“How do you feel about the abortion?”: pre-termination of pregnancy counselling in the public health sector in the Eastern Cape
Authors:   , Du Toit Ryan Rudolph 
Published: June 2024

Pre-abortion counselling, as an aspect of abortion provision, has received growing research interest in various contexts. Much of the research has primarily focused on whether abortion counselling takes place, the experiences of women and/or counsellors (usually through retrospective interviews and surveys), and the content discussed during the counselling session (often policy regulated). Such research has proven vital to addressing the various reproductive issues facing women seeking an abortion worldwide. However, little research has focused on how pre-abortion counselling as an everyday institutional practice is conducted at a conversational level in the medical setting. By drawing on both conversation analysis and discursive psychology, this study explored how pre-abortion counselling was conducted in the public health sector in South Africa. The study involved recording the conversation during pre-abortion counselling and analysing it in terms of its content, in particular, the discourses drawn on by all parties involved, and its structure and delivery. The data were collected from three public hospitals in the Eastern Cape of South Africa and involved the audio recording of pre-abortion counselling sessions as part of abortion services. In total, 28 counselling sessions were recorded: 21 were individual sessions, and 7 were group counselling sessions. At two of the sites, counselling was conducted by registered midwives who worked at the hospital. At one site, an external Christian organisation volunteered trained counsellors to counsel women at the hospital free of charge. Using conversation analysis, counselling sessions were analysed in terms of the main projects. Seven key projects were identified: (1) Context setting, (2) History taking, (3) Establishing reason for abortion, (4) Presenting options, (5) Providing procedural information, (6) Obtaining verbal informed consent, and (7) Discussion of family planning. Each project is explored in terms of what discourses and subject positions featured when speakers were orienting to a specific project. This process highlighted how the conversational projects and their respective goals enable the deployment of certain problematic discourses and interactive/reflexive positionings. Discourse analysis revealed a clustering of discourses around two central themes. In the first clustering, the discourses were primarily used to discuss the (1) medically related issues underpinning the abortion procedure [medical discourse, responsibilization discourse, risk discourse, and discourse of support]. Talk using these discourses positioned women as patients needing medical intervention, responsibilised women for conceiving, playing an active role in their termination, and navigating all the psychological and physical risks “associated” with abortion. The discourse of support illustrates how support was spoken about in the interaction whereby patients were constructed as subjects who required support and nurses/counsellors as the ones who offered the support. In the second clustering, the discourses (2) focused on women and the foetus. These discourses [reproductive choice, religious, pronatalist, and foetal personhood discourses] positioned women as being responsible for making a choice regarding their pregnancy and the consequences that may result. In addition, a religious discourse coupled with a pronatalist discourse was used to construct the pregnancy and motherhood as desirable and part of “God’s plan”, whereas the foetus was spoken about as a “gift from God”. The foetal personhood discourse was used to construct the foetus as a living and functional human. This research provides evidence of how abortion counselling is problematic at various levels. At a practical level, there is a lack of standardisation in the delivery of abortion counselling (e.g., variation in key projects, where the counselling is mandated, time taken, nurse/counsellor training, content and format – group vs. individual counselling). At a discursive level, the use of certain discourses works to render the counselling directive through : (1) awfulizing abortion by providing misinformation about the abortion procedure, foetus and post-abortion psychological distress, (2) chastising and responsibilising women for conceiving, (3) constructing abortion as immoral, the ending of life and not in line with God’s plan, (4) constructing parenthood as the preferred choice, (5) delegitimising abortion as a resolution for pregnancy when compared to the other options (e.g., parenting or adoption), and finally (6) providing counselling that does not take into account the broader socio-political contexts. Recommendations for future research are put forward, and a call to move to a reparative justice framework is made by highlighting how it can be used to identify and understand reproductive injustices as they occur along four intersecting dimensions: (1) Individual material, (2) Collective material, (3) Individual symbolic, and (4) Collective symbolic.