Legal termination of pregnancy among teenagers and older women in Soweto, 1999-2001
Background. Legal termination of pregnancy (TOP) was introduced in South Africa in 1996. No data are available to relate the numbers of TOPs to the total number of pregnancies in specific health regions. The level of use of TOPs by women of different age groups is not known.
Objective. To determine the proportion of pregnancies that end in TOP, with special reference to maternal age, and to measure trends in use from 1999 to 2001.
Setting. Greater Soweto, Orange Farm and Lenasia, a densely populated urban health region served by Chris Hani Baragwanath Hospital and comprehensive primary care reproductive health services.
Methods. Two cross-sectional studies performed in 1999 and 2001, counting all pregnancies managed in state-run health services, including legal terminations, spontaneous miscarriages, ectopic pregnancies and deliveries.
Results. There were 5412 pregnancies in the study period (9 weeks) in 1999, and 5316 in the study period (8 weeks) in 2001. The TOP rates decreased from 16.1% to 13.6% (P = 0.20). The TOP rates for teenagers decreased from 22.3% to 16.3% (P = 0.006), but were higher than those for older women (15.2% in 1999 and 13.2% in 2001, P = 0.006 and 0.028 respectively). TOP rates for teenagers 13- 16 years decreased from 28.0% to 23.0% (P = 0.44), and rates for older teenagers declined from 21.0% to 14.9% (P = 0.008). In 2001, 16.2% of women aged 35 and above underwent TOP, compared with 12.7% of women aged 20 - 34 years (P =0.014).
Conclusion. Use of TOP services was highest in women at the extremes of reproductive age. There was a significant decline in TOP rates among older teenagers between 1999 and 2001. These data, from a comprehensive urban reproductive health service, provide a benchmark for comparison elsewhere and in the future.