A qualitative exploration of knowledge, attitudes, and experiences with abortion among adolescents in Gauteng province, South Africa

Adolescents in South Africa continue to have unmet sexual and reproductive health (SRH) needs. Unplanned pregnancy is a persistent issue in the country, with 1,270,000 pregnancies in South Africa being unintended between 2015–2019. Furthermore, in a 2019 study on the association of pregnancy intention with HIV status, it was found that 76.3% of pregnancies among participants aged 15–19 were unintended, which was notably higher than the rates of unintended pregnancy among older age groups in the study. Research also shows that one-third of women in South Africa experience pregnancy during their adolescence and 31% of girls aged 15–19 in South Africa have an unmet need for contraception. Efforts have been made to promote SRH access and education for young people, such as the introduction of the National Adolescent and Youth Health Policy of 2017, which aimed to promote health and well-being among young people. However; more remains to be done in order to realise the successful implementation of these comprehensive policies and affect changes in health outcomes.

This brief presents findings from qualitative in-depth interviews, conducted in January 2023, with adolescents who had an unplanned pregnancy and/or an abortion. Participants were recruited through a larger explanatory sequential cross-sectional study that aimed to explore access to and experiences with sexual and reproductive health services, including abortion, among adolescents aged 12–17, as well as their knowledge of contraception and the CTOP Act. If quantitative survey respondents reported experience with unplanned pregnancy or abortion, they were invited to participate in an interview.

We held in-depth interviews with 10 respondents who were assigned female at birth, aged 16–17, and living in the Gauteng province. We used thematic analysis to identify and analyse recurring themes in the data. We created a deductive codebook based on the in-depth interview guide which was used to code units of meaning from the data using the qualitative analysis software, Dedoose. Inductive analysis was also used to identify new codes, in response to which the codebook was updated. Thereafter, the codes were reviewed for consistency and the data was written up in code summaries. Overarching themes were identified and documented throughout this process and used as a basis for presenting our findings. Ethical approval was obtained from the University of Witwatersrand’s Human Research Ethics Committee and written informed parental consent and minor assent were collected before participation in the study.