Browsing by Author "Kleinsmidt, Anita"

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    Deliberate delays in offering abortion to pregnant women with fetal anomalies after 24 weeks' gestation at a centre in South Africa
    (Wiley, 2023) Kleinsmidt, Anita; Malope, Malebo; Urban, Michael
    South Africa has an abortion law which codifies the broad themes of reproductiverights set out in the Constitution of South Africa, other laws and national guidelines.Certain wording of the conditions in the Choice Act for abortion after 20 weeks'gestation, are open to interpretation, being‘severe malformation of the fetus’and‘risk of injury to the fetus’. From 24 weeks onwards, abortion is carried out byfeticide/induced fetal cardiac asystole (‘IFCA’) and subsequent induction of labour inSouth Africa. Some maternal‐fetal units have developed guidelines to assist cliniciansand patients in decision‐making around eligibility for abortion after 20 weeks'gestation, given the broad terms in the law. We consider the guideline used by aninstitution in the Western Cape for abortion after 23 weeks and 6 days gestation, interms of its alignment with the law on reproductive rights and its compliance withfair and transparent procedures. We also note its effect on respect for patients andon staff professionalism.
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    Mpox and the ethics of outbreak management: lessons for future public health crises
    (John Wiley and Sons Inc, 2025) Kleinsmidt, Anita; Obasa, Adetayo; Botes, Marietjie
    Mpox, first identified in captive monkeys in 1958 and recognized in humans by 1970 in the Democratic Republic of Congo, was historically confined to sporadic zoonotic outbreaks in Central and West Africa. These outbreaks, often driven by rodent‐to‐human transmission in resource‐limited settings, reflect persistent systemic health disparities. In recent years, mpox has also been reported in high‐income countries (including the United States, United Kingdom and Europe), underscoring its global health implications beyond traditionally endemic regions. This article examines the mpox outbreak through the lens of public health ethics, evaluating how core ethical frameworks—justice (encompassing equitable vaccine distribution and addressing health inequities), solidarity and respect for rights (including intellectual property considerations)—shape outbreak management strategies. These strategies are ensuring equitable access to vaccines and therapeutics amid intellectual property barriers, combating stigma and misinformation through transparent risk communication and fostering international solidarity in coordinating responses. The analysis highlights how neglect of these principles exacerbates existing disparities and undermines the effectiveness of interventions. Integrating ethical principles into outbreak responses is critical for building public trust, accountability and community resilience. By distilling lessons from the mpox response, this article contributes to ongoing debates in public health ethics and outbreak preparedness, arguing that ethically grounded approaches are essential for fair and effective management of future public health crises.