A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in Soweto, South Africa: a Socio-ecological perspective

Abstract Background: In Southern Africa, an estimated 24% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations. Understanding of the reasons for termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to qualitatively explore young women’s reasons for terminating their pregnancy, in Soweto, South Africa, with a focus on the impact of socio-ecological factors on their experience. Methods: In-depth interviews were conducted with ten (10) participants who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach. Results: The majority of the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners. However, factors that influenced the participants’ decision and experience, such as the available of social support and (lack of) accessibility to termination services, were identified across all domains. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants’ decisions through detrimental changes in interpersonal support and financial situation. Conclusions: Amongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women’s needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.