Challenges Related to the Structure of the Choice on Termination of Pregnancy Services in Public Health Facilities in the Tshwane District of Gauteng

Lillian Jabu Nkosi, Fhumulani Mavis Mulaudzi, Mmapheko Doriccah Peu


In 1997 South Africa legalised termination of pregnancy services for all women living within the country. It is now more than a decade since Choice on Termination of Pregnancy (CTOP) services have been implemented however, the state of the infrastructure of CTOP services in public health facilities is a cause for concern. The assessment of the quality of CTOP services in public health facilities has been seriously neglected. The objectives of the study were to assess, determine and evaluate the challenges related to the quality of the infrastructure of CTOP services in public health facilities. A quantitative, non-experimental cross-sectional survey design was used. The population comprised of facility/quality managers, registered professional nurses and midwives. A universal sampling method was used. Data was collected from healthcare professionals who were involved in procuring CTOP services. The public health facilities were assessed in terms of space adequacy, provision of privacy, availability of ablution facilities, rest room as well as human and material resources using the Donabedian model. It was found that insufficient provision was made to the infrastructure of public health facilities to accommodate the high demand for CTOP services. Structural challenges remain a barrier in meeting the objectives of the CTOP services. There is evidence of significant differences between the facility/quality managers versus the professional nurses regarding their response to space provided for rendering CTOP services. The study recommends the revitalisation of the structure of CTOP services to improve the quality rendered. (Afr J Reprod Health 2020; 24[1]: 106-114).

Full Text:



Statistics South Africa. Sustainable Development Goals:

Baseline Report 2017. Pretoria, South Africa: Statistics South Africa. p. 86. ISBN: 978-0-621-45888-6

Gmeiner AC, van Wyk S, Poggenpoel M and Myburgh

CPH. Support for nurses directly involved with women who choose to terminate a pregnancy. Curationis 2000(March):70-1.

Donabedian A. An introduction to quality assurance in

health care. New York: Oxford University Press; 2003. pp. 46-53.

Turner KL, Pearson E, George A and Anderson KL.

Values clarification workshop to improve abortion knowledge, attitude and intentions: a pre-post assessment in 12 countries. Reproductive Health 2018; 15:2. 186/s12978-018-0 480 0/

Republic of South Africa. South African Council

Nursing Act No. 33 of 2005. Pretoria, South Africa: Government Printer.

Lebese MV. A phenomenological study of the

experiences of nurses directly involved with termination of pregnancies in the Limpopo province [Dissertation]. University of South Africa, Pretoria, South Africa, 2009. 115 pp.

Mhlanga RE. Abortion: developments and impact in

South Africa. Br Med Bull 2003; 67:115-26.

Adindu A. Assessing and assuring quality of health care

in Africa. African Journal of Medical Sciences 2010; 3(1):31-6. ISSN 2141-0151.

UNDP/UNFPA/WHO/World Bank. Special programme

of research, development and research training in human reproduction. World Health Organization 1999. Geneva, Switzerland.

Kajonius PJ and Kazemi A. Structure and process quality

as predictors of satisfaction with elderly care. Health and Social Care in the Community 2016;24(6)

Manyisa ZM and van Aswegen EJ. Factors affecting

working conditions in public hospitals: a literature review. International Journal of Africa Nursing Science 2017; 6:28-38.

World Health Organization. Sexual health, human rights

and the law. World Health Organization 2015. Geneva, Switzerland.

Nguyên MH, Gammeltoft T and Rasch V. Situation

analysis of quality of abortion care in the main maternity hospital in Ha ˛i Phòng Viet Nam. Reproductive Health Matters 2007:176.

Pickles C. Lived experiences of the choice on termination

of pregnancy Act 92 of 1996: bridging the gap for women in need South Africa. African Journal of Human Resources 2013:518.

Frederico M, Michielsen K, Arnaldo C and Decat P.

Factors influencing abortion decision-making processes among young women. International Journal of Environmental Research and Public Health 2018 https://doi:org/10.3390/ijerph15020329

World Health Organization. Natural ventilation for

infection control in health-care settings. World Health Organization 2009. Geneva, Switzerland.

Reeves LM, Priest, PS and Poore MR. School toilets:

facilitating hand hygiene? A review of primary school hygiene in a developed country. Journal of Public Health 2012 34(4):483-88.

Crous P, Haarhoff J and Buckley CA. Water demand

characteristics of shared water and sanitation facilities: experiences from community ablution blocks in eThekwini Municipality, South Africa. Water SA 2013; 39(3):361.

World Health Organization. Essential environmental

health standard in health care. World Health Organization 2008. Geneva, Switzerland. p.32.

Fink A. How to ask survey questions. 2nd ed. United

Kingdom: Sage Publications; 2003:1-2.

Creswell JW. Research design: qualitative, quantitative,

and mixed methods approaches. 3rd ed. USA: Sage Publications; 2009:146.

Farthing K. Succession planning: the right people in the

right positions at the right time. Am J Hosp Pharm 2013(March);48(3):175-6. https://doi:org/10.1310/hpj4803-175

Czabanowska K, Domagala A, Kalaitzi S, Krogulec A,

Burazeri G and Babich S. Exploring the added value of women health care managers in Poland. Mater Sociomed 2017(Dec); 29(4):280-5. https://doi:org/10.5455/msm.2017.29.280-285

Phillips T, Evans JL, Tooley S and Shirey MR. Nurse

manager succession planning: a cost-benefit analysis. Journal of Nursing Management 2017;

Tamang A, Shah IH, Shrestha P, Warriner IK, Wang D,

Thapa K, My Huong NT and Meirik O. Comparative satisfaction of receiving medical abortion services from nurses and auxiliary nurse-midwives or doctors in Nepal: results of a randomized trial. Reproductive Health 2017; 14:7.

Zamanzadeh V, Valizadeh L, Negarandeh R, Monadi M

and Azadi A. Influencing men entering the nursing profession and understanding the challenges faced by them: Iranian and developed countries’ perspectives. Nurse Midwifery Studies 2013 (Dec); 2(4):49-56.

Linda NS, Klopper HC and Phetlhu DR. Student’s voice

on spiritual care at a Higher Education institution in the Western Cape. Curationis 2015; 38(2). Art. #1520. p.9.

Roussanov N and Savor P. Marriage and managers

attitude to risk Management (December 14, 2013). AFA 2013 San Diego Meetings Paper. Available at SSRN: or

Hodes R. The culture of illegal abortion in South Africa.

Journal of Southern African Studies 2016; 42(1):79-93.

Clyde J, Bain J, Castagnaro K, Rueda M, Tatum C and

Watson K. Evolving capacity and decision-making in practice: adolescents’ access to legal abortion services in Mexico City. Reproductive Health Matters 2013; 21(41):167-75.

Beggs CB, Kerr KG, Noakes C, Hathway, EA and Sleigh

A. The ventilation of multiple-bed hospital wards: review and analysis. American Journal of Infection Control 2008; 36(3):250-9.

Röhrs S. The influence of norms and values on the

provision of termination of pregnancy services in South Africa. International Journal of Africa Nursing Science 2017; 6:39-44.

World Health Organization (WHO) 2016 Workload

indicators of staffing need (WISN): Selected country implementation experiences. Human Resources for Health Observer Series No 15 1. Health Manpower. 2. Personnel staffing and Scheduling-methods. 3. Workload. Health information systems. 5. National Health Programs. I. World Health Organisation. WHO Press, World Health Organisation 20 Avenue Appia Geneva Switzerland.


  • There are currently no refbacks.