Abortion Seeking Behaviours and Preferences in the Rural Eastern Cape

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An Assessment of Abortion Seeking Behaviours and Preferences in Rural Communities of the Eastern Cape, South Africa

Landscape

This research study, entitled An Assessment of Abortion Seeking Behaviours and Preferences in Rural Communities of the Eastern Cape, South Africa, was initiated by MSSA in focusing their service delivery in rural areas, and was conducted by the Critical Studies in Sexualities and Reproduction (CSSR) research unit of Rhodes University. This study used a mixed method approach, with qualitative data collection forming the foundation of the quantitative component. Qualitative data collection consisted of individual key stakeholder interviews; the quantitative aspect was a Discrete Choice Experiment (DCE).

Background of the study

In the Choice on Termination of Pregnancy Act (Act No. 92 of 1996), the decision to terminate a pregnancy within the first 12 weeks of gestation is placed with the pregnant woman, with the grounds for granting an abortion thereafter being relatively open (including continuing pregnancy affecting the woman socio-economically). Despite the promise of the CTOP Act, and initial indications of its implementation leading to decreased maternal morbidity and mortality, several challenges have been noted. Considering these concerns, MSSA wishes to offer appropriate information and service provision to rural populations in the Eastern Cape of South Africa. The aim of this research is to assist MSSA to focus service delivery to overcome barriers to safe abortion care, reduce stigma and ensure access to appropriate service provision for people living in rural areas. Currently MSSA only operates in seven of the nine South African provinces and has no presence in rural areas.

Methodology

This study used a mixed method approach, with qualitative data collection forming the foundation of the quantitative component. Qualitative data collection consisted of individual key stakeholder interviews; the quantitative aspect was a Discrete Choice Experiment (DCE). The DCE design allows researchers to investigate how people in a particular context rate selected attributes of a service by asking them to state their preference for different hypothetical alternatives. The study population was individuals living in rural Eastern Cape communities. Given the diversity of the province, three sites were selected based on the Municipal Demarcation Board’s classifications. Purposive and snowball sampling were employed for the qualitative portion of the study and cluster sampling for the quantitative portion. In each site we conducted in-depth interviews with 20 individuals between the ages of 18 and 45. DCE questionnaires were administered to 616 participants across the three sites (207, 209, and 200 respectively). An expert panel was consulted throughout the research process, and a partnership was formed with a local organisation in each site. The qualitative data were analysed using thematic analysis. Quantitative data were analysed using descriptive statistics and regression analysis. Ethical clearance was obtained through the Rhodes University Ethical Standards Committee (RUESC) as well as the MSI Ethics Research Committee.

Publications

The findings of the project were published in a full research report. A short report and a toolkit for global application were also produced.

The purpose of the CSSR/MSSA research toolkit is to provide a step-by-step guide in conducting mixed methods research – qualitative interviews and a discrete choice experiment (DCE) – on abortion seeking behaviours and service preferences. The toolkit enables users to surface features relevant to their setting (through qualitative interviews) and to ascertain community preferences in terms of service provision (through the DCE).

Short Report

Du Plessis, U, Macleod, C, Mavuso, J, Grapsa, E, Sanyangore, A. (2020) An assessment of abortion seeking behaviours and preferences in rural communities of the Eastern Cape, South Africa: Short report. Critical Studies in Sexuality and Reproduction, Rhodes University

Research Report

Du Plessis, U, Macleod, C, Mavuso, J, Grapsa, E, Sanyangore, A. (2020) An assessment of abortion seeking behaviours and preferences in rural communities of the Eastern Cape, South Africa: Research Report. Critical Studies in Sexuality and Reproduction, Rhodes University

Toolkit for global application

Du Plessis, U and Macleod, C. (2020) The CSSR/MSSA mixed methods research toolkit: Abortion-seeking behaviours and preferences. Critical Studies in Sexuality and Reproduction, Rhodes University

Research team

Dr Ulandi du Plessis (lead researcher)

Prof Catriona Macleod

Agnes Sanyagore

Dr Jabulile Mavuso

Site partners

Keiskamma Trust

Bulungula Incubator

Expert panel members

Bongezwa Sontuntu, health programme coordinator, Bulungula Incubator

Nolutho Matiwane, health point nurse, Bulungula Incubator

Nomthandazo Manjezi, health programme coordinator, Keiskamma Trust