South African women’s experience of the decision, procedure and recovery from “feticide” and late termination of pregnancy due to the presence of severe fetal abnormality: women’s and health service providers’ perspectives
- Authors: Vorster, Angela Carol
- Date: 2023-10-13
- Subjects: Feticide , Abortion , Late-term abortion , Fetus Abnormalities , Psychological trauma , Grief , Pregnancy loss
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/432359 , vital:72864 , DOI 10.21504/10962/432359
- Description: Routine antenatal care, including sonography and genetic testing, assist healthcare providers in identifying the presence of severe fetal abnormality. In countries where it is legal, the option to abort such a pregnancy may be presented to the pregnant person. When abortion takes place after the thirteenth week of gestation, it is generally referred to as a late termination of pregnancy and may entail the induction of labour or caesarean section. In cases where termination of the pregnancy is decided upon, and the gestation is further than 21 weeks and six days, the feticide procedure is recommended in order to ensure stillbirth. The feticide procedure entails the injection of potassium chloride directly into the fetal heart in order to ensure fetal demise. Existing literature on “feticide” and late termination of pregnancy (LTOP) owing to fetal abnormalities mostly takes a medical or psychological perspective in researching these procedures. Within the South African context, there are very few studies on feticide and LTOP, with none of these studies (to date – 8 January 2023) taking a feminist approach. This paucity of research that takes into account power relations, structural inequality and factors that affect decision-making and choice is one of the reasons that this study was undertaken. The main research question focused on in this study is: What are South African women’s experiences of feticide and late termination of pregnancy due to the presence of severe fetal abnormality, as related by the women themselves and the health service providers who perform the procedure or provide care? The sub-questions that initially drove the study were: How do the women relate their experience of the process of coming to the decision, undergoing and recovering from the procedure, and how do health service providers relate the experiences of these women? The methodological and theoretical framework employed in this research was a Feminist Social Constructionist approach to Grounded Theory. This reflexive, subjectivist, feminist lens encouraged awareness of the influence of gender, race, class and other structural and systemic factors on women’s experiences within the two healthcare systems. Data collection entailed semi-structured interviews conducted with 12 women, who had undergone feticide and LTOP procedures between one and five years prior to the interviews, in either the public or private healthcare system in South Africa. Semi-structured interviews were also conducted with 13 healthcare providers. The providers included medical specialists and participants from the fields of clinical psychology, genetic counselling and nursing and were employed in public or private healthcare in South Africa. Data relevant to public healthcare users and providers were collected from one tertiary (academic) public healthcare hospital and data regarding private healthcare users and providers were collected from across South Africa. Women’s constructions of their experiences of feticide and LTOP included stark contrasts between public and private healthcare users in South Africa, as well as women experiencing “no choice” and their voices being ignored or silenced. Healthcare providers’ constructions were frequently contradictory, referring to women as having freedom of choice and their needs largely prioritised within the healthcare system, while the providers within the public healthcare system relayed their own frustrations and emotional burden due to systemic failures. Findings from women and providers’ constructions were synthesised into a theoretical understanding of women’s experiences of feticide and LTOP in South Africa, which is grounded in, and emergent from, the data. Women’s experiences of feticide and LTOP in South Africa were conceptualised by framing the three phases of these experiences, namely the decision-making phase (I), undergoing the procedures and in-hospital recovery (phase II) and the recovery phase (III). The most prominent themes emerging in these phases included the schism between the public and private healthcare systems in South Africa, the lack of real choice women experience, as well as the silencing of women and providers with regard to feticide and LTOP. Underlying the three phases, and directly influencing the three prominent themes affecting women’s experiences, were the underlying and insidious structural inequality that undermined reproductive justice with regard to women’s decision-making, experiences of and recovery from feticide and LTOP. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2023
- Full Text:
- Date Issued: 2023-10-13
- Authors: Vorster, Angela Carol
- Date: 2023-10-13
- Subjects: Feticide , Abortion , Late-term abortion , Fetus Abnormalities , Psychological trauma , Grief , Pregnancy loss
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/432359 , vital:72864 , DOI 10.21504/10962/432359
