Jane Harries - Profile on Academia.edu (original) (raw)

Papers by Jane Harries

Original research article The costs of accessing abortion in South Africa: women's costs associated with second-trimester abortion services in Western Cape Province ☆

Objectives: To assess women’s costs of accessing second-trimester labor induction and dilation an... more Objectives: To assess women’s costs of accessing second-trimester labor induction and dilation and evacuation (DE58induction).Theirmedianagewas26;37.6%reportedbeingemployedordoingpaidwork. Most(73.2%)womenvisitedtwodifferent facilities,includingthestudyfacility, whileseekingtheprocedure.Inductionwomenreportedamedian of three required visits [interquartile range (IQR) 2.0–3.0] to the study facility, while D&E women reported two required visits [IQR 1.0–2.0]. Twenty-seven percent of women missed work due to the procedure, and few (4.6%) paid for childcare. At each visit, almost all women (180, 92.8%)paidfortransportationcostsandreportedadditionalone-timecosts(177,91.2%)suchassanitarysuppliesordoctor’sfees.Thetotalmedian cost incurred per woman was $21.23 [IQR 11.94–44.68]. Roughly half (49.0%) received help with these costs. Conclusions: Although technically offered freely or low cost in the public sector, women accessing second-trimester abortion lost income and incurred costs for tr...

The status of legal termination of pregnancy in South Africa

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2006

Extracted from text ... October 2006, Vol. 96, No. 10 SAMJ It is ten years this month since the C... more Extracted from text ... October 2006, Vol. 96, No. 10 SAMJ It is ten years this month since the Choice on Termination of Pregnancy (CTOP) Act of 19961 was enacted. The passing of this Act was in keeping with the South African Constitution and represented a major breakthrough for women's reproductive rights.2 The Act allows for abortion on request to be performed at a designated health facility. This may be performed by a doctor or, during the first trimester, by a registered midwife who has completed the prescribed training course. In the second trimester, abortions may be performed by doctors up to 20 weeks' ..

BackgroundSouth Africa has a liberal abortion law, yet denial of care is not uncommon, usually du... more BackgroundSouth Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility. For women successfully obtaining care, time from last menstrual period to confirmation of pregnancy is significantly longer among those having an abortion later in the second trimester compared to earlier gestations. This study explores women’s experiences with recognition and confirmation of unintended pregnancy, their understanding of fertile periods within the menstrual cycle as well as healthcare providers’ and policy makers’ ideas for public sector strategies to facilitate prompt confirmation of unintended pregnancy.Methods We recruited participants from July through September 2017, at an urban non-governmental organization (NGO) sexual and reproductive health (SRH) facility and two public sector hospitals, all providing abortion care into the second trimester. We conducted in-depth intervi...

Reproductive Health, 2021

Background South Africa has a liberal abortion law, yet denial of care is not uncommon, usually d... more Background South Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility. For women successfully obtaining care, time from last menstrual period to confirmation of pregnancy is significantly longer among those having an abortion later in the second trimester compared to earlier gestations. This study explores women’s experiences with recognition and confirmation of unintended pregnancy, their understanding of fertile periods within the menstrual cycle as well as healthcare providers’ and policy makers’ ideas for public sector strategies to facilitate prompt confirmation of pregnancy. Methods We recruited participants from July through September 2017, at an urban non-governmental organization (NGO) sexual and reproductive health (SRH) facility and two public sector hospitals, all providing abortion care into the second trimester. We conducted in-depth interviews and g...

