Pregnancy: The right to choose

Dr Judy Kluge and Prof Stefan Gebhardt.

Globally approximately 225 million women have no access to family planning and another 22 million undergo unsafe abortions.

“Providing these women with the choice to use effective contraception and to space their babies by 18 to 24 months, would prevent 54 million unattended pregnancies, 79 000 maternal deaths and 1,1 million infant deaths."

This statement by Prof Alison Fiander of the British-based Royal College of Obstetricians and Gynaecologists (RCOG ) summarises the motivation behind Leading Safe Choices (LSC). It is a donor-funded initiative that aims to strengthen the competence and raise the professional standing of workers in female healthcare. The programme is undertaken in partnership with colleagues in South Africa, including two experts of the Faculty of Medicine and Health Sciences (FMHS) of Stellenbosch University (SU).

“South Africa and Tanzania were chosen because the RCOG wanted to undertake a pilot programme in a country with a liberal abortion law (South Africa), as well as one with a very conservative approach to abortion (Tanzania)," explains Prof Stefan Gebhardt, Head of General Specialist Services at the FMHS' Department of Obstetrics and Gynaecology

The RCOG approached SU, the University of Cape Town (UCT ) and the Western Cape Department of Health to conduct the programme in Cape Town. Dr Judy Kluge, Head of the Family Planning Unit at SU, and Gebhardt were chosen as clinical lead and programme lead respectively. A clinical and programme lead were alsoappointed at UCT .

According to the LSC programme summary, obstetricians, gynaecologists and allied healthcare workers are ideally positioned to improve the provision of family planning and abortion services, but unfortunately often don't regard this as a priority.

In an effort to improve this, LSC aims to increase providers' knowledge of the abortion legislation, strengthen their capacity to provide counsel about pregnancy options, improve access to medical abortion and post-abortion contraception, and raise the providers' standing within the profession through a professional accreditation process to address the stigma associated with abortion.

Gebhardt says thus far the project is on track to deliver.

Ms Valerie Truby, South African LSC programme manager and training coordinator, says the best practice papers on post-partum planning and comprehensive abortion care, developed by the RCOG along with the South African experts, are currently an addendum to the Western Cape Department of Health's Sexual Reproductive Health and Termination of Pregnancy policies. In addition, sharing of best practice meetings will be conducted in future, “creating a platform where professionals can share lessons learnt and what works best".

Training is being successfully conducted at the Mowbray, Tygerberg, Khayelitsha, Mitchell's Plain and Michael Mapongwana community centra, where the three-year pilot programme is being conducted. “Training includes lectures, interactive sessions where trainees practise on pelvic models and partake in group discussions, and role playing the lecture content," Truby explains. “We want to train 150 people by the end of the year."

Gebhardt says the RCOG has applied for funding for the next 10 years to expand the project to the rest of the metro and the province.

According to the LSC summary this is a strategic partnership to respond to an unmet need. “For women to achieve their potentialin society, they must have control over their own fertility and the freedom to plan and space their pregnancies."

Liezel Engelbrecht