The South African Choice on Termination of Pregnancy (CTOP) Act, no.92 of 1996, replaced the previously restrictive Abortion and Sterilization Act, no.2 of 1975. The Act promotes a woman's reproductive right and choice to have an early, safe and legal abortion . As a direct result of the new abortion legislation, abortion related morbidity and mortality have decreased significantly . However, despite the legislation there are still major barriers to women accessing abortion services. These include provider opposition, stigma associated with abortion, poor knowledge of abortion legislation, a lack of providers trained to perform abortions and facilities designated to provide abortion services particularly in the rural areas [3-6].
Abortion is a time-restricted health service. The CTOP Act provides for abortion on request up to and including 12 weeks of gestation. In cases of socio-economic hardship, rape, incest and for reasons related to the health of the pregnant woman or foetus, terminations can be performed up to 20 weeks of gestation. From 20 weeks onward terminations are available under very limited circumstances. All abortions are performed at facilities designated by the National and Provincial Departments of Health. The CTOP Act allows for first trimester abortions (up to 12 weeks gestation) to be performed by trained nurse midwives, whereas second trimester abortions are provided by doctors.
In recent years the number of abortions performed nationally and in each of the provinces, including the Western Cape has increased substantially, indicating increased availability and accessibility to TOP services . Second trimester abortions account for over 20% of abortions performed in South Africa , which is greater than other countries with legalized abortion such as the United States and Vietnam, where 12% or less of abortions occur in the second trimester [8,9]. Abortions performed after 12 weeks of gestation pose greater risks of medical complications than abortions performed during the first trimester [9,10].
While the availability of second trimester abortion services is an important aspect of reproductive health care, reducing its proportion has several public health care advantages. These advantages include decreased risk of procedure related complications, decreased cost to the health services and increased feasibility of abortions becoming a predominantly primary health care service [9,10].
Understanding reasons for abortion delay may facilitate the improvement of referral networks and promote the development of health education programmes that reduce the need for second trimester abortions [11,12]. Yet, despite the need for interventions to encourage earlier abortions, it is important to ensure that second trimester abortion services continue to be accessible and available to all women in South Africa.
In South Africa, little is known about the reasons why women delay seeking an abortion until the second trimester . Exploring the reasons why women attend later in pregnancy for an abortion is important for informing interventions to reduce the proportion of second trimester abortions in South Africa. This paper reports on results from a qualitative study that explored the factors that contributed towards women accessing abortion services in their second trimester of pregnancy.