Despite being legal for more than 22 years, your access to a safe abortion in South Africa is under threat. In 2018 the Department of Social Development said, ‘It is estimated that between 52 to 58% of the estimated 260 000 abortions that take place in South Africa every year are illegal.’ So why, when it’s been legal for over two decades, are women risking dangerous, backstreet abortions?
According to a 2017 survey by Bhekisisa Centre for Health Journalism, less than five percent of SA’s public clinics and hospitals offered abortions in that year, while a staggering 32% of women in SA don’t know abortion is legal. In addition, less than 5% of SA’s public clinics and hospitals offer abortions.
Lack of resources and the moral stigma that plagues abortion are just some of the reasons why many women still pursue illegal and unsafe methods of termination, which can result in death.
Why education matters
‘I remember looking at the white ceiling while lying down on the hospital-like bed,’ Gaopalelwe Phalaetsile, 27, told Bhekisisa in 2018. ‘My legs were wide open. The two women working on me were talking about their boyfriends. The unbearable pain prompted me to scream, but my cries fell on deaf ears. Instead, my yells were met with emotionless expressions.’
She has since founded Black Womxn Healing Garden, a support group for people who are exploring their options. ‘I was in a dirty flat where I was having an abortion at an illegal provider.’ Gaopalelwe survived to tell her story – but she was lucky. ‘I could have died. It’s important that we give women access to the information they need. They are still the most vulnerable people in our society. Abortions are legal in South Africa. You can terminate your pregnancy safely. Back then, I didn’t know this.’
Abortion: it’s your legal right
‘An abortion or termination of pregnancy (TOP) refers to any measure taken to end a pregnancy after conception (which refers to fertilisation and then implantation in the uterus), and before a foetus reaches viability (which is when a foetus can live outside the uterus),’ explains Dr Lindi Murray, an obstetrician and gynaecologist based in Cape Town.
‘Safe abortion has an important impact on lowering the maternal mortality rate – and that’s a biggie,’ says Whitney Chinogwenya of Marie Stopes, an international, non-profit organisation that offers reproductive healthcare outside of the government system.
For over 22 years, access to safe, free abortions has been legal – your right as a woman in South Africa. ‘We know hat guaranteeing women safe access to abortions across the world saves lives,’ says Laura Lopez Gonzalez from Bhekisisa Centre for Health Journalism. ‘In SA, according to the Termination of Pregnancy Act, any woman can make the decision to have an abortion up until 12 weeks of pregnancy,’ confirms Murray.
Our laws are brilliant: they give you autonomy over your body and protect your freedom of choice. The problem is in how these laws are implemented. Actual access to free, safe abortions varies depending on where you live, who your doctor is, and how openly you were educated about your reproductive healthcare options. That’s where the alarmingly disparate experiences of abortions comes in. Not every woman in South Africa is receiving the same kind of care.
Where to get a safe abortion in South Africa
When congrats is the last thing you want to hear
For Tumi*, 24, from Cape Town, having a private gynae didn’t stop her from feeling like she was denied the right care when she fell pregnant unexpectedly at age 21. ‘I knew when the gynae told me I was pregnant that an abortion was the right option for me,’ she says. ‘Even how my gynae broke the news – “Congrats!” was uncomfortable. She had assumed pregnancy was a good thing.
When I asked if she could give me a TOP, I could see she was disappointed. She told me it was against her religious views. I felt judged; like I was asking to do something wrong.’ Per the law, Tumi’s gynae did refer her to another healthcare provider who could help. Since Tumi was only a few weeks pregnant, she had a medical abortion. ‘The next doctor explained to me what to expect. I took a pill while I was with her, and she gave me a few more pills to take at home over the next few days. I just felt like I was having a heavy period.
The doctor made me feel normal and comfortable about the whole thing. It was an easy decision. Aside from how my gynae made me feel initially, it was a positive experience. I knew I wasn’t ready to have a baby, and I felt confident in my right to choose.’
What if the problem is your doctor or nurse?
‘If you have a bad experience in the government sector, you’d need to follow the normal complaints procedure for that health facility,’ explains Lopez Gonzalez. ‘If you don’t get help there, you can escalate to the provincial department.’ At private facilities, if you feel wrongdoing is severe, you can lodge a complaint with the Health Professions Council of South Africa.’
A lack of care
Emily-Rose did know she could access a free, safe abortion when she was considering whether or not to terminate her pregnancy. But that didn’t mean the process on the government system was easy. ‘I didn’t want to go to my community clinic for a referral for a TOP because I knew I’d be recognised,’ she says. ‘Our community is small, and the people working at the clinic know me and my family.’
Even though it’s illegal for anyone working at your local clinic to tell others about your appointment and medical needs, this sadly isn’t always adhered to.
