South African women’s experience of the decision, procedure and recovery from “feticide” and late termination of pregnancy due to the presence of severe fetal abnormality: women’s and health service providers’ perspectives
- Authors: Vorster, Angela Carol
- Date: 2023-10-13
- Subjects: Feticide , Abortion , Late-term abortion , Fetus Abnormalities , Psychological trauma , Grief , Pregnancy loss
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/432359 , vital:72864 , DOI 10.21504/10962/432359
- Description: Routine antenatal care, including sonography and genetic testing, assist healthcare providers in identifying the presence of severe fetal abnormality. In countries where it is legal, the option to abort such a pregnancy may be presented to the pregnant person. When abortion takes place after the thirteenth week of gestation, it is generally referred to as a late termination of pregnancy and may entail the induction of labour or caesarean section. In cases where termination of the pregnancy is decided upon, and the gestation is further than 21 weeks and six days, the feticide procedure is recommended in order to ensure stillbirth. The feticide procedure entails the injection of potassium chloride directly into the fetal heart in order to ensure fetal demise. Existing literature on “feticide” and late termination of pregnancy (LTOP) owing to fetal abnormalities mostly takes a medical or psychological perspective in researching these procedures. Within the South African context, there are very few studies on feticide and LTOP, with none of these studies (to date – 8 January 2023) taking a feminist approach. This paucity of research that takes into account power relations, structural inequality and factors that affect decision-making and choice is one of the reasons that this study was undertaken. The main research question focused on in this study is: What are South African women’s experiences of feticide and late termination of pregnancy due to the presence of severe fetal abnormality, as related by the women themselves and the health service providers who perform the procedure or provide care? The sub-questions that initially drove the study were: How do the women relate their experience of the process of coming to the decision, undergoing and recovering from the procedure, and how do health service providers relate the experiences of these women? The methodological and theoretical framework employed in this research was a Feminist Social Constructionist approach to Grounded Theory. This reflexive, subjectivist, feminist lens encouraged awareness of the influence of gender, race, class and other structural and systemic factors on women’s experiences within the two healthcare systems. Data collection entailed semi-structured interviews conducted with 12 women, who had undergone feticide and LTOP procedures between one and five years prior to the interviews, in either the public or private healthcare system in South Africa. Semi-structured interviews were also conducted with 13 healthcare providers. The providers included medical specialists and participants from the fields of clinical psychology, genetic counselling and nursing and were employed in public or private healthcare in South Africa. Data relevant to public healthcare users and providers were collected from one tertiary (academic) public healthcare hospital and data regarding private healthcare users and providers were collected from across South Africa. Women’s constructions of their experiences of feticide and LTOP included stark contrasts between public and private healthcare users in South Africa, as well as women experiencing “no choice” and their voices being ignored or silenced. Healthcare providers’ constructions were frequently contradictory, referring to women as having freedom of choice and their needs largely prioritised within the healthcare system, while the providers within the public healthcare system relayed their own frustrations and emotional burden due to systemic failures. Findings from women and providers’ constructions were synthesised into a theoretical understanding of women’s experiences of feticide and LTOP in South Africa, which is grounded in, and emergent from, the data. Women’s experiences of feticide and LTOP in South Africa were conceptualised by framing the three phases of these experiences, namely the decision-making phase (I), undergoing the procedures and in-hospital recovery (phase II) and the recovery phase (III). The most prominent themes emerging in these phases included the schism between the public and private healthcare systems in South Africa, the lack of real choice women experience, as well as the silencing of women and providers with regard to feticide and LTOP. Underlying the three phases, and directly influencing the three prominent themes affecting women’s experiences, were the underlying and insidious structural inequality that undermined reproductive justice with regard to women’s decision-making, experiences of and recovery from feticide and LTOP. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2023
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- Date Issued: 2023-10-13
The use of creative-arts therapies in treating trauma-related mental health conditions in South Africa: perspectives from three practising creative-arts therapists
- Authors: Makube, Tshegofatso Bennia Basetsana
- Date: 2023-10-13
- Subjects: Arts Therapeutic use , Mental health South Africa , Mental health services South Africa , Health services accessibility South Africa , Psychological trauma , Stigma (Social psychology) , Mental illness Social aspects South Africa
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/425399 , vital:72235
- Description: Multiple factors contribute to the prevailing mental health conditions of South Africans. According to Kaminer and Eagle (2010, p.8), 75% of South Africans are trauma survivors, half of whom have experienced multiple traumas, some directly and some indirectly. However, many trauma survivors are not adequately treated due to the limited access and availability of mental health specialists in the country. Thus, mainstream medical treatments ought to be supplemented by alternative forms of therapy such as creative-arts therapy that cater to the wide demographic range of citizens in South Africa. This research aims to explore the efficacy of creative-arts therapies as a treatment for trauma-related mental health conditions in South Africa from the perspectives of three practising creative-arts therapists. The research is a qualitative study and uses Interpretive Phenomenological Analysis (IPA) to interpret the data. The research participants consisted of three accredited creative-art therapists practising in Music, Art, and Dance. The participants were interviewed using semi-structured, in-depth interviews which were conducted online. The interview data was transcribed and analysed using the IPA framework provided by Smith, Flowers and Larkin (2009). The results yielded three superordinate themes which were supported by eight subordinate themes. The results suggest that creative-arts therapies are underutilized in South Africa due to a lack of public awareness and general (mis)perceptions about mental health conditions. Furthermore, access to these therapies in formal settings is limited as they are not offered as treatment options in public health facilities, which negatively impacts the viability of creative-arts therapies practice in the country. Creative-arts therapies offer several unique benefits to individuals of all ages, backgrounds and abilities as they do not require prior artistic knowledge or experience to participate in treatment. In addition, they are non-verbal which helps to bridge the language and cultural barriers that often arise as a result of South Africa’s diverse cultural population. Finally, creative-arts therapies are an effective method of treating mental health conditions incurred through trauma as they focus on accessing stored trauma in the body or unconscious mind through a natural and non-judgemental platform of creative expression. As a result, they address the physical, emotional, psychological, and cognitive effects of trauma while empowering the individual. In conclusion, this research suggests that creative-arts therapies are highly effective in the treatment of trauma-related mental health conditions, particularly in a country like South Africa which experiences high incidents of trauma. They should be better integrated into public health care facilities so that they are accessible to the general public. This will result in an increase in the use of creative-arts therapies as a treatment option for mental health conditions, particularly those related to trauma. It would also help to address the limited awareness and poor perceptions of the nature of mental health, mental illness, mental health care and mental health care services. , Thesis (MMus) -- Faculty of Humanities, Music and Musicology, 2023
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- Date Issued: 2023-10-13