Judith Kluge


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    RCOG Leading Safe Choices: Training abortion providers in South Africa

    Alison Fiander3, Judith Kluge1 ,2
    1University of Stellenbosch, Western Cape Province, South Africa, 2Tygerberg Hospital, Western Cape Province, South Africa, 3Royal College of Obstetricians and Gynaecologists, London, UK

    The Choice-on-Termination-of-Pregnancy ACT of 1996 changed laws in South Africa from highly restrictive to more liberal laws for abortion provision. It legalised abortion-on-demand for women in the first trimester and allowed abortion provision for socio-economic reasons, amongst others, up to 20 weeks gestation. The law also allowed trained registered nurses to provide both surgical and medical abortions in the first trimester. In the ensuing years, non-governmental organisations such as Marie Stopes and IPAS assisted the Department of Health with training of nursing staff. Following withdrawal from South Africa by some NGO's a void was left in comprehensive abortion care training. Additionally, other ongoing challenges to ensuring designated TOP facilities had trained staff to provide abortion services continued. In 2011 only 57% of designated abortion facilities were providing abortion services. A persistent high proportion of abortions are performed in the second trimester. Forty present of women who had a second trimester abortion had initially presented to a health facility in the first trimester but had the procedure delayed at the facility or by a requirement to refer to other health facilities. Women still have unsafe abortions, accessing illegal abortion providers. Unsafe abortions also occur in legal facilities due to lack of training and services failing to meet minimum standards.
    The RCOG Leading Safe Choices initiative aims to improve the competence and standing of abortion care providers. It has recently been implemented in Western Cape Province, South Africa with the training of master trainers in December 2015. Subsequent Comprehensive Abortion Care training was initiated in March 2016. The Best Practice paper on Comprehensive Abortion Care was included in the Western Cape Province Department of Health Abortion Policy in 2016. Progress regarding this initiative in South Africa will be presented.