CoChat
Sign Up
Cited by 13Reproductive Health and ContraceptionMaternal and Perinatal Health InterventionsAdolescent Sexual and Reproductive Health

A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in soweto, South Africa: a socio-ecological perspective

Open access
Mabetha, Khuthala, Soepnel, Larske M., SSewanyana, Derrick, Draper, Catherine E., Lye, Stephen, Norris, Shane A.·2024·Reproductive Health
DOI 10.1186/s12978-024-01852-8PMC PMC11265480
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Pregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18–28 years, and ii) factors characterising the decision to terminate. Methods: In-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach. Results: An application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants’ decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants’ decisions through detrimental changes in interpersonal support and financial situation. Conclusions: Amongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women’s needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s12978-024-01852-8

Cites

4 of 4 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 50

  1. [2]Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, et al. Unsafe abortion: the preventable pandemic. Lancet. 2006;368(9550):1908–19. Available from: http://www.thelancet.com/article/S0140673606694816/fulltext. Cited 2022 Mar 14. 17126724 10.1016/S0140-6736(06)69481-6 · DOI · Paper page
  2. [3]Ganatra B, Gerdts C, Rossier C, Johnson BR, Tunçalp Ö, Assifi A, et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. Lancet. 2017;390(10110):2372–81 Available from: http://www.thelancet.com/article/S0140673617317944/fulltext. Cited 2022 Mar 14. 28964589 10.1016/S0140-6736(17)31794-4 PMC5711001 · DOI · Paper page
  3. [5]Bain LE, Zweekhorst MBM, de Cock Buning T. Prevalence and determinants of unintended pregnancy in sub –saharan africa: A systematic review. Afr J Reprod Health. 2020;24(2):187–205. 34077104
  4. [6]Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and Meta-analysis 11 Medical and Health Sciences 1117 Public Health and Health Services. Reprod Health. 2018;15(1):1–17. Available from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-018-0640-2. Cited 2022 Mar 8. 30497509 10.1186/1742-4755-9-1 PMC6267053 · DOI
  5. [7]World Health Organization. Safe abortion Clinical practice handbook for. WHO. 2012. Available from: http://apps.who.int/iris/bitstream/10665/97415/1/9789241548717_eng.pdf 24624482
  6. [8]Ndwambi A, Govender I. Characteristics of women requesting legal termination of pregnancy in a district hospital in Hammanskraal, South Africa. South African J Infect Dis. 2015;30(4):129–33. 10.1080/23120053.2015.1107265. Cited 2022 Mar 15. 10.1080/23120053.2015.1107265 · DOI
  7. [9]Mendes JF, Basu D, Basu JK. Addressing the demand for termination of pregnancy services in district health facilities in Johannesburg. S Afr Med J. 2010;100(10):614 (https://pubmed.ncbi.nlm.nih.gov/21080989/). 21080989 10.7196/SAMJ.4407 · DOI
  8. [10]Jewkes R, Rees H. Dramatic decline in abortion mortality due to the Choice on Termination of Pregnancy Act. S Afr Med J. 2005;95(4):250. 15889846
  9. [13]Harries J, Stinson K, Orner P. Health care providers’ attitudes towards termination of pregnancy: A qualitative study in South Africa. BMC Public Health. 2009;9(1):1–11. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-296. Cited 2022 Mar 8. 19689791 10.1186/1471-2458-9-296 PMC2734857 · DOI
  10. [14]Teffo ME, Rispel LC. ‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces. Glob Health Action. 2017;10(1). Available from: /pmc/articles/PMC5645649/. Cited 2022 Mar 8. PMC5645649 28786327
  11. [15]Magwentshu M, Chingwende R, Jim A, van Rooyen J, Hajiyiannis H, Naidoo N, Orr N, Menzel J, Pearson E. Definitions, perspectives, and reasons for conscientious objection among healthcare workers, facility managers, and staff in South Africa: a qualitative study. Sex Reprod Health Matters. 2023;31(1):2184291. 36988125 10.1080/26410397.2023.2184291 PMC10062214 · DOI
  12. [16]Bankole A, Singh S, Haas T. Reasons Why Women Have Induced Abortions: Evidence from 27 Countries. Int Fam Plan Perspect. 1998;24(3):117–52. 10.2307/3038208 · DOI
  13. [17]Masanabo DKK, Govender I, Bongongo T. Reasons women terminate their pregnancies legally and their contraceptive practices at Soshanguve 3 community health centre, Tshwane district, South Africa. S Afr Fam Pract. 2020;62(1):e1–5. 10.4102/safp.v62i1.4310 PMC8378048 32242435 · DOI
  14. [18]Megersa BS, Ojengbede OA, Deckert A, Fawole OI. Factors associated with induced abortion among women of reproductive age attending selected health facilities in Addis Ababa, Ethiopia: a case control study. BMC Womens Health. 2020;20(1). Available from: https://pubmed.ncbi.nlm.nih.gov/32883263/. Cited 2022 Mar 15. PMC7469090 32883263
  15. [19]Ples L, Popescu I, Margarit I, Ionescu CA, Cazaceanu A, Moga MA, et al. Factors affecting the decision to undergo abortion in Romania: Experiences at our clinic. J Eval Clin Pract. 2020;26(2):484–8 Available from: https://pubmed.ncbi.nlm.nih.gov/31368205/. Cited 2022 Mar 15. 31368205 10.1111/jep.13250 · DOI