Emily-Rose was in her second trimester, meaning a medical abortion wasn’t an option. ‘I needed to have a surgical abortion [this is conducted if the pregnancy poses a danger to the woman’s physical or mental health, or if the pregnancy is as a result of rape or incest],’ she explains. ‘Once I’d made up my mind to have a TOP, I couldn’t have a medical abortion. I had to go to my local clinic – even though I was worried about it not being kept confidential.’
The nurse did a blood test to confirm Emily-Rose’s pregnancy, and then provided her with a referral letter to a government hospital for a surgical abortion. Emily-Rose was never offered counselling during the process, nor was she given much information about what to expect.
‘When the day came, I arrived early in the morning at the hospital,’ she says. ‘I wasn’t allowed to eat anything, so I remember being nervous and hungry. I was asked to undress and put on a hospital gown.’ Emily-Rose was taken to a waiting room with a handful of other women. ‘I was one of the youngest, at 19,’ she recalls. A nurse arrived with pills for each of the women. ‘We all sat together, in this bare, cold room and took our pills. We were told we should remain seated until we were called,’ adds Emily-Rose.
‘The pill made me feel quite nauseous,’ she says. ‘I could literally feel my vagina opening up, and I had what felt like very bad period pain.’ The pill, Misoprostol (also used in medical abortion procedures), does indeed open up the cervix. This allows the doctor to clear the womb of pregnancy- related tissues in theatre.
‘A surgical termination refers to a procedure where the pregnancy is removed from the uterus,’ explains Murray. ‘These methods refer to either using suction or an instrument to empty the uterus. No cutting is involved.’
As Emily-Rose waited, a nurse would come and fetch each woman to go into theatre, where a doctor completed the procedure. While uncomfortable, for Emily-Rose the experience was traumatic primarily because of how she was treated. ‘I felt like none of the nurses or doctors cared,’ she says. ‘I barely remember the procedure because it wasn’t a huge deal. What was a big deal was how I felt. I remember so clearly the nurse and doctor chatting to each other and ignoring me as they worked. No-one let me know what the doctor was going to do, what to expect, or how things were going. The way in which I was treated felt more traumatic for me than the abortion itself.’
Emily-Rose’s story is sadly not uncommon. Whether through limited resources and time, poor training or lack of care, the way healthcare providers treat women seeking a TOP often leaves much to be desired.
Can your healthcare provider refuse you an abortion?
Healthcare providers can – in non-emergency cases – refuse to perform a TOP, according to the Constitution, which allows the right to freedom of conscience, religion, thought, belief and opinion. But this cannot prevent you from receiving the care you have a right to. ‘If you choose, as a healthcare provider, not to offer termination of pregnancy, then you have to be able to guarantee that your patient is referred to somebody else and will be able to access the procedure,’ says Lopez Gonzalez. If you’ve been denied access to an abortion, you can report it to the Women’s Legal Centre,’ she adds. ‘They can help you troubleshoot the situation further.’
Healthcare workers suffer stigma too
Spare a thought for the healthcare workers who do offer TOP services in the government sector. ‘They can be stigmatised by their peers or colleagues for doing so, due to the personal views of others who consider abortion to be “wrong”,’ says Lopez Gonzalez. She recalls the story of a healthcare worker who was nicknamed ‘Lucifer’ by her medical colleagues, because she was happy to assist women with TOPs at the government hospital she worked at. Lopez Gonzalez also heard of a healthcare facility manager who changed the locks during the night so that the nurses who did TOPs couldn’t open for patients the next day to offer care. It’s illegal and unethical, and it shows how far South Africa still has to go in destroying the stigma.
How to spot an illegal provider
- They likely won’t advertise their physical address.
- They prefer to chat via social media or WhatsApp.
- They will want you to pay in cash upfront.
- They might want to post you tablets without conducting an examination or knowing your medical history.
- They will likely offer abortions above 20 weeks.
- Murray warns that illegal providers may not have trained staff, clean and safe equipment and facilities, or a proper understanding of the correct procedures and medication. Illegal providers are illegal for a reason: you don’t want to end up admitted to hospital with complications that could endanger your health.
Do you want to talk about it?
Something that every woman we spoke to had in common was that none of them were offered pre- and post- counselling – even though legally this should be offered. Lopez Gonzalez confirms: ‘The law says that this counselling can’t be “directive” (it can’t tell you what you should or shouldn’t do) and it’s not mandatory, so you can refuse it if you don’t want it. But it should definitely be offered to you.
Take a stand. Sign the #COSMOSafeAbortion petition here.
COSMO is calling on the Department of Health to formalise abortion guidelines.
- We want government to help equalise and standardise the quality of care across the country and offer to abortion support for government facilities where there aren’t enough or any specialists able to offer abortion services to patients.
- Provincial health departments could turn to private providers (like Marie Stopes) to assist in providing safe, free access to abortion across the country, particularly for government facilities where there aren’t enough or any specialists able to offer abortion services to patients.
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