O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2022 | ISSUE 3 | 27 Hospital and its feeder healthcare facilities is necessary. Teenage pregnancy remains a huge public health issue particularly in Gauteng and improved adolescent contraceptive services would limit the number of TOPS required and furthermore prevent teenage pregnancy which comes with its own implications. 14 e decentralization of TOP services is dependent on the increased training of healthcare providers at primary and secondary level healthcare facilities in the provision of TOPs – both medical and surgical however medical outpatient-based TOP regimen using mifepristone is safe and e ective and could easily be administered at MOU level with minimal need for increased nancial input or training. 10,18 is would reduce stigma as women would be managed in MOUs and would allow the overburdened KPTH clinic to focus on more complicated TOPs and consider opening services to those women that are >12 weeks gestation. e medical TOP outpatient-based regimen using Mifepristone 200mg and Misoprostil 800 micrograms 24 – 48 hours later is safe and e ective with similar e cacies and safety seen in other studies. 16,18 ere is a clear lack of known TOP services in the community and community-wide public health campaigns to educate communities on the facility; services o ered; the working hours of the clinic; appropriate timing of TOPs; and health and safe sexual practices are required with speci c engagement with the youth – both male and female. Further research into this topic at other facilities within South Africa is important to be able to compare techniques and programmes of sexual health and reproductive services. is information will be able to better inform national responses and programmes. References 1. Government Gazette, Republic of South Africa. Choice on Termination of Pregnancy Amendment Act 1 of 2008. 2008. 2. Mbele AM, Snyman L, Pattison RC. Impact of the Choice on Termination of Pregnancy Act on maternal morbidity and mortality in the west of Pretoria. S Afr Med J [Internet]. 2006 Nov [cited 2019 Jul 4];96(11):1196–8. Available from: http:// www.ncbi.nlm.nih.gov/pubmed/17167707 3. National Committee on Con dential Enquiries into Maternal Deaths. Saving Mothers 2014 -2016: Seventh triennial report on con dential enquiries into maternal deaths in South Africa. NCCEMD Rep [Internet]. 2018;138. Available from: http:// www.doh.gov.za/docs/reports/2007/savingmothers.pdf 4. Basu J, Basu D. Morbidity from unsafe termination of pregnancy in South Africa. J Obstet Gynaecol (Lahore) [Internet]. 2013 [cited 2019 Jun 4];33(6):22. Available from: le:///C:/Users/Farai/Downloads/Morbidity from unsafe termination of pregnancy in South Africa_ Journal of Obste.pdf 5. HIV/AIDS Research Division/ University of KwaZulu-Natal. Country fact sheet: South Africa - Unsafe Abortions [Internet]. 2010 [cited 2019 June 4]. Available from: http://dx.doi . org/10.1016/S0140- 6. Lince-Deroche N, Harries J, Mullick S,Mulongo M, sinanovic E, Pleaner M, Morroni C, Firnhaber C, Holele P. Achieving universal access to sexual and reproductive health services: the potential and pitfalls for contraceptive services in South Africa. South african Health Review 2016; 39(1): . https:// www.hst.org.za/publications/South%20African%20Health%20 Reviews/9%20Achieving%20universal%20access%20to%20 sexual%20and%20reproductive%20health%20services.pdf (accessed 4 January 2021). 7. United Nations Department of Economic and Social A airs. Sustainable Development Goals [Internet]. Sustainable Development Knowledge Platform. 2015 [cited 26 November 2015]. URL: https://sustainabledevelopment.un.org/topics Murray M-E, Casson M, Pudwell J, Waddington A. Patients’ Motivation for Surgical Versus Medical Abortion. J Obstet Gynaecol Canada [Internet]. 2019 Mar 14 [cited 2019 Jun 1]; Available from: https://www.sciencedirect.com/science/article/ abs/pii/S1701216319300258 8. World Health Organization. Preventing unsafe abortion. https:// www.who.int/news-room/fact-sheets/detail/preventing-unsafe- abortion (accessed 06 January 2021). 9. Frederico M, Michielsen K, Arnaldo C, Decat P (2018) 'Factors In uencing Abortion Decision-Making Processes among Young Women', International Journal of Environmental Research and Public Health, 15(2), pp. 329 [Online]. Available at: https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC5858398/ (Accessed: 4th June 2019). 10. WHO. Medical management of abortion. Geneva. World Health Organization. 2018. 11. Global information and education on HIV and AIDS. HIV AND AIDS IN SOUTH AFRICA. https://www.avert. org/professionals/hiv-around-world/sub-saharan-africa/ south-africa#:~:text=South%20Africa%20has%20the%20 biggest,and%20people%20who%20inject%20drugs. (accessed 10 January 2021). 12. Jewkes RK, Gumede T, Westaway MS, Dickson K, Brown H, Rees H. Why are women still aborting outside designated facilities in metropolitan South Africa? BJOG. 2005 Sep;112(9):1236-42. doi: 10.1111/j.1471-0528.2005.00697.x. PMID: 16101602. 13. Woldesenbet, S.A., Kufa, T., Lombard, C., Manda, S., Ayalew, K., Cheyip, M., and Puren, A. (2019). e 2017 National Antenatal Sentinel HIV Survey, South Africa, National Department of Health. 14. National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), and ICF. 2019. South Africa Demographic and Health Survey 2016. Pretoria, South Africa, and Rockville, Maryland, USA: NDoH, Stats SA, SAMRC, and ICF. 15. WHO. Medical management of abortion. Geneva. World Health Organization. 2018. 16. Guillebaud J. Medical termination of pregnancy. BMJ. 2009 Apr 2;301(6748):352–4. 17. World Health Organisation. Clinical practice handbook for safe abortion. : WHO Publication; 2014. https://apps.who.int/iris/ bitstream/handle/10665/97415/9789241548717_eng. 18. Barron P, Subedar H, Letsoko M, Makua M, Pillay Y. Teenage births and pregnancies in South Africa, 2017 - 2021 - a re ection of a troubled country: Analysis of public sector data. S Afr Med J. 2022 Apr 1;112(4):252-258. PMID: 35587803. 19. Saejeng K, Jaisamrarn U, Naravage W. Women’s experiences and acceptability of medical termination of pregnancy: Results of an introductory study in ailand. Journal of Health Research. Journal of Health Research. 2019. 33; 2:127 -137. O&G Forum 2022; 32: 22-27 ORIGINAL RESEARCH