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SOUTH AFRICA


South Africa occupies the southern tip of Africa. It has a population of 47.4 million (PRB-UNFPA 2005) and has 11 official languages. South Africa is a constitutional democracy with a three-tier system of government and an independent judiciary. Although South Africa is in many respects a developed country, much of its population lives in poverty.

In 1997, South Africa became the only country in the world to legislate access to abortion services. The Choice on Termination of Pregnancy Act not only affirmed the right of women to choose abortion, it also encouraged the development and integration of abortion as part of reproductive health services at the primary health care level.

Mifepristone (RU-486) was approved for use in abortion procedures by the South African Medicines Control Council in August 2001. With significant expertise in training medical abortion providers, NAF began working with South African and international colleagues to develop and provide training on mifepristone for use in the public sector.

In March 2002, the first medical abortion training for South Africans was convened in Paris by the Population Council and the Center for Training in Reproductive Health Technologies (France). During 2003, NAF worked with Ibis Reproductive Health and Gynuity Health Projects to plan a training program in conjunction with the launch of an operations research study to determine the feasibility of offering medical abortion in the public health sector. In November 2003, NAF and a coalition of colleagues conducted a medical abortion training in Johannesburg for teams of nurses, physicians, and researchers in two provinces, Guatang and Western Cape.

Training Goals

The goals of the South Africa training program were to:

  • provide training and resources on mifepristone, and
  • provide participants with the survey instruments and information needed to conduct the operations research study on provider and patient acceptability.

Training

In November 2003, NAF and Gynuity faculty conducted a three-day medical abortion training course for 15 participants in Johannesburg, South Africa. The training involved:

  • Didactic and interactive components of medical abortion care models,
  • A problem-solving approach to clinical case studies, and
  • Development of strategies for overcoming barriers to service delivery.

Participants agreed that including medical abortion in termination of pregnancy (TOP) services:

  • Offers women increased access to abortion care.
  • Offers the health system the potential to serve more women earlier in their pregnancies.
  • Has the potentioal to reduce the demand for later abortions, thereby increasing the health system's capacity to provide those services

Medical Abortion Training Curriculum

NAF's training program included the following:

  • overview of global medical abortion;
  • pharmacology and mechanism of action of mifepristone and misoprostol;
  • medical abortion regimens;
  • indications and contraindications;
  • counseling;
  • blood tests and ultrasound for gestational dating;
  • side effects and complications of medical abortion;
  • patient management;
  • post-medical abortion management;
  • post-medical abortion contraception;
  • review of study methods and instruments; and
  • discussion of challenges and how to overcome barriers.

Next Steps

NAF's training and technical assistance in South Africa are designed to help introduce and build a strong foundation for high-quality medical abortion services. The South African medical community and policy officials at local, provincial and national levels have reviewed the favorable results of the initial feasibility, costing, and operations research studies.

Further deliberations are being carried out regarding practical aspects of integrating medical abortion into current termination of pregnancy (TOP) curricula and services for the Republic of South Africa.

NAF will continue to provide technical assistance in the development of up-to-date educational materials and curricula for health care providers and trainers. NAF also provides faculty for national and regional meetings and Training of Trainers workshops

We also provide information for policymakers and advocates: short user-friendly documents that provide a basic overview of medical abortion. All of these documents include both South African and international research and experience in the field of medical abortion. See for example the fact sheets South Africa/Medical Abortion: History and Overview and South Africa/Mifepristone and Misoprostol for Medical Abortion: A Brief Background.

South African caregivers
Curriculum. NAF's 2nd Edition Clinical Training Curriculum in Abortion Practice is one of several curricula that have been developed specifically for training medical students, residents, and other health care providers in abortion care.
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