Gynecology

Draft legislation to further streamline abortion laws has been tabled in Parliament. According to a memorandum attached to the Choice on Termination of Pregnancy Amendment Bill, the measure seeks, among other things, to allow registered nurses who have undergone the prescribed training to perform abortions. It also proposes to empower provincial health MECs to approve facilities where abortions may take place, instead of the national health minister. Further, all public and private health facilities with a 24-hour maternity service will be able to end pregnancies of up to 12 weeks without permission of the MEC. The bill requires MECs to report to the minister every year on the number of facilities approved. It also makes it an offence for any person to end a pregnancy unlawfully, or allow it to be done at a facility that is not approved. (Source: SAPA, 18 November 2003) Link\//\ Draft Termination of Pregnancy Bill http://www.polity.org.za/pdf/DraftChoiOnTermOfPre.pdf

The issue of abortion or termination of pregnancy in South Africa has received increasing attention throughout this year culminating in the Choice of Termination of Pregnancy (TOP) Bill which was passed in November 1996.

The Medical Research Council said on Monday the health system was failing to provide women with abortion services and called for unwanted pregnancies to be recognised as a specific health risk It said that many women were still being denied access to termination of pregnancy services and were resorting to back street abortions. It also warned that besides the associated health risks, unwanted pregnancies could also result in neglect or abandoned children as well as in family violence. The MRC's Prof Jack Moodley recently found that hostile moral attitudes of health workers were one of the main factors preventing women from gaining access to legal abortions. The ignorance of women with respect to the law was cited as one of the factors preventing them from legally terminating their pregnancies. It called for women to be educated about their right to legal recourse when access or information about legal abortions was denied. Similarly the health professionals should be educated about the limitation of their rights when it came to providing information and access to abortion services. (Source: SAPA, 30 September 2002).

The Reproductive Health Priorities Conferences have been a great success in presenting research in this field from the Southern African region, in promoting new research in sexual and reproductive health and in enabling a close interaction between researchers, policy makers and service providers from around South Africa and the neighbouring countries. The conference covers all aspects of sexual and reproductive health, including: Sexuality, STI prevention and management, Microbicides, Barrier methods (male & female), HIV/AIDS (Including VCT, pose exposure prophylaxis, MTCT & other topical issues), Adolescents, SRH in children,Men, High risk groups(including se workers, truck drivers, MSM), Contraception, Unsafe abortion, Termination of pregnancy,Maternal health, Infertility, Reproductive tract cancers, Other related SRH subjects. Original papers from a range of research disciplines will be presented including biomedical, healthsystems, social science and behavioural research and issues related to rights and ethics. Guest speakers at this year's conference will include experts from South Africa and the African region, and invited participants from the international agencies, institutions and organisations. We invite you to attend the conference and to submit papers or posters for presentation.

The same number of women are flocking to state hospitals to be treated for the consequences of botched or incomplete abortions as they did before terminations became legal five years ago.

Research suggests that proper treatment of sexually transmitted infections (STI) could reduce HIV incidence by as much as 40 percent. A study by the UK's Nuffield Institute of Health and London School of Hygiene and Tropical Medicine and the Ghanaian Health Ministry suggests that pharmacists could play a crucial role in effective STI management and represent an under-utilised resource for HIV prevention activities. Interviews with patients and pharmacists the Greater Accra Region revealed that: Each pharmacist sees an average of 30 STI patients a month and more than 60 percent come without a prescription. Pharmacists give first-line treatments for urethral and vaginal discharge but usually refer genital ulcer cases to health facilities. Most also refer patients if they return with symptoms after the first treatment. The most common treatments given are spectinomycin and norfloxacin for urethral discharge and nystatin and metronidazole for vaginal discharge. On the basis of these results, pharmacist training schemes were developed, implemented and evaluated. Following these sessions, bogus patients were sent to each of the pharmacies, pretending to have urethral discharge or a genital ulcer. They found: marked improvements in prescribing patterns for urethral discharge , an increase (up from five to 39 percent) in the proportion of patients given ciprofloxacin as a first-line treatment for urethral discharge, as recommended by the WHO, addition of a second drug, such as doxycycline or tetracycline, in 20 percent of cases, to cover possible Chlamydia trachomatis infections. Pharmacists represent a valuable point of contact for STI patients. To capitalise on this, policymakers should: train pharmacists in the national guidelines for syndromic management of STIs , involve them in promoting condoms and displaying posters and incorporate STI management into pharmacy training curricula (Source: Pharmacists’ role in managing sexually transmitted infections: policy issues and options for Ghana' by S. Mayhew, K. Nzambi, J. Pepin and S. Adjei, Health Policy and Planning 16 (2001)

The Reproductive Health Research Unit in collaboration with the Health Systems Trust, and the South African Medical Research Council, offers a four-week short course in Reproductive Health Research Methods. The purpose of this course is to support and improve reproductive health policy, plan programmes by building capacity and develop a network of regional expertise in reproductive health research.

For more information and applications forms, please contact the course co ordinator : Nomsa Mtimkulu Reproductive Health Research Unit Dept. of Obstetrics and Gynaecology Chris Hani Baragwanath Hospital P.O. Bertsham 2013 – SOUTH AFRICA Tel : +27 (0)11 933-1228 ext. 224 Fax : +27(0)11 933-1227 E-mail address : n.mtimkulu@rhrujhb.co.za Closing date : 30th March 2001.

The Reproductive Rights Alliance (RRA) has been admitted as an amicus curiae - or friend of the court - in a new challenge to the Choice on Termination of Pregnancy Act by the Christian Lawyers' Association (CLA). This means that when the case is heard in court on July 31, the RRA will be allowed to join the state and introduce arguments to support the state's contention that the CLA's case has no basis in law. The CLA is challenging the right of adolescents under 18 years of age to terminate an unwanted pregnancy. It argues that because the law does not legally require an adolescent to seek the consent of their parents, this is a violation of children's rights. Although the Act encourages minors to seek the counsel of parents, family or friends, it does not compel an adolescent to do so. Having failed to challenge the entire Act, in a legal bid launched in May 1997, the CLA has decided to target provisions in the Act that it finds objectionable. The RRA was a friend of the court in 1998 when the CLA unsuccessfully challenged the constitutional basis of the Choice on Termination of Pregnancy Act and was instrumental in advocating for its enactment in 1996. (Source: Health-e, 19 July 2001)

This is the first review conducted in South Africa on research addressing the implementation of the Choice on Termination of Pregnancy Act. A systematic and detailed methodology was undertaken to identify published and on-going research. Of the 86 identified studies, 41 were reviewed, 13 were forthcoming studies, three were published but unavailable, 6 focused on the process of advocacy reform and 23 were excluded as they did not meet the inclusion criteria. A framework developed for the review looked service and community factors affecting access of potential and current abortion service users.