Men and talk about legal abortion in South Africa: equality, support and rights discourses undermining reproductive 'choice'

Men's involvement in women's abortion-related care: a scoping review of evidence from low- and middle-income countries

Men’s involvement in abortion is significant, intersecting across the individual, community and macro factors that shape abortion-related care pathways. This scoping review maps the evidence from low- and middle-income countries relating to male involvement in abortion trajectories. Five databases were searched, using search terms, to yield 7493 items published in English between 01.01.2010 and 20.12.2019. 37 items met the inclusion criteria for items relating to male involvement in women’s abortion trajectories and were synthesised using an abortion-related care-seeking framework. The majority of studies were conducted in sub-Saharan Africa and were qualitative. Evidence indicated that male involvement was significant, shaping the ability for a woman or girl to disclose her pregnancy or abortion decision. Men as partners were particularly influential, controlling resources necessary for abortion access and providing or withdrawing support for abortions. Denial or rejection of paternity was a critical juncture in many women’s abortion trajectories. Men’s involvement in abortion trajectories can be both direct and indirect. Contextual realities can make involving men in abortions a necessity, rather than a choice. The impact of male (lack of) involvement undermines the autonomy of a woman or girl to seek an abortion and shapes the conditions under which abortion-seekers are able to access care. This scoping review demonstrates the need for better understanding of the mechanisms, causes and intensions behind male involvement, centring the abortion seeker within this.

Reproductive awareness and recognition of unintended pregnancy: young women, key informants and health care providers perspectives in South Africa

BACKGROUND

South Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility. For women successfully obtaining care, time from last menstrual period to confirmation of pregnancy is significantly longer among those having an abortion later in the second trimester compared to earlier gestations. This study explores women's experiences with recognition and confirmation of unintended pregnancy, their understanding of fertile periods within the menstrual cycle as well as healthcare providers' and policy makers' ideas for public sector strategies to facilitate prompt confirmation of pregnancy.

METHODS

We recruited participants from July through September 2017, at an urban non-governmental organization (NGO) sexual and reproductive health (SRH) facility and two public sector hospitals, all providing abortion care into the second trimester. We conducted in-depth interviews and group discussions with 40 women to elicit information regarding pregnancy recognition and confirmation as well as fertility awareness. In addition, 5 providers at these same facilities and 2 provincial policy makers were interviewed. Data were analysed using thematic analysis.

RESULTS

Uncertainties regarding pregnancy signs and symptoms greatly impacted on recognition of pregnancy status. Women often mentioned that others, including family, friends, partners or colleagues noticed pregnancy signs and prompted them to take action. Several women were unaware of the fertility window and earliest timing for accurate pregnancy testing. Health care providers and policy makers called for strategies to raise awareness regarding risk and signs of pregnancy and for pregnancy tests to be made more readily accessible.

CONCLUSION

Early recognition of unintended pregnancy in this setting is frustrated by poor understanding and awareness of fertility and pregnancy signs and symptoms, compounded by a distrust of commercially available pregnancy tests. Improving community awareness around risk and early signs of pregnancy and having free tests readily available may help women confirm their pregnancy status promptly.

Reasons for Abortion: Religion, Religiosity/Spirituality and Attitudes of Male Secondary School Youth in South Africa

This study focused on the relationship between religion, religiosity/spirituality (R/S), and attitudes of a sample of South African male secondary school youth toward women's rights to legal abortion in different situations. We distributed 400 self-administered questionnaires assessing the main variables (attitudes toward reasons for abortion and R/S) to the target sample in six different secondary schools in KwaZulu-Natal, South Africa. The responses of a final sample of 327 learners were then analyzed using the Statistical Package for the Social Sciences (SPSS) software. The findings revealed that religion and R/S play a role in the youths' attitudes toward abortion. While the Hindu subsample indicated higher overall support across the different scenarios, the Muslim subsample reported greater disapproval than the other groups on 'Elective reasons' and in instances of 'Objection by significant others.' The Christian youth had the most negative attitudes to abortion for 'Traumatic reasons' and 'When women's health/life' was threatened. Across the sample, higher R/S levels were linked with more negative attitudes toward reasons for abortion.

Expanding reproductive justice through a supportability reparative justice framework: the case of abortion in South Africa

Theoretical refinement of the concept of reproductive justice has been called for. In this paper, I propose the use of a supportability reparative justice approach. Drawing on intra-categorical intersectionality, the supportability aspect starts from the event of a pregnancy to unravel the interwoven embodied and social realities implicated in women experiencing pregnancy as personally supportable/unsupportable, and socially supported/unsupported. The reparative justice aspect highlights the need for social repair in the case of unsupportable pregnancies and relies on Ernesto Verdeja's critical theory of reparative justice in which he outlines four reparative dimensions. Using abortion within the South African context, I show how this framework may be put to use: (1) the facilitation of autonomous decision-making (individual material dimension) requires understanding women within context, and less emphasis on individual-driven 'choice'; (2) the provision of legal, safe state-sponsored healthcare resources (collective material dimension) demands political will and abortion service provision to be regarded as a moral as well as a healthcare priority; (3) overcoming stigma and the spoiled identities (collective symbolic dimension) requires significant feminist action to deconstruct negative discourses and to foreground positive narratives; and (4) understanding individual lived experiences (individual symbolic dimension) means deep listening within the social dynamics of particular contexts.

