{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T16:44:17Z","timestamp":1787330657466,"version":"build-2736575974"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The liberalisation of abortion law does not necessarily translate into quality services. The South African Choice on Termination of Pregnancy Act includes the requirement of non-mandatory and non-directive pre-abortion counselling. However, pre-abortion counselling in public abortion clinics is often directive, coercive and, at times, anti-abortion.\n                      <jats:italic toggle=\"yes\">Objectives<\/jats:italic>\n                      : We reflect on our attempts to ensure that the legislative requirement of \u201cnon-directive\u201d pre-abortion counselling is realised in public termination of pregnancy clinics through the nurses\u2019 participation in an in-service abortion counselling certificate course (ACCC) based on person-centred and reproductive justice principles.\n                      <jats:italic toggle=\"yes\">Design<\/jats:italic>\n                      : We adopted a qualitative exploratory transfer of training research design, with a goals-focused approach.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using stratified purposive sampling, we interviewed eleven (of the 29) nurses who participated in the course about their current consultation\/counselling practices and experiences. We analysed the data using template analysis, with the outcomes of the ACCC as\n                      <jats:italic toggle=\"yes\">a priori<\/jats:italic>\n                      themes, supplemented by themes emerging in the analytical process.\n                      <jats:italic toggle=\"yes\">Results<\/jats:italic>\n                      : Participants emphasised that their practice is now person-centred and non-directive. Non-judgmentalism, active listening, empathy, and facilitating autonomous decision-making were all listed as attributes they now bring to their pre-abortion interactions with users. These declarations were, however, interwoven with reference to contraceptive coercion and discomfort with \u201crepeat\u201d abortions. Providers also mentioned several institutional and systems challenges that undermined person-centred care.\n                      <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>\n                      : In-service training focused on non-directive, person-centred counselling, such as the ACCC, while necessary, is not sufficient to ensure that legislative or policy requirements for non-directiveness will be met. Two key elements need addressing in addition to person-centred in-service training: (1) gendered understandings of women as always having the agency to prevent pregnancies, as well as primarily responsible for contraceptive use; and (2) structural inadequacies that work against person-centredness and non-directiveness in these encounters.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17455057261466309","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T10:22:28Z","timestamp":1787134948000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Policy to practice: Translating \u201cnon-directive\u201d pre-abortion counselling from legal stipulation to healthcare encounters"],"prefix":"10.1177","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0992-3525","authenticated-orcid":false,"given":"Catriona Ida","family":"Macleod","sequence":"first","affiliation":[{"name":"Rhodes University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timalizge","family":"Zgambo","sequence":"additional","affiliation":[{"name":"Rhodes University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"e_1_3_9_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2013-100862"},{"key":"e_1_3_9_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2017.07.165"},{"key":"e_1_3_9_4_2","volume-title":"Barriers to Safe and Legal Abortion in South Africa","author":"Amnesty International","year":"2017","unstructured":"Amnesty International. Barriers to Safe and Legal Abortion in South Africa. : Amnesty International Publications, 2017."},{"key":"e_1_3_9_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/03057070.2016.1133086"},{"key":"e_1_3_9_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2019.05.005"},{"key":"e_1_3_9_7_2","doi-asserted-by":"publisher","DOI":"10.1080\/13691058.2016.1257738"},{"key":"e_1_3_9_8_2","doi-asserted-by":"publisher","DOI":"10.18772\/12024038738"},{"key":"e_1_3_9_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2019.07.006"},{"key":"e_1_3_9_10_2","first-page":"2","volume-title":"The Choice on Termination of Pregnancy Act 92 of 1996","author":"Republic of South Africa","year":"1996","unstructured":"Republic of South Africa. The Choice on Termination of Pregnancy Act 92 of 1996. Government Gazette 1996; 2\u201310. [Internet]. Available from: https:\/\/www.parliament.gov.za\/storage\/app\/media\/ProjectsAndEvents\/womens_month_2015\/docs\/Act92of1996.pdf"},{"key":"e_1_3_9_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12676"},{"issue":"92","key":"e_1_3_9_12_2","first-page":"1","article-title":"\u2018Bad choices\u2019: Unintended pregnancy and abortion in nurses and counsellors\u2019 accounts of providing pre-abortion counselling","volume":"25","author":"Mavuso JMJJ","year":"2021","unstructured":"Mavuso JMJJ, Macleod CI. \u2018Bad choices\u2019: Unintended pregnancy and abortion in nurses and counsellors\u2019 accounts of providing pre-abortion counselling. Health (Irvine Calif) 2021; 25(92): 1\u201319. https:\/\/doi.org\/10.1177\/1363459320988873","journal-title":"Health (Irvine Calif)"},{"key":"e_1_3_9_13_2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.5040\/9781978726901.ch-14","volume-title":"Sexual and Reproductive Justice: From the Margins to the Centre","author":"Mavuso J","year":"2022","unstructured":"Mavuso J, Macleod CI, Du Toit R, et al. Directive Counselling Undermines \u201c Safe \u201d Abortion. In: Morison T, Mavuso JMJ (eds). Sexual and Reproductive Justice: From the Margins to the Centre. Lexington Books, 2022, pp. 247\u2013266."},{"key":"e_1_3_9_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12330"},{"key":"e_1_3_9_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2023-202020"},{"issue":"0","key":"e_1_3_9_16_2","first-page":"1","article-title":"Contraceptive Coercion in Pre-Abortion Counseling: A Conversation Analysis","volume":"0","author":"du Toit R","year":"2024","unstructured":"du Toit R, Macleod CI. Contraceptive Coercion in Pre-Abortion Counseling: A Conversation Analysis. Women\u2019s Reprod Heal [Internet] 2024; 0(0): 1\u201320, Available from: https:\/\/doi.org\/10.1080\/23293691.2024.2426159","journal-title":"Women\u2019s Reprod Heal [Internet]"},{"key":"e_1_3_9_17_2","volume-title":"exploring pre-termination of pregnancy counselling in the public health sector in the Eastern Cape","author":"Du Toit R","year":"2023","unstructured":"Du Toit R. How do you feel about the abortion? exploring pre-termination of pregnancy counselling in the public health sector in the Eastern Cape. Rhodes University, 2023."},{"key":"e_1_3_9_18_2","volume-title":"Abortion counselling in South Africa: A step-by- step guide for providers","author":"Mavuso J","year":"2018","unstructured":"Mavuso J, du Toit R, Macleod CI, et al. Abortion counselling in South Africa: A step-by- step guide for providers. Makhanda, 2018. [Internet]Available from: https:\/\/srjc.org.za\/wp-content\/uploads\/2017\/06\/Abortion_Counselling_Guide_Version_1-1.pdf"},{"issue":"33","key":"e_1_3_9_19_2","first-page":"1","article-title":"Abortion learning mechanisms for nurses and midwives: a scoping review of evidence","volume":"0397","author":"Nicholson M","year":"2025","unstructured":"Nicholson M, Hoggart L. Abortion learning mechanisms for nurses and midwives: a scoping review of evidence. 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