This publication is the latest in a series of Research in Focus papers showing how demand for termination of pregnancy (TOP) services in South Africa is continuing to outstrip supply despite high levels of contraceptive awareness and usage.

According to Marie Stopes South Africa the consistently high demand for termination services is unexpected in a nation where the knowledge of family planning methods is widespread. Despite the high prevalence of contraceptive use overall, this conceals the very low rate of usage in rural compared with urban areas where services are much harder to come by. "For example - while you have a contraceptive prevalence rate of almost 80% in the urban areas in the Eastern Cape, the rate is only just over 22% in the rural areas," said Paul Cornellisson, Programme Director of Marie Stopes South Africa (MSSA).

Before the 1996 Choice of Termination of Pregnancy Act came into effect in South Africa, more than 44,000 women attended hospitals each year to be treated for complications arising from unsafe clandestine or 'back street' TOP procedures. Although women no longer need to risk their lives, many cannot get the help they need via the government health services. The paper suggests that reasons for this include a lack of trained staff, resources and beds, and the fear or unwillingness of staff to participate in the provision of TOP services.

MSSA is a not-for-profit private sector provider delivering comprehensive reproductive health services including TOPs. MSSA provides a comprehensive package of reproductive health services and not just TOP services, including sexually transmitted infection (STI) diagnosis and treatment, HIV/AIDS voluntary counselling and confidential testing (VCCT), and cervical screening. MSSA also provides support to the public sector in the provision of care to women with HIV/AIDS who request TOP services.