ecancermedicalscience, 2021

Objectives: Women with potential breast and cervical cancer symptoms in South Africa (SA) usually... more Objectives: Women with potential breast and cervical cancer symptoms in South Africa (SA) usually self-present to primary health care (PHC) clinics. The aim of this study was to explore PHC provider interpretation and management of potential breast and cervical cancer signs and symptoms. Methods: In-depth interviews with PHC providers incorporating vignettes were conducted between April and May 2019 in two sites in SA. Four vignettes (two breast and two cervical) were developed by the research team to capture aspects of provider symptom interpretation, reasoning, actions and challenges. The content of the vignettes was informed by a preceding community-based survey and qualitative interviews with symptomatic women. Interviews were audio recorded, transcribed verbatim and analysed using a thematic analysis approach. Results: Twenty-four PHC providers were interviewed (12 urban, 12 rural; median age: 43 years). Four main themes relating to clinical assessment and reasoning; referral and feedback challenges; awareness of breast and cervical cancer policy guidelines and training and education needs emerged. Vignette-prompted questions relating to presenting symptoms, and possible accompanying symptoms and signs, demonstrated comprehensive proposed history taking and clinical assessment by PHC providers. Cancer was considered as a potential diagnosis by the majority of PHC providers. PHC providers also considered the possibility of infectious causes for both breast and cervical vignettes indicating they would ask questions around human immunodeficiency virus status, use of anti-retroviral therapy, and, for those with cervical symptoms, would need to rule out a sexually transmitted infection. Sexual assault was considered in assessing the cervical Research

PLOS ONE, 2018

Table of Contents-Second-trimester abortion analysis NB: Contents listing is hyperlinked to workb... more Table of Contents-Second-trimester abortion analysis NB: Contents listing is hyperlinked to workbook tabs. Functional and analytical worksheets Description Dashboard (cost summary and sensitivity analysis) Summarized listing of cost outcomes with levers/ranges for adjustments for sensitivity analysis Decision tree for cost-effectiveness calculations Clinical and service parameters X average costs per activity, including unscheduled visits Average cost per activity calculations Resource usage x unit costs per resource for abortion procedure activities (does not include unscheduled visits) Analysis parameters Listing of parameters (analysis year, discount rate, etc) which can be varied if desired Research usage and clinical outcomes data Source First trimester IMF, World Bank, Statistics South Africa, etc Clinical service parameters and outcomes Study database, provider interviews Service volume statistics, D&E Study enrollment records Service volume statistics, MI Study enrollment records Staff time-summary calculations Calculated based on detailed accounts (see below) Staff time-D&E detail Provider interviews Staff time-MI-mife, detail Provider interviews Staff time-MI-miso, detail Provider interviews Consumables usage

Reproductive Health, 2021

BMC Public Health, 2019

Background: This study explored primary healthcare provider and HIV/contraception expert stakehol... more Background: This study explored primary healthcare provider and HIV/contraception expert stakeholder perspectives on South Africa's public sector provision of contraceptive implants to women living with HIV. We investigated the contraceptive service-impact of official advice against provision of implants to women using the HIV antiretroviral drug, efavirenz, issued by the South African National Department of Health (NDoH) in 2014. Methods: Qualitative data was collected in Cape Town in 2017 from primary healthcare contraceptive providers in four clinics that provide implants, as well as from other expert stakeholders selected for expertise in HIV and/or contraception. In-depth interviews and a group discussion explored South Africa's implant introduction and implant provision to women living with HIV. Data was analysed using an inductive thematic analysis approach. Results: Interviews were conducted with 10 providers and 10 stakeholders. None of the four clinics where the providers worked currently offered the implant to women living with HIV. Stakeholders confirmed that this was consistent with patterns of implant provision at primary healthcare facilities across Cape Town. Factors contributing to providers' decisions to suspend provision of the implant to women living with HIV included: inadequate initial and ongoing provider training; interpretation of NDoH communications about implant use with efavirenz; provider unwillingness to risk harming clients and concerns about professional liability; and other pressures related to provider capacity. Conclusions: All South African women, including those living with HIV, should have access to the full range of contraceptive options for which they are medically eligible. Changing guidance should be initiated and communicated in consultation with primary-level providers and service beneficiaries. Guidance issued to providers needs to be clear and fully evidence-informed, and its correct interpretation and implementation facilitated and monitored. Guidance should be accompanied by provider training, as well as counselling messages and tools to support providers. Generalized retraining of providers in rights-based, client-centred family planning, and in particular implant provision for women with HIV, is needed. These recommendations accord with the right of women living with HIV to access the highest possible standard of sexual and reproductive healthcare, including informed contraceptive choice and access to the contraceptive implant.

