Ukukhishwa kwezisu - ' taking out the stomach ' : young women's conversations about abortion in KwaZulu-Natal.
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The World Health Organisation (WHO) (2004) estimates that 68 000 women die a year from injuries sustained during unsafe abortions. 38,000 of those women are estimated to be from Africa. 19 million of the 46 million abortion procedures are performed in unhygienic settings by unskilled practitioners. Roughly, just under half of all abortions carried out globally are unsafe. Women who survive the procedure do not emerge unscathed. Many women endure chronic health complications that result from the procedure. Unsafe abortions are a pertinent issue for discussion in light of the immense consequences for public health. The South African health sector is struggling with the high rate of unplanned pregnancies. The Choice on Termination of Pregnancy Act, 1996 (Act No. 92 of 1996) legalised abortion with the hope that the regulation and legalisation of the procedure would provide vulnerable women with a safe recourse instead of turning to unskilled practitioners. Despite this Act, the practice of women and girls having unsafe abortions continues. This study investigates this phenomenon. The parameter of this investigation is around the Amahlongwa and Amandawe areas in the UGu district within the Umdoni Municipality in KwaZulu-Natal (KZN). The need for the study was highlighted during discussions held in 2011 after entertainment-education interventions in the area focused on reproductive health (Gumede and Delate n.d.: n.p). The data collected during those dialogues revealed that few women use condoms or oral contraceptives to prevent pregnancies. In the event of an unplanned pregnancy, many women opted to undergo an unsafe or 'backstreet'1 abortion procedure. The objective of this study is to establish how young women understand abortion, how they talk about it in their community and where do they get information about abortion from? This study later in the findings reveals that abortion, irrespective of whether it is legal or backstreet, is not a topic that is commonly talked about by the community and youth in rural areas like Amahlongwa and Amandawe. When women do talk about abortion, it is often in a way that is judgmental, and is mostly in the realm of local gossip. The findings from the focus groups also highlight that stigma attached to abortion in health institutions is another factor leading to the high rate of backstreet abortions in the area. The study shows that young women are not comfortable using the spaces created for legal abortion in hospitals. Based on these findings, the study concludes with recommendations for public health campaigns on the topic, and suggests ways to improve abortion services so that the continuing problem of young women opting for backstreet abortion is reduced.