  16. [20]Ngene NC, Ross A, Moodley J. Characteristics of women having first-trimester termination of pregnancy at a district hospital in Kwazulu-Natal. South African J Epidemiol Infect. 2013;28(2):102–5. 10.1080/10158782.2013.11441527 · DOI
  17. [22]Petersen MN, Jessen-Winge C, Møbjerg ACM. Scandinavian women’s experiences with abortions on request: A systematic review. JBI Database Syst Rev Implement Reports. 2018;16(7):1537–63. 10.11124/JBISRIR-2017-003344 29995714 · DOI
  18. [23]Steyn C, Govender I, Ndimande JV. An exploration of the reasons women give for choosing legal termination of pregnancy at Soshanguve Community Health Centre. Pretoria, South Africa. 2018;60(4):126–31. 10.1080/2078619020181432138. Available from: https://www.tandfonline.com/doi/abs/10.1080/20786190.2018.1432138. Cited 2021 Oct 28. 10.1080/2078619020181432138 · DOI
  19. [24]Kirkman M, Rosenthal D, Mallett S, Rowe H, Hardiman A. Reasons women give for contemplating or undergoing abortion: a qualitative investigation in Victoria, Australia. Sex Reprod Healthc. 2010;1(4):149–55. 21122614 10.1016/j.srhc.2010.08.001 · DOI
  20. [25]Ekstrand M, Tydén T, Darj E, Larsson M. An illusion of power: qualitative perspectives on abortion decision-making among teenage women in Sweden. Perspect Sex Reprod Health. 2009;41(3):173–80 Available from: https://pubmed.ncbi.nlm.nih.gov/19740236/. Cited 2022 Mar 15. 19740236 10.1363/4117309 · DOI
  21. [26]Jayaweera RT, Ngui FM, Hall KS, Gerdts C. Women’s experiences with unplanned pregnancy and abortion in Kenya: A qualitative study. PLoS One. 2018;13(1):e0191412. 10.1371/journal.pone.0191412. PMC5784933 29370220 · DOI
  22. [27]Chibber KS, Biggs MA, Roberts SCM, Foster DG. The role of intimate partners in women’s reasons for seeking abortion. Womens Health Issues. 2014;24(1). Available from: https://pubmed.ncbi.nlm.nih.gov/24439939/. Cited 2022 Mar 15. 24439939
  23. [28]Rehnström Loi U, Lindgren M, Faxelid E, Oguttu M, Klingberg-Allvin M. Decision-making preceding induced abortion: a qualitative study of women’s experiences in Kisumu, Kenya. Reprod Health. 2018.;15(1). Available from: https://pubmed.ncbi.nlm.nih.gov/30285768/. Cited 2022 Mar 15. PMC6171301 30285768
  24. [29]Kaye DK, Mirembe F, Bantebya G, Johansson A, Ekstrom AM. Reasons, methods used and decision-making for pregnancy termination among adolescents and older women in Mulago Hospital. Uganda East Afr Med J. 2005;82(11):579–85. Available from: https://pubmed.ncbi.nlm.nih.gov/16463752/. Cited 2022 Mar 15. 16463752
  25. [30]Bosire EN, Ware LJ, Draper CE, Amato B, Kapueja L, Lye S, et al. Young women’s perceptions of life in urban south africa: Contextualising the preconception knowledge gap. Afr J Reprod Health. 2021;25(2):39–49. 37585752
  26. [31]Muluneh MD, Stulz V, Francis L, Agho K. Gender Based Violence against Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Int J Environ Res Public Health. 2020;17(3):903. 10.3390/ijerph17030903. PMC7037605 32024080 · DOI
  27. [32]Riley T, Sully E, Ahmed Z, Biddlecom A. Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health In Low- and Middle-Income Countries. Int Perspect Sex Reprod Health. 2020;46:73–6. Available from: https://pubmed.ncbi.nlm.nih.gov/32343244/. Cited 2023 Jun 1 32343244 10.1363/46e9020 · DOI
  28. [33]Ameyaw EK, Ahinkorah BO, Seidu AA, Njue C. Impact of COVID-19 on maternal healthcare in Africa and the way forward. Arch Public Heal. 2021;79(1):1–5. Available from: https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-021-00746-6. Cited 2023 Jun 1. PMC8660651 34886893 · DOI
  29. [34]Tiew A, Berro Pizzarossa L, Jastaniah I, Jayaweera RT. The impact of COVID-19 on safe abortion access in Africa: an analysis through a framework of reproductive justice and lens of structural violence. Front Glob Women’s Heal. 2022;23(3):127. PMC9563014 36247111
  30. [35]Adelekan T, Mihretu B, Mapanga W, Nqeketo S, Chauke L, Dwane Z, et al. Early Effects of the COVID-19 Pandemic on Family Planning Utilisation and Termination of Pregnancy Services in Gauteng, South Africa: March–April 2020. Wits J Clin Med. 2020;2(2):91. 10.18772/26180197.2020.v2n2a7 · DOI
  31. [36]Mcleroy KR, Bibeau D, Steckler A, Glanz K. An Ecological Perspective on Health Promotion Programs. Heal Educ Behav. 1988;15(4):351–77. Available from: https://journals.sagepub.com/doi/10.1177/109019818801500401. Cited 2022 Jul 20. 3068205 · DOI · Paper page
  32. [37]Norris SA, Draper CE, Prioreschi A, Smuts CM, Ware LJ, Dennis C, et al. Building knowledge, optimising physical and mental health and setting up healthier life trajectories in South African women (Bukhali): a preconception randomised control trial part of the Healthy Life Trajectories Initiative (HeLTI). BMJ Open. 2022;12(4):e059914 http://bmjopen.bmj.com/content/12/4/e059914.abstract. 35450913 10.1136/bmjopen-2021-059914 PMC9024255 · DOI · Paper page
