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Open Access Research article

Surgical and medical second trimester abortion in South Africa: A cross-sectional study

Daniel Grossman12*, Deborah Constant3, Naomi Lince4, Marijke Alblas5, Kelly Blanchard6 and Jane Harries3

Author Affiliations

1 Ibis Reproductive Health, Oakland, CA, 94612, USA

2 Bixby Center for Global Reproductive Health and San Francisco General Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, 94143-0744, USA

3 Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa

4 Ibis Reproductive Health, Johannesburg, 2041, South Africa

5 Independent consultant, Cape Town, 7925, South Africa

6 Ibis Reproductive Health, Cambridge, MA, 02238, USA

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BMC Health Services Research 2011, 11:224  doi:10.1186/1472-6963-11-224

Published: 19 September 2011

Abstract

Background

A high percentage of abortions performed in South Africa are in the second trimester. However, little research focuses on women's experiences seeking second trimester abortion or the efficacy and safety of these services.

The objectives are to document clinical and acceptability outcomes of second trimester medical and surgical abortion as performed at public hospitals in the Western Cape Province.

Methods

We performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. Two hundred and twenty women underwent D&E with misoprostol cervical priming, and 84 underwent induction with misoprostol alone. Information was obtained about the procedure and immediate complications, and women were interviewed after recovery.

Results

Median gestational age at abortion was earlier for D&E clients compared to induction (16.0 weeks vs. 18.1 weeks, p < 0.001). D&E clients reported shorter intervals between first clinic visit and abortion (median 17 vs. 30 days, p < 0.001). D&E was more effective than induction (99.5% vs. 50.0% of cases completed on-site without unplanned surgical procedure, p < 0.001). Although immediate complications were similar (43.8% D&E vs. 52.4% induction), all three major complications occurred with induction. Early fetal expulsion occurred in 43.3% of D&E cases. While D&E clients reported higher pain levels and emotional discomfort, most women were satisfied with their experience.

Conclusions

As currently performed in South Africa, second trimester abortions by D&E were more effective than induction procedures, required shorter hospital stay, had fewer major immediate complications and were associated with shorter delays accessing care. Both services can be improved by implementing evidence-based protocols.