ecancermedicalscience, 2021

Reproductive health matters, 2018

The objective of this study is to measure the preliminary efficacy of a pilot intervention, groun... more The objective of this study is to measure the preliminary efficacy of a pilot intervention, grounded in behavioural economics, increasing adherence of dual protection (simultaneous use of effective modern contraception and a barrier method, such as a condom) to protect against HIV, other sexually transmitted infections, and unintended pregnancy. Between 2015 and 2016, 100 women aged 18-40 years, seeking post-abortion care in Cape Town, South Africa were recruited to Empower Nudge, a randomised controlled trial to test a lottery incentive intervention designed to increase dual protection. At baseline, the mean age of participants was 27 years; 82% of them were from South Africa; 58% self-identified as Black African; average education completed was 11.7 years. At three months, assignment to the lottery intervention was associated with higher odds of returning for study visits (OR: 6.0; 95%CI: 2.45 to 14.7, p < 0.01), higher condom use (OR: 4.5; 95%CI: 1.43 to 14.1; p < 0.05), an...

PLOS ONE, 2018

BMC women's health, Jan 2, 2017

In settings where abortion is legally restricted, or permitted but not widely accessible, women f... more In settings where abortion is legally restricted, or permitted but not widely accessible, women face significant barriers to abortion access, sometimes leading them to seek services outside legal facilities. The advent of medication abortion has further increased the prevalence of informal sector abortion. This study investigates the reasons for attempting self-induction, methods used, complications, and sources of information about informal sector abortion, and tests a specific recruitment method which could lead to improved estimates of informal sector abortion prevalence among an at-risk population. We recruited women who have sought informal sector abortion services in Cape Town, South Africa using respondent driven sampling (RDS). An initial seed recruiter was responsible for initiating recruitment using a structured coupon system. Participants completed face-to-face questionnaires, which included information about demographics, informal sector abortion seeking, and safe aborti...

Reproductive Health, 2017

Background: The requirement for ultrasound to establish gestational age among women seeking abort... more Background: The requirement for ultrasound to establish gestational age among women seeking abortion can be a barrier to access. Last menstrual period dating without clinical examination should be a reasonable alternative among selected women, and if reliable, can be task-shared with non-clinicians. This study determines the accuracy of gestational age estimation using last menstrual period (LMP) assessed by community health care workers (CHWs) , and explores providers' and CHWs' perspectives on task sharing this activity. The study purpose is to expand access to early medical abortion services. Methods: We conducted a multi-center cross-sectional study at four urban non-governmental reproductive health clinics in South Africa. CHWs interviewed women seeking abortion, recorded their LMP and gestational age from a pregnancy wheel if within 63 days. Thereafter, providers performed a standard examination including ultrasound to determine gestational age. Lastly, investigators calculated gestational age for all LMP dates recorded by CHWs. We compared mean gestational age from LMP dates to mean gestational age by ultrasound using t-tests and calculated proportions for those incorrectly assessed as eligible for medical abortion from LMP. In addition, in-depth interviews were conducted with six providers and seven CHWs. Results: Mean gestational age was 5 days (by pregnancy wheel) and 9 days (by LMP calculation) less than ultrasound gestational age. Twelve percent of women were eligible for medical abortion by LMP calculation but ineligible by ultrasound. Uncertainty of LMP date was associated with incorrect assessment of gestational age eligibility for medical abortion (p = 0.015). For women certain their LMP date was within 56 days, 3% had ultrasound gestational ages >70 days. In general, providers and CHWs were in favour of task sharing screening and referral for abortion, but were doubtful that women reported accurate LMP dates. Different perspectives emerged on how to implement task sharing gestational age eligibility for medical abortion. Conclusions: If LMP recall is within 56 days, most women will be eligible for early medical abortion and LMP can substitute for ultrasound dating. Task sharing gestational age estimation is feasible in South Africa, but its implementation should meet women's privacy needs and address healthcare workers' concerns on managing any procedural risk.

