O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2022 | ISSUE 3 | 25 experienced side e ects from family planning, depicted in the chart below. In future, 90.6% (n=222) of study participants plan on making use of family planning. Injectable contraceptives 56.2% (n=114) were the most popular method of family planning, followed by pills (oral contraceptives) at 20.2% (n=41); implants (13.8% (n=28)); intrauterine devices5.4% (n=11); sterilization 3.9% (n=8) and lastly, 0.5% (n=1) who stated the use of dual protection. Post-TOP follow up group One of the 102 (<1%) participants that underwent medical TOP and presented for follow up questionnaire had a positive pregnancy test at the two-week follow up post TOP using the mifepristone/ misoprostol medical regimen. ere were no side e ects reported from the medical TOP regimen in 23.5% (n=24) of the study population. Of those that experienced side e ects, 52% (n=53) experienced heavy bleeding; 15.7% (n=16) had a vaginal discharge; 5.9% (n=6) had pain; 2% (n=2) had a fever; lastly 1% (n=1) developed an infection. Only 18.8% (n=15) used further medical treatment for side e ects experienced. Bleeding post TOP mostly lasted either 0 -3 days and 38.2% (n=39) experienced bleeding up to 7 days. Family planning options were discussed with 91.2% (n=93) of the study participants who completed the follow-up questionnaire. Pills (oral contraceptives) were chosen by 16.7% (n=17), injectables by 54.9% (n=56), intrauterine device 14.7% (n=15), implants 2% (n=2), and no answer/none in 11.8% (n=12). Contraception use is documented in table 3. e majority of the study population would recommend the TOP service to other people 88.2% (n=90). Table 3: to compare family planning decisions between di erent age groups AGE GROUP 16 – 18 (n = 24) ≥ 19 (n= 220) Total (n=244) Were you making use of family planning prior to falling pregnant? Yes 2 (0.8%) 73 (29.8%) 75 (30.6%) No 23 (9.4%) 137 (55.9%) 160 (65.3%) No answer 0 9 (3.7%) 9 (3.7%) What method were you making use of? No answer/not applicable 24 (9.8%) 151 (61.6%) 175 (71.4%) Pills 1 (0.4%) 34 (13.9%) 35 (14.3%) Implant 0 4 (1.6%) 4 (1.6%) IUD 0 2 (0.8%) 2 (0.8%) Injection 0 27 (11.2%) 27 (11.0%) Condoms 0 1 (0.4%) 1 (0.4%) If not using family planning, why not? Afraid of side effects 11 (4.5%) 82 (33.5%) 93 (38.0%) Don’t know about family planning 10 (4.1%) 6 (2.4%) 16 (6.5%) Previous side effects 0 27 (11.2%) 27 (11.0%) Don’t believe in family planning 0 4 (1.6%) 4 (1.6%) No answer 0 4 (1.6% 4 (1.6%) Side effects experienced from family planning Heavy bleeding 1 (0.4%) 24 (9.8%) 25.2 (10.2%) Headaches 0 20 (8.2%) 20 (8.2%) Weight gain 1 (0.4%) 19 (7.8%) 20 (8.2%) Amenorrhoea 1 (0.4%) 34 (13.9%) 35 (14.3%) Discussion South Africa’s laws surrounding sexual and reproductive health are both progressive and comprehensive and yet the accessibility for safe terminations of pregnancy is still lowwithin our communities. 6 In 2015, e Sustainable Development Goals were set out, one such goal was the attainment of universal access to sexual and reproductive health. 7 Globally, between the year 2015 – 2019 there was an annual average of 73.3 million abortions - both safe and unsafe – with most induced abortions in women between the ages of 15-49 years. Unwanted pregnancies have a huge nancial, social and psychological burden on women as well as their families and the community at large. 8 In our setting we are yet to combat issues such as: poor access to reproductive healthcare and contraception; a lack of education around safe sexual practices; gender-based violence, sexual coercion and transactional sex; teenage pregnancy, unsafe and illegal abortions and the disempowerment of women resulting in the lack of control over their own reproductive health. 9,12 Demographics Our study shows similar results to global statistics. Notably, close to 10% of our respondents fall between the ages of 16-18 years illustrating the need for greater youth-directed education and contraceptive services in our setting. A parity of 1 or more children was recorded in 12.5% (n=3) participants aged 16-18. is is worrisome and further illustrates the need for adequate contraception and education. Gauteng Department of Health recorded 23226 teenage pregnancies (15 -19 years) in the province between March 2020 and April 2021 with 19316 deliveries in the public sector further illustrating the public health issues around teenage pregnancy. 18 Multiparity, unintuitively, is not a drawing factor for TOPs with the largest proportion of respondents having had either one living child or were pregnant for the rst time at the time of their visit to the clinic. Most participants were single at the time of their visit to the clinic, perhaps highlighting the necessity of both relational and social support to complete a pregnancy. Despite South Africa’s 20,4% HIV prevalence in the general population and 30% prevalence among pregnant women, most respondents 76.7%(n=188), were actively aware of their negative HIV status. is is contrary to previous ndings where knowledge of one’s HIV status prior to one’s rst antenatal visit was low.10 Highlighting the success of antenatal education surrounding HIV and the presumed destigmatization of HIV in South Africa. In South Africa, the current unemployment rate sits at 31,3% for women; much lower than the ndings of our study where 48,8% (n= 119) of participants were unemployed. A lack of nancial stability, o en associated with a lower level of education or the lack of completion of studies, remains a key factor in the choice to opt for a TOP. 11,12 O&G Forum 2022; 32: 22-27 ORIGINAL RESEARCH