Creating safe abortion access in South Africa

Abortion has been legal in South Africa since December 1996 when the government passed the Choice on Termination of Pregnancy Act. However, many women still opt for illegal and unsafe abortions. 

Despite the fact that abortion is legal in South Africa, it is estimated that between 52% and 58% of the estimated 260 000 abortions that take place in South Africa every year are illegal.

This estimate was presented by the Department of Social Development at a conference on Abortion and Reproductive Justice in 2018.

A 2017 study by Amnesty International found that only 264 health facilities were providing first and second trimester pregnancy termination services out of the 505 claimed by the government. The study also claimed that some health care professionals refuse to provide abortion services, despite this being a punishable offence.

The study mentioned “the untimely death of a 19 year old student in Johannesburg in 2016, following complications due to an unsafe abortion” as an “urgent need for action to address barriers to abortion services”

“[She] was a poor student, who could not access private health care. There was insufficient information available of the [abortion] services that she could access at public health care facilities and there is also some speculation that she may have been afraid of the attitudes of the public health care workers based on the experiences of some of her friends.

Special Advisor to the Minister of Social Development of South Africa, Speech to United Nations, April 2016.

Another group of researchers surveyed women presenting for an abortion at two clinics in Cape Town for a period between 2012 and 2013.

In South Africa, 45% of women in our survey did not receive the abortions they sought at the clinic: 20% of all women interviewed were turned away for advanced gestational age, 20% because the clinic did not have the staff to perform their abortions that day, and 5% because of an inability to pay for their abortions.

Study: Denial of abortion in legal settings, Journal of Family Planning and Reproductive Health Care

Advanced gestational age means the women were too old to receive an abortion at that clinic. The study claims this is because women don’t have adequate access to information on abortion and there are “long delays between the date of first clinic appointment and the date of admission for an abortion, and complex referral processes.”

The study also cites a negative stigma against abortion as a factor. “I do think there is a lot of stigma around abortion. I think, in my perspective, it comes all the way from religion and patriarchy, and the need to control women’s bodies,” states Gaopalelwe Phalaetsile, founder of Abortion Support South Africa.

People who need and require abortion end up getting the wrong information because of this stigma and these myths — and that makes it really hard for us to tackle the stigma and ensure that people get safe abortions.

A survey conducted between 2003 – 2006 found that 9 in 10 South Africans felt abortion was wrong even if the family has low income and cannot afford any more children and 3 out of 4 South Africans felt abortion was wrong even when there was a strong chance of a strong defect in the fetus.

“Abortion ends up being this dirty little secret that people keep on their own, which ends up making the black market around abortion really achieve its goals,” Phalaetsile said. “I think, for me personally, the stigma around abortion is the same thing that is around the controlling of women’s bodies and the decision by society that our jobs is to bear children and that’s all we are good for — and in any circumstance that we find ourselves in, it does not matter. We just have to bear those children and that’s quite ridiculous.”

So, legal abortion access is also about preventing this harm. Achieving this requires sharing information on where people can access a safe and legal abortion. The Bhekisisa Centre for Health Journalism created a map of places in South Africa where clinics offer abortions.

When we contacted the health department about this issue, we discovered it had no updated list of available facilities, and even the outdated list was not freely available to the public.

Bhekisisa claimed.

A group of organisations, including Abortion Support South Africa, are working together on the My Body, My Choice campaign which brings people together for more conversation on abortion and sexual and reproductive health rights (SRHR).

“My Body, My Choice is basically a campaign by a group of different organisations regarding abortion. Basically, reasserting the view that our bodies are our choice and we can do as we please with our bodies provided we have the right information,” Phalaetsile explained. “In South Africa, as much as we have the Choice on Termination of Pregnancy Act, there are still so many South African women and members of the LGBTI community who cannot access abortion services or other sexual and reproductive health services. This is a cry for help.”

“It’s also to reduce the number of people who go to illegal abortion providers and end up dying or having severe complications because they cannot access safe abortion services. Basically, it’s a call to say, ‘let’s end the stigma against abortion and other sexual and reproductive services, like contraceptives and so on.’ Let’s allow people who do reproduce and fall pregnant the right to choose what to do with their bodies, provided they have the right information — and to ask the government, ‘please equip the department of health with these services,'” Phalaetsile states.

In South Africa, when barriers to safe pregnancy terminations are removed, there can be less stories like the 19-year old in Johannesburg, and more stories like Patricia’s:

Patricia”s story – MSF South Africa

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