Treatment Monitor: Abortion

HIV-positive pregnant women should be told about and referred to, if they request this, abortion services as part of a continuum of care. Currently, only surgical abortions are available; however, medical abortion clinical guidelines are being finalized by the DOH. This should expand options for safe early legal termination of pregnancy; the earlier a pregnancy is terminated, the safer it will be. Medical abortion is generally done in the first 56 days of pregnancy so would assist greatly in reducing costs and the demands on a health facility. It may be easier for health workers to administer medical abortion if they feel uncomfortable with pregnancy termination. However, HIV-positive women – like other health-service clients – should be offered both options for abortion – surgical and medical – and not be pushed into medical abortion because health-care workers do not want to touch or physically deal with HIV-positive clients. Pressuring HIV-positive women to have a medical rather than surgical abortion (which would be over quicker and therefore possibly preferable for the woman) would be a violation of her rights.

Care should be given to afford women the choice to continue their pregnancies or to have access to quality termination of pregnancy services. No woman should be denied safe legal TOP services and conditions for access – such as making the HIV-positive woman agree to sterilization – must never be imposed as this is also a violation of the woman’s rights.

In August 2007 the NCOP facilitated public hearings on the Choice on Termination of Pregnancy Act no 38 of 2004 HST made the following submission to the hearings.

From a health systems perspective the Act is essentially about access.
1. It enables decentralization where the designating of services is a provincial responsibility and provinces approve facilities for service provision;
2. It increases the pool of trained TOP service providers, specifically nurses in addition to midwives and doctors. This is consistent with other health system strengthening measures in dealing with the human resources crisis, and is well accepted and described as 'task-shifting.

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