What are the barriers to the implementation of the Choice on Termination of Pregnancy Act 92, 1996 as amended, in Xhariep District in the Free State Province? : a view of doctors, nurses, and hospital management in three district hospitals in Xhariep.

Abstract

Background The Choice on Termination of Pregnancy Act (CTOPA) No 92 of 1996 replaced the Abortion and Sterilization Act of 1975. It promotes reproductive rights and the choice on termination of pregnancy. It aims to reduce deaths resulting from illegal abortions. It designates District Hospitals and Community Health Centres to render Termination of Pregnancy (TOP). In the Free State there are 24 District Hospitals and ten Community Health Centres. Currently nine render TOP. None are in Xhariep District. Aim of the study The study investigated barriers to the implementation of the CTOPA in Xhariep District among doctors, nurses and managers in District Hospitals. Methodology It was descriptive in nature, and was divided into the quantitative and qualitative parts. The quantitative part targeted doctors and nurses, while thelatter targeted management. The response rate was 95%. Findings The findings are summarised below:-  Ninety five per cent of the respondents were nurses.  Infrastructural and human resource deficiencies are a barrier to the implementation of the act.  There are insufficient budgets to procure equipment, consumables and pharmaceuticals to render the service.  Training on reproductive health and TOP is not sufficient, except for family planning.  There is stigma towards TOP from the community, and peers. Its origin is religion and culture.  There is no psychosocial and management support for those willing to participate in TOP.  Respondents are willing to refer patients for TOP, and believe that women are entitled to choose whether to terminate unwanted pregnancies or not.  There are no incentives to for those willing to implement the Act, nor provincial support to the Districts. Recommendations  Train staff on reproductive health and TOP.  Hold management accountable by including TOP and the reproductive health package in their performance agreements.  Negotiate incentives for those willing to implement TOP, and recogniseTOP as a speciality in line with the Occupation Specific Dispensation.  Provide infrastructure and equipment for the implementation of TOP.  Develop a recruitment and retention strategy for professionals. The policy on community service for health professionals is a case in point.  Resource the District Health System as a vehicle for Primary Health Care Services.