Contraception, 2017

Objective(s): To estimate the costs of public-sector abortion provision in South Africa and to ex... more Objective(s): To estimate the costs of public-sector abortion provision in South Africa and to explore the potential for expanding access at reduced cost by changing the mix of technologies used. Study design: We conducted a budget impact analysis using public sector abortion statistics and published cost data. We estimated the total costs to the public health service over 10 years, starting in South Africa's financial year 2016/17, given four scenarios: (1) holding service provision constant, (2) expanding public sector provision, (3) changing the abortion technologies used (i.e. the method mix), and (4) expansion plus changing the method mix. Results: The public sector performed an estimated 20% of the expected total number of abortions in 2016/17; 26% and 54% of all abortions were performed illegally or in the private sector respectively. Costs were lowest in scenarios where method mix shifting occurred. Holding the proportion of abortions performed in the public-sector constant, shifting to more cost-effective service provision (more first-trimester services with more medication abortion and using the combined regimen for medical induction in the second trimester) could result in savings of 28.1millioninthepublichealthserviceoverthe10−yearperiod.Expandingpublicsectorprovisionthrougheliminationofunsafeabortionswouldrequireanadditional28.1 million in the public health service over the 10-year period. Expanding public sector provision through elimination of unsafe abortions would require an additional 28.1millioninthepublichealthserviceoverthe10−yearperiod.Expandingpublicsectorprovisionthrougheliminationofunsafeabortionswouldrequireanadditional192.5 million. Conclusions: South Africa can provide more safe abortions for less money in the public sector through shifting the methods provided. More research is needed to understand whether the cost of expanding access could be offset by savings from averting costs of managing unsafe abortions. Implications: South Africa can provide more safe abortions for less money in the public sector through shifting to more first-trimester methods, including more medication abortion, and shifting to a combined mifepristone plus misoprostol regimen for second trimester medical induction. Expanding access in addition to method mix changes would require additional funds.

PloS one, 2017

To evaluate feasibility of self-assessment of medical abortion outcome using a low-sensitivity ur... more To evaluate feasibility of self-assessment of medical abortion outcome using a low-sensitivity urine pregnancy test, checklist and text messages. The study assessed whether accurate self-assessment required a demonstration of the low-sensitivity urine pregnancy test or if verbal instructions suffice. This non-inferiority trial enrolled 525 adult women from six public sector abortion clinics. Eligible women were undergoing medical abortion at gestations within 63 days. Consenting women completed a baseline interview, received standard care with mifepristone and home-administration of misoprostol. All were given a low-sensitivity urine pregnancy test and checklist for use 14 days later, sent text reminders, and asked to attend in-clinic follow-up after two weeks. Women were randomly assigned 1:1 to an instruction-only group (n = 262; issued with pre-scripted instructions on the low-sensitivity pregnancy test), or a demonstration group (n = 263; performed practice tests guided by lay h...

Reproductive health matters, 2016

This paper is a sequel to a 2004 article that reviewed South Africa's introduction of new sex... more This paper is a sequel to a 2004 article that reviewed South Africa's introduction of new sexual and reproductive health (SRH) and rights laws, policies and programmes, a decade into democracy. Similarly to the previous article, this paper focuses on key areas of women's SRH: contraception and fertility, abortion, maternal health, HIV, cervical and breast cancer and sexual violence. In the last decade, South Africa has retained and expanded its sexual and reproductive health and rights (SRHR) policies in the areas of abortion, contraception, youth and HIV treatment (with the largest antiretroviral treatment programme in the world). These are positive examples within the SRHR policy arena. These improvements include fewer unsafe abortions, AIDS deaths and vertical HIV transmission, as well as the public provision of a human papillomavirus vaccine to prevent cervical cancer. However, persistent socio-economic inequities and gender inequality continue to profoundly affect South...

