“How do you feel about the abortion?”: pre-termination of pregnancy counselling in the public health sector in the Eastern Cape
- Authors: Du Toit, Ryan Rudolph
- Date: 2023-10-13
- Subjects: Abortion counseling South Africa Eastern Cape , Conversation analysis , Discursive psychology , Public health South Africa , Reproductive justice , Abortion Psychological aspects
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/437238 , vital:73355 , DOI 10.21504/10962/437239
- Description: Pre-abortion counselling, as an aspect of abortion provision, has received growing research interest in various contexts. Much of the research has primarily focused on whether abortion counselling takes place, the experiences of women and/or counsellors (usually through retrospective interviews and surveys), and the content discussed during the counselling session (often policy regulated). Such research has proven vital to addressing the various reproductive issues facing women seeking an abortion worldwide. However, little research has focused on how pre-abortion counselling as an everyday institutional practice is conducted at a conversational level in the medical setting. By drawing on both conversation analysis and discursive psychology, this study explored how pre-abortion counselling was conducted in the public health sector in South Africa. The study involved recording the conversation during pre-abortion counselling and analysing it in terms of its content, in particular, the discourses drawn on by all parties involved, and its structure and delivery. The data were collected from three public hospitals in the Eastern Cape of South Africa and involved the audio recording of pre-abortion counselling sessions as part of abortion services. In total, 28 counselling sessions were recorded: 21 were individual sessions, and 7 were group counselling sessions. At two of the sites, counselling was conducted by registered midwives who worked at the hospital. At one site, an external Christian organisation volunteered trained counsellors to counsel women at the hospital free of charge. Using conversation analysis, counselling sessions were analysed in terms of the main projects. Seven key projects were identified: (1) Context setting, (2) History taking, (3) Establishing reason for abortion, (4) Presenting options, (5) Providing procedural information, (6) Obtaining verbal informed consent, and (7) Discussion of family planning. Each project is explored in terms of what discourses and subject positions featured when speakers were orienting to a specific project. This process highlighted how the conversational projects and their respective goals enable the deployment of certain problematic discourses and interactive/reflexive positionings. Discourse analysis revealed a clustering of discourses around two central themes. In the first clustering, the discourses were primarily used to discuss the (1) medically related issues underpinning the abortion procedure [medical discourse, responsibilization discourse, risk discourse, and discourse of support]. Talk using these discourses positioned women as patients needing medical intervention, responsibilised women for conceiving, playing an active role in their termination, and navigating all the psychological and physical risks “associated” with abortion. The discourse of support illustrates how support was spoken about in the interaction whereby patients were constructed as subjects who required support and nurses/counsellors as the ones who offered the support. In the second clustering, the discourses (2) focused on women and the foetus. These discourses [reproductive choice, religious, pronatalist, and foetal personhood discourses] positioned women as being responsible for making a choice regarding their pregnancy and the consequences that may result. In addition, a religious discourse coupled with a pronatalist discourse was used to construct the pregnancy and motherhood as desirable and part of “God’s plan”, whereas the foetus was spoken about as a “gift from God”. The foetal personhood discourse was used to construct the foetus as a living and functional human. This research provides evidence of how abortion counselling is problematic at various levels. At a practical level, there is a lack of standardisation in the delivery of abortion counselling (e.g., variation in key projects, where the counselling is mandated, time taken, nurse/counsellor training, content and format – group vs. individual counselling). At a discursive level, the use of certain discourses works to render the counselling directive through : (1) awfulizing abortion by providing misinformation about the abortion procedure, foetus and post-abortion psychological distress, (2) chastising and responsibilising women for conceiving, (3) constructing abortion as immoral, the ending of life and not in line with God’s plan, (4) constructing parenthood as the preferred choice, (5) delegitimising abortion as a resolution for pregnancy when compared to the other options (e.g., parenting or adoption), and finally (6) providing counselling that does not take into account the broader socio-political contexts. Recommendations for future research are put forward, and a call to move to a reparative justice framework is made by highlighting how it can be used to identify and understand reproductive injustices as they occur along four intersecting dimensions: (1) Individual material, (2) Collective material, (3) Individual symbolic, and (4) Collective symbolic. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2023
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- Date Issued: 2023-10-13
Nurses’ experiences of an abortion counselling training course and their understandings of quality abortion services
- Authors: Mogonong, Laurah Carolina
- Date: 2023-03-30
- Subjects: Abortion counseling , Abortion Psychological aspects , Nurses Attitudes , Abortion services South Africa Eastern Cape , Grounded theory , Person-centered therapy
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/408862 , vital:70532
- Description: This research study focuses on nurses’ experiences of participating in an abortion counselling training programme in the Eastern Cape Province (E.C), using a grounded theory and symbolic interactionism framework. The study aims to investigate how participating in a women-centred abortion counselling training course offered through the Critical Studies in Sexualities and Reproduction research unit may modify or improve nurses’ practice of abortion counselling and understanding of quality abortion services. Through purposive sampling, nine research participants working as abortion providers in EC health care facilities were recruited. Research data were produced using discussions around prior abortion counselling experiences, a reflective activity, power point case presentations conducted within the counselling training, and semi-structured interviews conducted two months after the training with five of the providers. A grounded theory analysis was used to generate themes that highlighted different aspects that enabled or hindered access to quality abortion services. In accordance with prior research, it was revealed that nurses undergo abortion training but there is limited content on abortion counselling training. Findings from this study reveal the modifications of practice and understanding of quality abortion services of nurses who participated in the client-centred abortion counselling training course. Themes of change that emerged from the nurses’ experiences were rendering counselling services in a non- judgemental, non-directive way, being acknowledged and recognized for the services they offer as abortion providers, and accepting that abortion is a reproductive legal right that can be accessed whenever a woman in need of the service requests it. The findings of this research also indicate that, despite the controversy and stigma attached to providing abortion services, the participants were motivated to continue offering abortion services because they felt equipped since undergoing abortion counselling training. The training course improved reported abortion counselling practices, but systematic issues such as lack of managerial support, space for individual counselling and procedure equipment continue to undermine services. , Thesis (MA) -- Faculty of Humanities, Psychology, 2023
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- Date Issued: 2023-03-30