  33. [39]Willan S, Gibbs A, Petersen I, Jewkes R. Exploring young women’s reproductive decision-making, agency and social norms in South African informal settlements. PLoS One. 2020;15(4):e0231181. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231181. Cited 2022 Jul 27. 32348303 10.1371/journal.pone.0231181 PMC7190118 · DOI
  34. [40]Kriel Y, Milford C, Cordero J, Suleman F, Beksinska M, Steyn P, et al. Male partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in KwaZulu-Natal, South Africa. Reprod Health. 2019;16(1):1–15. 10.1186/s12978-019-0749-y. 31238960 10.1186/s12978-019-0749-y PMC6593556 · DOI
  35. [41]Jewkes R, Morrell R, Christofides N. Empowering teenagers to prevent pregnancy: lessons from South Africa. Cult Health Sex. 2009;11(7):675–88. Available from: https://pubmed.ncbi.nlm.nih.gov/19459086/. Cited 2022 Jul 27 19459086 10.1080/13691050902846452 · DOI
  36. [43]Ware LJ, Kim AW, Prioreschi A, Nyati LH, Taljaard W, Draper CE, et al. Social vulnerability, parity and food insecurity in urban South African young women: the healthy life trajectories initiative (HeLTI) study. J Public Health Policy. 2021;(0123456789). 10.1057/s41271-021-00289-8 PMC8131491 34012015 · DOI
  37. [44]Soepnel LM, Kolkenbeck-Ruh A, Crouch SH, Draper CE, Ware LJ, Lye SJ, et al. Prevalence and socio-structural determinants of tobacco exposure in young women: Data from the Healthy Trajectories Initiative (HeLTI) study in urban Soweto, South Africa. Drug Alcohol Depend. 2022;1(232):109300. 10.1016/j.drugalcdep.2022.109300 35042098 · DOI
  38. [46]Gerdts C, Jayaweera RT, Motana R, Bessenaar T. Cumulative lifetime incidence of abortion in Soweto. South Africa: A respondent-driven sampling study. Prepr JMIR Publich Heal Surveill; 2022. PMC9782381 36480253
  39. [47]Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589-97.
  40. [48]Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol. 2021;18(3):328–52. 10.1080/14780887.2020.1769238 · DOI · Paper page
  41. [50]Pestvenidze E, Stray-Pedersen B. Who obtains abortion in Georgia and why? Int J Womens Health. 2018;10:733–43. Available from: https://pubmed.ncbi.nlm.nih.gov/30532601/. Cited 2022 Jul 26. PMC6241701 30532601
  42. [51]Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Reasons U.S. women have abortions: quantitative and qualitative perspectives. Perspect Sex Reprod Health. 2005;37(3):110–8. Available from: https://pubmed.ncbi.nlm.nih.gov/16150658/. Cited 2022 Jul 26. 16150658 10.1363/3711005 · DOI · Paper page
  43. [52]Somefun OD, Harries J, Constant D. Reproductive awareness and recognition of unintended pregnancy: young women, key informants and health care providers perspectives in South Africa. Reprod Health. 2021;18(1). Available from: https://pubmed.ncbi.nlm.nih.gov/34702283/. Cited 2022 Jul 26. PMC8549136 34702283
  44. [53]Lince-Deroche N, Hendrickson C, Moolla A, Kgowedi S, Mulongo M. Provider perspectives on contraceptive service delivery: findings from a qualitative study in Johannesburg, South Africa. BMC Health Serv Res. 2020;20(1). Available from: https://pubmed.ncbi.nlm.nih.gov/32085756/. Cited 2022 Jul 26. PMC7035764 32085756
  45. [54]Biney AAE, Atiglo DY. Examining the association between motivations for induced abortion and method safety among women in Ghana. Women Health. 2017;57(9):1044–60. Available from: https://pubmed.ncbi.nlm.nih.gov/27636891/. Cited 2022 Jul 26. 27636891 10.1080/03630242.2016.1235076 · DOI
  46. [55]Rominski SD, Lori JR, Morhe ESK. “My friend who bought it for me, she has had an abortion before”. The influence of Ghanaian women’s social networks in determining the pathway to induced abortion. J Fam Plan Reprod Heal care. 2017;43(3):216–21. Available from: https://www.pubmed.ncbi.nlm.nih.gov/28330856/. Cited 2022 Jul 26. 10.1136/jfprhc-2016-101502 28330856 · DOI
  47. [56]Sullivan ME, Harrison A, Harries J, Sicwebu N, Rosen RK, Galárraga O. Women’s Reproductive Decision Making and Abortion Experiences in Cape Town, South Africa: A Qualitative Study. Health Care Women Int. 2018;39(11):1163 Available from: /pmc/articles/PMC5938154/. Cited 2022 Jul 26. 29111909 10.1080/07399332.2017.1400034 PMC5938154 · DOI
  48. [58]Mosley EA, Anderson BA, Harris LH, Fleming PJ, Schulz AJ. Attitudes toward abortion, social welfare programs, and gender roles in the U.S. and South Africa. Crit Public Health. 2020;30(4):441 Available from: /pmc/articles/PMC8975127/. Cited 2022 Aug 23. 35368244 10.1080/09581596.2019.1601683 PMC8975127 · DOI
  49. [59]Kaswa R, Yogeswaran P. Abortion reforms in South Africa: An overview of the Choice on Termination of Pregnancy Act. South African Fam Pract. 2020;62(1):1–5 Available from: /pmc/articles/PMC8378188/. Cited 2023 May 22. PMC8378188 33314950
  50. [60]Gerdts C, Jayaweera RT, Motana R, Bessenaar T, Wesson P. Incidence of and Experiences with Abortion Attempts in Soweto, South Africa: Respondent-Driven Sampling Study. JMIR Public Heal Surveill. 2022;8(12):e38045. Available from: https://publichealth.jmir.org/2022/12/e38045. Cited 2023 May 22. 10.2196/38045 PMC9782381 36480253 · DOI

