Addressing the demand for termination of pregnancy services in district health facilities in Johannesburg.
Article Type: Letter to the editor
Subject: Maternal health services (Forecasts and trends)
Maternal health services (Laws, regulations and rules)
Authors: Mendes, J.F.
Basu, D.
Basu, J.K.
Pub Date: 10/01/2010
Publication: Name: South African Medical Journal Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 South African Medical Association ISSN: 0256-9574
Issue: Date: Oct, 2010 Source Volume: 100 Source Issue: 10
Topic: Event Code: 010 Forecasts, trends, outlooks; 930 Government regulation; 940 Government regulation (cont); 980 Legal issues & crime; 970 Government domestic functions Advertising Code: 94 Legal/Government Regulation Computer Subject: Market trend/market analysis; Government regulation
Geographic: Geographic Scope: South Africa Geographic Name: Johannesburg, South Africa Geographic Code: 6SOUT South Africa
Accession Number: 239347148
Full Text: To the Editor: The Choice of Termination of Pregnancy (CTOP) Act instituted safe, effective, affordable and acceptable methods of fertility regulation for women. Universal access to reproductive health services is available through the district health services. (1)

By 2001, there had been a 91% decline in maternal mortality from unsafe abortions in South Africa (SA) as a result of the CTOP Act. (2) However, despite the availability of free reproductive health services, few women are utilising family planning services in SA. (3) Recent studies have reported that unsafe abortions are on the increase. (4-6)

We wished to determine the number of terminations of pregnancy (TOPs) requested and the number of TOPs performed from January 2008 to December 2009 in the Johannesburg Metropolitan District (JM). We conducted a descriptive cross-sectional study including TOP data from district health information systems in the JM. All health facilities offering TOP services at the district level were included.

The analyses showed that a total of 14 683 and 16 031 women requested TOPs in 2008 and 2009 respectively; these figures might have included women in their second trimester, at district facilities. A third of requests were performed, with 4 921 and 5 338 first-trimester TOPs performed in 2008 and 2009 respectively (Fig. 1). In 2008, a total of 6 clinics offered TOP services in the JM. The majority (68%) of the first-trimester TOPs were performed by 2 facilities. Two clinics which collectively had performed 15% of the total number of TOPs in 2008, ceased offering TOP services in 2009; only a new clinic initiated TOP services in 2009.

Although the number of TOP requests increased from 2008 to 2009, the facilities offering first-trimester TOP services declined. In addition, the number of first-trimester procedures performed was far less than the number of requests received. A major concern is that if the demand for TOPs remains unmet in the public sector, the incidence of unsafe abortions may continue to rise further.


(1.) Choice of Termination of Pregnancy Act No. 92 of 1996. Pretoria: Department of Health, 1996.

(2.) Jewkes R, Rees H. Dramatic decline in abortion mortality due to choice of Termination of Pregnancy Act. S Afr Med J 2005; 95: 250.

(3.) MacPhail C, Pettifor AE, Pascoe S, Rees H. Contraception use and pregnancy among 15 - 24 years old South African women: a nationally representative cross-sectional survey. BMC Med 2007; 28: 31.

(4.) Meel B, Kaswa RP. The impact of Choice of Termination of Pregnancy Act of 1996 (Act 92 of 1996) on criminal abortions in the Mthatha area of South Africa. African Journal of Primary Health Care and Family Medicine 2009; 1: 79-81.

(5.) Basu JK. Legal unsafe abortion in South Africa. Conference proceeding XIX FIGO World Congress of Gynaecology and Obstetrics, Cape Town, South Africa, 4 - 9 October 2009.

(6.) Morroni C, Moodley J. Characteristics of clients seeking first and second trimester termination of pregnancy in public health facilities in Cape Town. S Afr Med J 2006; 96: 574.

J F Mendes

D Basu

School of Public Health

Charlotte Maxeke Johannesburg Academic Hospital, and University of the Witw atersrand


J K Basu

Department of Obstetrics and Gynaecology

Charlotte Maxeke Johannesburg Academic Hospital, and University of Witwatersrand

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