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CURRENT SITUATION REGARDING CTOP SERVICE DELIVERY IN SOUTH AFRICA
The internationally set targets for SA to reach MDG5 (improving maternal health) by 2015 was benchmarked as 38 deaths per 100 000 live births as well as to assure provision and access to reproductive health services by the same year (Millennium Development Goals (MDG) Country Report 2013:74; WHO, UNICEF, UNPPA & The World Bank, 2012:1). Since 1994 the South African Government together with the NDoH have put in place a wide range of policies, programmes, treaties, and conventions to promote maternal and reproductive health in an effort to decrease SA‟s
maternal rates. Yet, the most recent available estimates produced by Statistic South Africa (SSA) show that in 2010 the ratio was 269 maternal deaths per 100 000 live births (MDG Country Report 2013:74,77).
The current high level of maternal mortality expressed in its population policy and th NSD of 2010 – 2014 is a major concern to the South African Government and Department of Health (DoH) (MDG Country Report 2013:71). Since SA became a democracy in 1994 women‟s health became an important issue on government societal and community level (Gmeiner, van Wyk, Poggenpoel & Myburgh 2000:70). The passing of the CTOP Act (92 of 1996) and more recently the CTOP Act (1 of 2008) as an amendment of section 1 of the CTOP Act (92 of 1996) gave women in SA the right to independently choose to terminate a pregnancy and make decisions about their reproductive health. This is in line with the country‟s constitutional framework that “endorses the right to health for the population” and Bill of Rights that enshrines the rights of all people in our country and affirms the democratic values of human dignity, CHAPTER 2: LITERATURE REVIEW 2018 equality and freedom” (Bill of Rights 1996:5).The ultimate aim with these Acts is for legal termination of pregnancy to be carried out in an environment that conforms to minimal medical standards (Srivasta, Rai, Saxena, Roy, Chaudhary & Singh 2013:211) by registered nurses and midwives who have the necessary skills and training (Harries, Stinson, & Orner 2009:2).
Giving women in SA the freedom of choice in terms of the legal termination of pregnancy was a confident step to honour their human rights and to to decrease maternal mortality rates, but various serious problems emerged over time and remain prevalent. Stigmatisation (of both women who opt for CTOP services as well as of nurses who provide these services) is still a problematic issue; moral and ethical issues remain a personal as well as societal concern while the absence of knowledge regarding abortion legislation is an additional barrier. In addition, illegal abortions (whether self-induced or conducted illegally by quacks) unabatedly continues to endanger women‟s lives. CTOP services provision are substandard in terms of infrastructure and trained staff (Cooper, Dickson, Blanchard, Cullingworth, Nqobile & von Mollendorf et al 2005:35-39, Harries et al 2009:2, Lebese 2009:35-7, Mhlanga 2003:125, Srivastava et al 2013:211-13).
CHAPTER 1 INTRODUCTION AND OVERVIEW OF THE STUDY
1.1 INTRODUCTION
1.2 BACKGROUND AND RATIONALE
1.3 PROBLEM STATEMENT
1.4 SIGNIFICANCE OF THE STUDY
1.5 AIM OF THE STUDY
1.6 RESEARCH QUESTIONS
1.7 OBJECTIVES OF THE STUDY
1.8 THEORETICAL FRAMEWORK
1.8.1 Structure
1.8.2 Processes
1.8.3 Outcomes
1.9 PARADIGM
1.10 DEFINITION OF CONCEPTS
1.10.1 Guidelines
1.10.2 Improve
1.10.3 Quality
1.10.4 Choice on termination of pregnancy
1.11 RESEARCH DESIGN AND METHODOLOGY
1.12 RESEARCH DESIGN
1.12.1 Research setting
1.12.2 Population
1.12 3 Sampling method
1.12.4 Sample size
1.12.5 Data collection instrument
1.12.6 Data collection method
1.12.6.1 Pilot study
1.13 DATA ANALYSIS
1.14 ETHICAL CONSIDERATIONS
1.14.1 Consent form
1.14.2 Confidentiality
1.14.3 Anonymity
1.14.4 Privacy
PHASE 2
1.15 DEVELOPMENT OF GUIDELINES
1.15.1 Design
1.15.2 Population and sampl
1.15.3 Validity of guidelines
1.16 OUTLINE OF THE STUDY
1.17 CONCLUSION
CHAPTER 2 LITERATURE REVIEW
2.1 INTRODUCTION
2.2 CURRENT SITUATION REGARDING CTOP SERVICE DELIVERY IN SOUTH AFRICA
2.3 QUALITY OF THE STRUCTURE OF CTOP SERVICES IN PUBLIC HEALTH FACILITIES
2.3.1 Material resources
2.3.2 Human resources
2.4 QUALITY OF THE PROCESSES OF CTOP SERVICES IN PUBLIC HEALTH FACILITES
2.5 THE QUALITY OF THE OUTCOMES OF CTOP SERVICES IN PUBLIC HEALTH FACILITIES
2.6 CONCLUSION
CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY
3.1 INTRODUCTION
3.2 RESEARCH DESIGN
3.7 VALIDITY AND RELIABILITY
3.7.1 Validity
3.7.2 Reliability
3.8 DATA ANALYSIS
3.9 ETHICAL CONSIDERATIONS
3.10 CONCLUSION
CHAPTER 4 INTERPRETATION AND PRESENTATION OF RESULTS
CHAPTER 5 DISCUSSION OF FISHERS’ TEST RESULTS
CHAPTER 6 DEVELOPMENT OF GUIDELINES TO IMPROVE THE QUALITY OF THE CHOICE ON TERMINATION OF PREGNANCY SERVICES IN PUBLIC HEALTH FACILITIES IN TSHWANE DISTRICT IN GAUTENG PROVINCE