Cited by

Sorted by citations

Authors
Mabetha, K., Soepnel, L. M., SSewanyana, D., Draper, C. E., Lye, S., & Norris, S. A.
Affiliations
  • University of the Witwatersrand (ZA)
  • University of Toronto (CA)
Corresponding author
Mabetha, Khuthala
ORCID
Venue
Reproductive Health
Publisher
Springer Science and Business Media LLC
Published
2024-07-23
Volume
21
Issue
1
Pages
109-109
ISSN
1742-4755 (ISSN-L)
DOI
10.1186/s12978-024-01852-8
PMC
PMC11265480
OpenAlex
W4400926316
Cited by
13
References
4
Citations by year
2026: 7 · 2025: 4 · 2024: 1 · 2023: 1
FWCI
4.97
Type
journal article
Language
en
Open access
Licence
Locations
  • Reproductive Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • South African Medical Research Council
  • Canadian Institutes of Health Research
  • South African DSI/NRF Centre of Excellence in Human Development
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Adolescent Sexual and Reproductive Health
Keywords
abortion, young women, socio-ecological framework, reasons for termination, financial insecurity, family and partner support, social support, COVID-19 lockdown, unintended pregnancy, reproductive decision-making, Soweto
MeSH terms
Abortion, Induced, Adolescent, Adult, Decision Making, Female, Humans, Pregnancy, Socioeconomic Factors, South Africa, Qualitative Research, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review