 6.3, p = 0.012, OR 0.51 (0.31, 0.85)). The reason for discontinuation of hormonal contraception was obtained from 31.2% of TOP seekers and 63.3% of controls; no reason for discontinuation was acknowledged by 30.1% of the former and 6.3% of the latter (chi 2 = 33.4, p < 0.0001, OR 6.40 (3.25, 12.56)). Side-effects of hormonal contraception prompted more discontinuation in the failed-contraception group (chi 2 = 120.5, p < 0.0001, OR 49.4 (21.6, 112.5)). Poor compliance and absence of an acknowledged reason for discontinuing hormonal contraception resulted in 173 unwanted pregnancies. CONCLUSION: In South Africa two main components of women's reproductive health and rights are freely available, namely contraception and TOP. Not using contraception is one of the main causes of unwanted pregnancy. Better education of both service providers and users is needed to improve use, compliance and perseverance with contraception.

Abortion, Induced↗

PubMed2002

Comments on the Thandi case.

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Abortion, Legal↗

PubMed2002

The limits of conscientious objection to abortion in the developing world.

The South African Choice on Termination of Pregnancy Act 92 of 1996 gives women the right to voluntary abortion on request. The reality factor, however, is that five years later there are still more 'technically illegal' abortions than legal ones. Amongst other factors, one of the main obstacles to access to this constitutionally enshrined human right is the right to conscientious objection/refusal. Although the right to conscientious objection is also a basic human right, the case of refusal to provide abortion services on conscientious objection grounds should not be seen as absolute and inalienable, at least in the developing world. In the developed world, where referral to another service provider is for the most part accessible, a conscientious objector to abortion does not really put the abortion seeker's life at risk. The same cannot be said in developing countries even when abortion is decriminalised. This is because referral procedures are fraught with major obstacles. Therefore, it is argued that the right to conscientious objection to abortion should be limited by the circumstances in which the request for abortion arises.

Abortion, Illegal↗

PubMed2002

The state attitude to antiretroviral treatment--the doctor's duty to speak out.

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Anti-HIV Agents↗