- Description: Routine antenatal care, including sonography and genetic testing, assist healthcare providers in identifying the presence of severe fetal abnormality. In countries where it is legal, the option to abort such a pregnancy may be presented to the pregnant person. When abortion takes place after the thirteenth week of gestation, it is generally referred to as a late termination of pregnancy and may entail the induction of labour or caesarean section. In cases where termination of the pregnancy is decided upon, and the gestation is further than 21 weeks and six days, the feticide procedure is recommended in order to ensure stillbirth. The feticide procedure entails the injection of potassium chloride directly into the fetal heart in order to ensure fetal demise. Existing literature on “feticide” and late termination of pregnancy (LTOP) owing to fetal abnormalities mostly takes a medical or psychological perspective in researching these procedures. Within the South African context, there are very few studies on feticide and LTOP, with none of these studies (to date – 8 January 2023) taking a feminist approach. This paucity of research that takes into account power relations, structural inequality and factors that affect decision-making and choice is one of the reasons that this study was undertaken. The main research question focused on in this study is: What are South African women’s experiences of feticide and late termination of pregnancy due to the presence of severe fetal abnormality, as related by the women themselves and the health service providers who perform the procedure or provide care? The sub-questions that initially drove the study were: How do the women relate their experience of the process of coming to the decision, undergoing and recovering from the procedure, and how do health service providers relate the experiences of these women? The methodological and theoretical framework employed in this research was a Feminist Social Constructionist approach to Grounded Theory. This reflexive, subjectivist, feminist lens encouraged awareness of the influence of gender, race, class and other structural and systemic factors on women’s experiences within the two healthcare systems. Data collection entailed semi-structured interviews conducted with 12 women, who had undergone feticide and LTOP procedures between one and five years prior to the interviews, in either the public or private healthcare system in South Africa. Semi-structured interviews were also conducted with 13 healthcare providers. The providers included medical specialists and participants from the fields of clinical psychology, genetic counselling and nursing and were employed in public or private healthcare in South Africa. Data relevant to public healthcare users and providers were collected from one tertiary (academic) public healthcare hospital and data regarding private healthcare users and providers were collected from across South Africa. Women’s constructions of their experiences of feticide and LTOP included stark contrasts between public and private healthcare users in South Africa, as well as women experiencing “no choice” and their voices being ignored or silenced. Healthcare providers’ constructions were frequently contradictory, referring to women as having freedom of choice and their needs largely prioritised within the healthcare system, while the providers within the public healthcare system relayed their own frustrations and emotional burden due to systemic failures. Findings from women and providers’ constructions were synthesised into a theoretical understanding of women’s experiences of feticide and LTOP in South Africa, which is grounded in, and emergent from, the data. Women’s experiences of feticide and LTOP in South Africa were conceptualised by framing the three phases of these experiences, namely the decision-making phase (I), undergoing the procedures and in-hospital recovery (phase II) and the recovery phase (III). The most prominent themes emerging in these phases included the schism between the public and private healthcare systems in South Africa, the lack of real choice women experience, as well as the silencing of women and providers with regard to feticide and LTOP. Underlying the three phases, and directly influencing the three prominent themes affecting women’s experiences, were the underlying and insidious structural inequality that undermined reproductive justice with regard to women’s decision-making, experiences of and recovery from feticide and LTOP. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2023
- Full Text:
- Date Issued: 2023-10-13
Women's experience of abortion : a qualitative study
- Authors: Taylor, Gaye Lesley
- Date: 1998
- Subjects: Abortion , Abortion -- South Africa , Women -- Counseling of
- Language: English
- Type: Thesis , Masters , MSocSc
- Identifier: vital:708 , http://hdl.handle.net/10962/d1006522 , Abortion , Abortion -- South Africa , Women -- Counseling of
- Description: Abortion is an emotive topic that always raises strong feelings. The purpose of this study, however, is not to focus on the religious, political or moral questions surrounding abortion. Abortion is a reality and in South Africa, where it has only recently become legal, there is a need to have an understanding of the effects on women in order to provide counselling services. There is also a need to provide services for the many women who have had illegal terminations in the past. This study reviewed the most recent literature on the subject and the researcher takes the view that although the scientific literature states there is little long term psychological effect of abortion, the non-positivist literature which records women's experiences tells another story. Some of the problems with the scientific literature is that psychological effects are not defined and there may be political motivation for the study, ie. an attempt is made to prove that the health costs are not high for abortion because there is little long term effect. The researcher, however, feels this does a disservice to women who have had abortions because there is a failure to provide counselling services. Some members of the feminist movement also deserve criticism because in their haste to give women their rights they fail to allow a woman to thoroughly explore her options beforehand and to provide support services afterwards. The researcher, however, also identified a new theme in the