Socio-ecological analysis of nurses’ roles and challenges in choice on termination of pregnancy services in South Africa: A scoping review

Abstract

Background: Choice on termination of pregnancy remains a sensitive and complex aspect of reproductive healthcare, particularly in settings where cultural, religious, legal and institutional factors intersect.
Aim: To identify nurses’ roles and challenges in providing choice on termination of pregnancy services in South Africa using a socio-ecological framework.
Setting: The review was conducted using findings from studies on nurses regarding the provision of choice on termination of pregnancy services in South Africa.
Method: A scoping review was conducted following the Arksey and O’Malley framework and aligned with the Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Electronic databases include ScienceDirect, EBSCOhost, PsycINFO, PubMed and regional databases like African Index Medicus. Literature published between January 1996 and December 2024 was searched; only English-language studies were included.
Results: Twenty-one studies, published between 1998 and 2023, were included. The results show diverse and in-depth insights into the multifaceted challenges of nurses involved in choice on termination of pregnancy services, highlighting emotional and moral challenges, interpersonal dynamics, organisational constraints, sociocultural influences and legal gaps.
Conclusion: This review reveals that nurses’ roles in providing choice on termination of pregnancy services are shaped by multiple levels of influence, with moral beliefs, stigma and systemic barriers hindering the delivery of quality care.
Contribution: This review enhances understanding of the multi-level barriers nurses face in providing choice on termination of pregnancy services in South Africa and underscores the need for targeted interventions to improve access to sexual and reproductive health services.