O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2022 | ISSUE 3 | 26 Barriers Barriers surrounding accessibility are largely rooted in cultural and stigma-related issues, as is seen globally.6 e lack of knowledge of legal and appropriate healthcare facilities; fear of being seen by a known community member and the fear of maltreatment by healthcare providers are factors that negatively a ected the experiences of many of our respondents. At hospital level creating a safe discrete environment for women attending the KWHC is essential and thus the renaming of the clinic to the Kalafong Women’s Health Clinic was a step in the right direction to reduce stigma associated with TOP / Womens choice clinic as before. Further barriers include the lack of money for transport to the correct healthcare facility, as women’s rst interaction with the healthcare systemwas usually at a facility that did not provide TOP services and thus needed to be referred to another facility. 12 ere is a clear lack of known services by the community and most respondents knew only of the clinic through word-of-mouth or through referral from another known healthcare facility, a er enquiry. A decentralization of the provision of safe medical TOPs by o ering these services at healthcare facilities such as Maternal Obstetric Units (MOUs), will increase accessibility to those within this community. 8,12 Medical TOP for pregnancies <63days have a success rate of 97% and require very little intervention and are done on an outpatient basis, this could be o ered at primary heath care clinic level rather than dedicated TOP clinics not only improving access to TOP but most likely reducing stigma by attending a dedicated TOP clinic. 15 Lastly, in a bid to improve access and information of safe free TOP services advertisements and government website information should be made readily available to the public. Services Received e perceived notion of possible ill-treatment by hospital sta at legal healthcare facilities did not hinder the experiences of most respondents who reported positive experiences at every level of interaction at the hospital. Respondents recounted feeling safe; being well informed of the TOP process; receiving comprehensive information on their contraception choices; and positive attitudes of the healthcare providers at the facility. is demonstrates the dedication of the midwives who so passionately dedicated their time to the KWHC. However, some patients’ experiences were less positive, having experienced untoward comments from administrative workers surrounding the want to seek out TOP services; and xenophobic remarks directed at respondents by both healthcare providers and administrative sta . Training of all hospital sta on professional and non-judegementalism is important in the destimatization of TOPs along with decentralization of services for early pregnancies of <63 days. Contraception e Contraceptive Prevalence Rate (CPR), a measure of women aged 15-49 who are currently using contraception, is currently 60% and has been at this level for almost 20 years. 6 In the study only 30.6% of the participants reported using contraception and less than 8.5% of the teenager that present for TOP. is ultimately highlights the argument that without e cient sexual education and easy access to good quality contraception unwanted and unplanned pregnancies will continue to be a signi cant public health issue. e poor use of contraception prior to a respondents visit– including the majority of teenagers - can be largely attributed to misinformation; a lackof informationregardingone’s contraception methods; concerns of side e ects despite most respondents having never personally experienced these side e ects; and biased counselling from healthcare providers – either intentionally or unintentionally. 6,12 Post TOP, the majority of respondents le with some form of contraception, mostly short-acting methods such as injectables or oral contraception. is can be attributed to contraceptive health counselling as respondents con rmed that they felt they were well and adequately informed of their contraceptive method options from the healthcare workers at the facility. ere is room for improvement on counselling regarding contraception as this should be at 100% however there are challenges in this resource restricted setting. Educational contraceptive videos in the waiting area and hand outs are a consideration to improve counselling on contraceptives. Safety e medical TOPS were performed as per the WHO Guidelines of Medical Termination of Pregnancy, under the guidance of 3 trained professional sisters and a rotating doctor to perform sonography to con rm a gestational age of less than 12 weeks. 10 e most common side e ects experienced included bleeding; discharge and pain, the majority of which were self-limiting. No major complications such as hameorrhage and infections were noted and there was no need to seek further medical care by any of the respondents. One patient, <1% reported having a positive pregnancy test at 2 weeks post medical TOP thus indicating that the success of the TOP was higher than the documented 97% in the literature.17,18TOP was acceptable and safe as an outpatient-based regimen in this community. Weaknesses & Limitations e topic of sexual health and reproduction is a sensitive one, with TOPs being one of the most taboo subjects of discussion. Many questions were le unanswered or only partially answered which could be attributed to the sensitivity of the topic broached in these questions. It is understandable that many questions may have le respondents feeling uncomfortable. Less than 50 % of women who answered the initial questionnaire quali ed for medical TOP and thus did not present for the follow up questionnaire. Even then there was also some loss to follow up that could introduce bias as 7 women underwent medical TOP and did not return for 2 week review possibly impacting assessment of safety and e cacy of this out patient regimen. Poorly answered questions were mostly questions that followed- on from a previous question asked. Poor phrasing or a lack of clarity of the questions posed may also have played a role in the poor response to some questions. A lack of follow up, as seen by our decreased population of respondents that completed the follow-up questionnaire further demonstrates the sensitive nature of the topic and the stigma it holds. Conclusion TOP remains a highly stigmatized topic within communities and with health care service providers. 12,18 Appropriate and comprehensive training on sexual health and contraceptive counselling, speci cally on LARCs, at Kalafong Provincial Tertiary O&G Forum 2022; 32: 22-27 ORIGINAL RESEARCH