literature which has been called a maturing of the feminist viewpoint that along with the right to abortion, women also have a right to the mixed feelings that go with making, what is for many, a very painful decision. There is a recognition that abortion is about loss and thus there is a corresponding need to acknowledge women's need to mourn and to provide services. The study does not include the experience of women who seek abortions for reasons of poverty. It also excludes the experience of women who have abortions as a result of rape, incest or harm to the foetus. It is a qualitative study and a non-probability sampling technique which comprised snowball and purposive methods was used to identify respondents. In-depth semi-structured interviews using a broad theme of questions were conducted with five respondents. The women were asked to tell the stories of their abortions: their and their partner's feelings before and after, how they decided and the actual experience. They were also asked to identify counselling requirements, what they found helpful and what would have helped. The literature and the findings support the researcher's view that women who find themselves with an unexpected pregnancy need an opportunity to objectively consider all their options, namely keeping the baby, adoption or abortion, and to have an objective counsellor assist them in vigorously considering these. If they decide on a termination they need to be given as much information as possible about the procedure and about how they are likely to feel. Afterwards counselling should be made available and women should be encouraged to use the service. They need to be assisted to explore all ways of coming to terms with it such as through dream work, dialogueing with the unborn child through a letter and for those with religious beliefs seeking absolution from the church. There is a great need for a Christian and other religious ministry in this regard. Self-help therapies such as support groups can also be helpful
- Full Text:
- Date Issued: 1998
- Authors: Taylor, Gaye Lesley
- Date: 1998
- Subjects: Abortion , Abortion -- South Africa , Women -- Counseling of
- Language: English
- Type: Thesis , Masters , MSocSc
- Identifier: vital:708 , http://hdl.handle.net/10962/d1006522 , Abortion , Abortion -- South Africa , Women -- Counseling of
- Description: Abortion is an emotive topic that always raises strong feelings. The purpose of this study, however, is not to focus on the religious, political or moral questions surrounding abortion. Abortion is a reality and in South Africa, where it has only recently become legal, there is a need to have an understanding of the effects on women in order to provide counselling services. There is also a need to provide services for the many women who have had illegal terminations in the past. This study reviewed the most recent literature on the subject and the researcher takes the view that although the scientific literature states there is little long term psychological effect of abortion, the non-positivist literature which records women's experiences tells another story. Some of the problems with the scientific literature is that psychological effects are not defined and there may be political motivation for the study, ie. an attempt is made to prove that the health costs are not high for abortion because there is little long term effect. The researcher, however, feels this does a disservice to women who have had abortions because there is a failure to provide counselling services. Some members of the feminist movement also deserve criticism because in their haste to give women their rights they fail to allow a woman to thoroughly explore her options beforehand and to provide support services afterwards. The researcher, however, also identified a new theme in the literature which has been called a maturing of the feminist viewpoint that along with the right to abortion, women also have a right to the mixed feelings that go with making, what is for many, a very painful decision. There is a recognition that abortion is about loss and thus there is a corresponding need to acknowledge women's need to mourn and to provide services. The study does not include the experience of women who seek abortions for reasons of poverty. It also excludes the experience of women who have abortions as a result of rape, incest or harm to the foetus. It is a qualitative study and a non-probability sampling technique which comprised snowball and purposive methods was used to identify respondents. In-depth semi-structured interviews using a broad theme of questions were conducted with five respondents. The women were asked to tell the stories of their abortions: their and their partner's feelings before and after, how they decided and the actual experience. They were also asked to identify counselling requirements, what they found helpful and what would have helped. The literature and the findings support the researcher's view that women who find themselves with an unexpected pregnancy need an opportunity to objectively consider all their options, namely keeping the baby, adoption or abortion, and to have an objective counsellor assist them in vigorously considering these. If they decide on a termination they need to be given as much information as possible about the procedure and about how they are likely to feel. Afterwards counselling should be made available and women should be encouraged to use the service. They need to be assisted to explore all ways of coming to terms with it such as through dream work, dialogueing with the unborn child through a letter and for those with religious beliefs seeking absolution from the church. There is a great need for a Christian and other religious ministry in this regard. Self-help therapies such as support groups can also be helpful
- Full Text:
- Date Issued: 1998
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