Ethical challenges in research on post-abortion care with adolescents: experiences of researchers in Zambia

Post-abortion care (PAC) research is increasingly being conducted in low- and middle-income countries (LMICs) to help reduce the high burden of unsafe abortion. This study aims to help address the evidence gap about ethical challenges that researchers in LMICs face when carrying out PAC research with adolescents. Employing an explorative qualitative approach, the study identified several ethics challenges encountered by PAC researchers in Zambia, including those associated with seeking ethics and regulatory approvals at institutional and national levels. Persistent stigma around abortion and community perceptions that PAC studies encourage adolescents to seek abortion affected adolescents' right to exercise their autonomy and to make decisions as well as exposed adolescents to social stigmatization risks. Challenges with recruitment was reported to result in abandoning of studies, thereby undermining development of PAC services that are more responsive to adolescent needs. Training needs identified included knowledge of best practices for conducting and disseminating PAC research. Strategies for addressing the ethical challenges included trust building and using less value-laden terminology when seeking permission and consent. It is essential to the future of PAC research in Zambia and globally that these important challenges be addressed through the development of comprehensive ethics guidance.

Abortion attitudes among South Africans: findings from the 2013 social attitudes survey

Abortion is legal in South Africa, but over half of abortions remain unsafe there. Evidence suggests women who are (Black) African, of lower socioeconomic status, living with HIV, or residents of Gauteng, KwaZulu-Natal, or Limpopo provinces are disproportionately vulnerable to morbidity or mortality from unsafe abortion. Negative attitudes toward abortion have been documented in purposively sampled studies, yet it remains unclear what attitudes exist nationally or whether they differ across sociodemographic groups, with implications for inequities in service accessibility and health. In the current study, we analysed nationally representative data from 2013 to estimate the prevalence of negative abortion attitudes in South Africa and to identify racial, socioeconomic and geographic differences. More respondents felt abortion was 'always wrong' in the case of family poverty (75.4%) as compared to foetal anomaly (55%), and over half of respondents felt abortion was 'always wrong' in both cases (52.5%). Using binary logistic regression models, we found significantly higher odds of negative abortion attitudes among non-Xhosa African and Coloured respondents (compared to Xhosa respondents), those with primary education or less, and residents of Gauteng and Limpopo (compared to Western Cape). We contextualise and discuss these findings using a human rights-based approach to health.

The role of men in induced abortion decision making in an urban area of the Philippines

OBJECTIVE

To understand beliefs about unintended pregnancy and abortion, and perceptions about male roles related to pregnancy decision-making among men in the Philippines.

METHODS

Qualitative data were collected during in-depth interviews and focus group discussions with men in an urban area of the Philippines between October 2007 and July 2008. Interview participants were purposively sampled from a local survey based on their having reported being "afraid or troubled" or "afraid and planned to terminate" in response to a recent pregnancy. Focus group participants were selected from the same communities. Data were analyzed using the constant comparative method.

RESULTS

In-depth interview data from 15 men-each interviewed twice-and five focus group discussions were included. Male interview participants reported feeling morally responsible for the pregnancy and as wanting to avoid the "sin" of induced abortion; however, they were concerned about being able to support a family financially. Participants expressed resentment towards partners who attempted or completed an induced abortion without their knowledge. In such cases, men would disparage their partner and cease interacting with them to avoid the "sin" of induced abortion.

CONCLUSION

Participants described negative feelings towards women seeking induced abortions, and their own desire to avoid associated "sin". This highlights the effects of unintended pregnancy and induced abortion on young Filipino men, including their own experience of abortion stigma.

Articulating reproductive justice through reparative justice: case studies of abortion in Great Britain and South Africa

Public health and rights-based approaches to abortion advocacy are well established. Feminists are, however, increasingly using a broader framework of 'reproductive justice', which considers the intersecting conditions that serve to enhance or hinder women's reproductive freedoms, including their capacities to decide about the outcome of their pregnancies. Nonetheless, reproductive justice approaches to abortion are, conceptually, relatively under-developed. We introduce a reparative justice approach as a method of further articulating the concept of reproductive justice. We first explain how this approach can be used to conceptualise safe, accessible and supportive abortion as a key element of reproductive justice in relation to the injustice of unwanted or unsupportable pregnancies. Using Ernesto Verdeja's critical theory of reparative justice and case studies of two countries (South Africa and Great Britain) where abortion is legal, we show how such an approach enables an analysis of reproductive justice within the specificities of particular contexts. We argue that both the rights-based legal framework adopted in South Africa and the medicalised approach of British law have, in practice, limited reparative justice in these contexts. We discuss the implications of reparative justice for abortion advocacy.