PLOS ONE, 2016

Objective To document clinical outcomes and women's experiences following the introduction of mif... more Objective To document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. Methods Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2-4 weeks after discharge for the 2014 cohort. Results The 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the PLOS ONE |

Reproductive Health, 2016

Background: Although abortion is legally available in South Africa, barriers to access exist. Ear... more Background: Although abortion is legally available in South Africa, barriers to access exist. Early medical abortion is available to women with a gestational age up to 63 days and timely access is essential. This study aimed to determine women's acceptability and ability to self-assess eligibility for early medical abortion using an online gestational age calculator. Women's acceptability, views and preferences of using mobile technology for gestational age (GA) determination were explored. No previous studies to ascertain the accuracy of online self-administered calculators in a non-clinical setting have been conducted. Methods: A convenience sample of abortion seekers were recruited from two health care clinics in Cape Town, South Africa in 2014. Seventy-eight women were enrolled and tasked with completing an online self-assessment by entering the first day of their last menstrual period (LMP) onto a website which calculated their GA. A short survey explored the feasibility and acceptability of employing m-Health technology in abortion services. Self-calculated GA was compared with ultrasound gestational age obtained from clinical records. Results: Participant mean age was 28 (SD 6.8), 41 % (32/78) had completed high school and 73 % (57/78) reported owning a smart/feature phone. Internet searches for abortion information prior to clinic visit were undertaken by 19/78 (24 %) women. Most participants found the online GA calculator easy to use (91 %; 71/78); thought the calculation was accurate (86 %; 67/78) and that it would be helpful when considering an abortion (94 %; 73/78). Eighty-three percent (65/78) reported regular periods and recalled their LMP (71 %; 55/78). On average women overestimated GA by 0.5 days (SD 14.5) and first sought an abortion 10 days (SD 14.3) after pregnancy confirmation. Conclusions: Timely access to information is an essential component of effective abortion services. Advances in the availability of mobile technology represent an opportunity to provide accurate and safe abortion information and services. Our findings indicate that an online GA calculator would be accurate and helpful. GA could be calculated based on LMP recall within an error of 0.5 days, which is not considered clinically significant. An online GA calculator could potentially act as an enabler for women to access safe abortion services sooner.

South African Medical Journal, 2010

To the Editor: The role of family planning in achieving the Millennium Development Goals is well ... more To the Editor: The role of family planning in achieving the Millennium Development Goals is well recognised. 1 The benefits of family planning, in developing countries in particular, extend beyond decreasing fertility and include poverty reduction, improved health for both mother and child, the promotion of gender equality by increasing women's opportunities beyond reproductive and domestic activities, and environmental sustainability. 1 In addition, prevention of undesired pregnancies among HIV-positive women by eliminating unmet need for contraception is a highly cost-effective means of preventing mother-to-child transmission. 2 In South Africa, free contraceptives are available at public sector health care facilities, and contraception use is high: an estimated 65% of sexually active women use a method. 3 The method mix comprises predominantly short-acting methods-primarily injectable contraceptives. Long-acting contraceptives, such as the intra-uterine device (IUD), are highly effective among typical users owing to consistency of function, yet are underutilised in South Africa's public sector facilities. Of importance, especially in South Africa's high HIVprevalent setting, is that the IUD can be safely used on clinically well HIV-positive women. 4 The 2004 Demographic and Health Survey showed that 10% of sexually active women were sterilised, while less than 1% of women were using the IUD. 3 In preparation for an intervention aimed at improving contraceptive options, including long-acting and permanent methods (LAPM), for all postpartum women, we assessed women's knowledge and attitudes to LAPM. We report on findings from our baseline survey, which have prompted the question: Where is the 'planning' in family planning services? Methods Is 'planning' missing from our family planning services?

Original research article The costs of accessing abortion in South Africa: women's costs associated with second-trimester abortion services in Western Cape Province ☆

The status of legal termination of pregnancy in South Africa

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2006

Reproductive Health, 2021

ecancermedicalscience, 2021

PLOS ONE, 2018

Reproductive Health, 2021

BMC Public Health, 2019

ecancermedicalscience, 2021

Reproductive health matters, 2018

PLOS ONE, 2018

BMC women's health, Jan 2, 2017

Reproductive Health, 2017

Contraception, 2017

PloS one, 2017

Reproductive health matters, 2016

PLOS ONE, 2016

Reproductive Health, 2016

South African Medical Journal, 2010