Reproductive justice in context: South African and Zimbabwean women’s narratives of their abortion decision

The abortion decision-making process is embedded within overlapping power relations. Using a post-colonial feminist framework, we analyse South African and Zimbabwean women’s narratives regarding their abortion decision. As neighbouring countries, South Africa and Zimbabwe provide a useful counterpoint as they have common and differing social histories and very different abortion legislation. In our analysis, we unpick transversal commonalities and divergences in the discursive resources deployed by the women in their narratives in the two sites. Commonalities included the women feeling compelled to justify their abortion decision in the interactive interview space, an absence of a reproductive rights discourse, and the deployment of relationship embedded discourses in the justificatory work performed by the women. The “conjugalisation of reproduction”, “imperative of good mothering”, and “unstable partner relationships” discourses featured across both sites but the manner in which these were deployed differed. These discursive resources allowed the women to position themselves as making responsible decisions. The Zimbabwean women spoke of shame and hiding, a discursive resource that was explicitly absent in the South African women’s accounts. We conclude by arguing that our post-colonial feminist approach allows for a contextualised reproductive justice stance to abortion decision-making that identifies both transnational and context-specific power relations.

A critical review of sanctioned knowledge production concerning abortion in Africa: Implications for feminist health psychology

Taking a feminist health psychology approach, we conducted a systematic review of published research on abortion featured in PsycINFO over a 7-year period. We analysed the 39 articles included in the review in terms of countries in which the research was conducted, types of research, issues covered, the way the research was framed and main findings. Despite 97 per cent of abortions performed in Africa being classifiable as unsafe, there has been no engagement in knowledge production about abortion in Africa from psychologists, outside of South Africa. Given this, we outline the implications of the current knowledge base for feminism, psychology and feminist health psychology in Africa.

An easy test but a hard decision: ethical issues concerning non-invasive prenatal testing for autosomal recessive disorders

Prenatal testing based on cell-free fetal DNA in maternal serum is now possible for specific monogenic conditions, and studies have shown that the use of non-invasive testing is supported by prospective parents and health professionals. However, some ethical issues have been raised concerning informed consent and paternal rights. The objective of this study was to explore ethical aspects of the use of non-invasive prenatal diagnostic testing for autosomal recessive disorders. We used a qualitative cross-sectional design, based on Thematic Analysis, and recruited 27 individuals of reproductive age who were carriers of one of four conditions: thalassaemia, sickle cell disease, cystic fibrosis or spinal muscular atrophy. Data were collected via focus groups or interviews. Participants were aware of the potential for such tests to be viewed as routine and suggested that obtaining written consent and allowing time for consideration is needed to facilitate autonomous choice and informed consent. All participants felt that mothers should be able to request such tests, but fathers who declined carrier testing should be made aware that fetal test results may reveal their status. We suggest that a written record of consent for non-invasive prenatal diagnosis should be used as a standard to help reinforce the serious nature of the test results. Where the father's carrier status could be revealed through fetal testing, he should be made aware of this before the results are available. Health professionals should discuss with the pregnant woman the best way to manage unsought information about the father's carrier status to minimise family disruption.

The stigmatisation of abortion: a qualitative analysis of print media in Great Britain in 2010

The media play a significant part in shaping public perceptions of health issues, and abortion attracts continued media interest. Detailed examination of media constructions of abortion may help to identify emerging public discourse. Qualitative content analysis was used to examine if and how the print media in contributes to the stigmatisation of abortion. Articles from seven British and five Scottish national newspapers from 2010 were analysed for overall framings of abortion and emergent themes, including potentially stigmatising discursive constructs and language. Abortion was found to be presented using predominantly negative language and discursive associations as 'risky', and in association with other 'discredited' social practices. Key perspectives were found to be absent or marginalised, including those of women who have sought abortion. Few articles framed abortion as a positive and legitimate choice. Negative media representations of abortion contribute to the stigmatisation of the procedure and of women who have it, and reflect a discrediting of women's reproductive decision-making. There is a need to challenge the notion that abortion stigma is inevitable, and to encourage positive framings of abortion in the media and other public discourse.

Claiming Rosa Parks: conservative Catholic bids for 'rights' in contemporary Latin America

When the Rosa Parks Prize was awarded to a conservative Argentine senator in 2009 for her outspoken opposition to contraception, sterilisation and abortion, it was clear that something odd was happening. This paper documents the appropriation of 'human rights' discourses by conservative Catholics in Latin America, where the recent success of reproductive and sexual rights social movements has generated a significant backlash. It specifically traces an effort by Catholic legal scholars to justify what they term 'a distinctively Latin American approach to human rights' while ignoring decades of human rights activism by others. Opponents of reproductive and sexual rights are deploying rights-talk selectively and strategically, it is argued, using this as secular cover to advance pro-life and pro-family policies.