Must-Read: South Africa's Abortion Crisis

Abortion may be legal, but that doesn’t mean it’s accessible for all.

February 2017 marked 20 years since abortion was first legalised in South Africa, making the abortion law among the most progressive in the world. So why, two decades on, are 150 000* South African women a year risking dangerous and illegal abortions in backstreet clinics? Aoife Stuart-Madge reports.

There’s a lot I can’t tell you about Babawal. I can’t tell you her real name, the township she’s from or what she does for a living. But I can tell
you that when she was 20, she went to a backstreet clinic in Johannesburg for an illegal abortion – without telling her family and friends.

Babawal knew the moment she fell pregnant that she couldn’t have a baby. She was in her second year at varsity – something her strict Christian parents had made sacrifices to make happen. She knew she couldn’t break their hearts by derailing her studies. ‘Having a baby at that time would have devastated them – not to mention I was nowhere near ready to be a mother to a human being,’ says Babawal, now 29.

Similarly, her boyfriend at the time was definitely not ready to be a father. ‘I fell in love with a great guy – but as great as he was, he had his own plans and ambitions, and having a baby was not part of those,’ she says.

By the time Babawal found out she was pregnant, she was four months along – barely eligible to seek a legal abortion under South African law. Besides, to do so meant confiding in her family doctor and risk being judged – or worse, her parents finding out. ‘I was very ashamed,’ she says. ‘It’s difficult to face people you know or people who know your parents, knowing they will frown upon you.’

So she took matters into her own hands and, using the Internet, set about finding a clinic that would perform the abortion secretly without the risk of her family finding out. She didn’t have to look far: Johannesburg is awash with billboards and flyers advertising discreet ‘quick, pain-free, same-day’ abortions. When she picked a clinic, she called the mobile number and was told to bring R800 in cash.

Babawal’s boyfriend drove her to the clinic but, once inside, she immediately felt uneasy. ‘The whole atmosphere was uncomfortable,’ she says. Her boyfriend was asked to pay cash upfront, before Babawal was taken to a small room. ‘I was given a pill and left alone to wait for the foetus to loosen and detach before they could use instruments to remove it,’ she says. ‘After an hour, another woman took me to a dark room at the back of the house. I remember being told to get on a bed and open my legs. Then an instrument was placed in me to remove the foetus. I was terrified. All I could do was close my eyes and wait for it to go away. The pain was the worst part. I have honestly never felt pain like that in my entire life. I didn’t even know whether I would be able to walk again. I cried throughout the whole thing, much to the annoyance of the woman who was doing the procedure.’

Far from the straightforward termination procedure South African women are entitled to by law, Babawal endured a living nightmare – which eventually led to her suffering a nervous breakdown. Nine years later, she’s still struggling to come to terms with the horror of that day. You see, the clinic that Babawal went to was operating illegally, and the woman performing her termination had no medical training and was unqualified to carry out the procedure or prescribe medication. She was a criminal more interested in fast cash than in Babawal’s mental or physical wellbeing. The clinic was not a medical facility but a rented house that served as a front for one of a growing number of illegal cash-for-abortion outfits popping up around inner cities.

According to global reproductive health group Marie Stopes International, between 52 and 58% of the estimated 260 000 abortions* that take place in South Africa every year are illegal. These abortions are carried out by criminals masquerading as medical practitioners, with devastating consequences that include complications such as infection, infertility and, in extreme cases, death. These clinics offer no aftercare (Babawal was sent home the same day with a sanitary pad and an aspirin) and sever ties with a patient the second she leaves the clinic. With no land line to contact, it’s not unusual for a patient to discover the clinic’s mobile-phone number has been switched off or changed after she has attended. ‘These fly-by-night providers, who women contact either via text or online, often disappear when it’s time to assist further or to provide basic aftercare or deal with clinical complications that may arise,’ says Andrea Thompson, advocacy and engagement manager for Marie Stopes South Africa, an organisation that offers safe, legal abortions. ‘It is heartbreaking to hear what Babawal went through and that she didn’t have the support of a clinical expert to guide her through the process.’

Babawal is one of the ‘lucky’ ones: her ordeal could have been much worse. According to Thompson, complications that can arise from unsafe abortions include severe bleeding, uterine perforation, the tearing of the cervix, severe damage to the genitals and the abdomen, internal infection of the abdomen and the reproductive tract, pelvic inflammatory disease and blood poisoning.

You only have to look at the flyers and billboards freely advertising fast-fix abortions in unregulated clinics to see just how widespread the problem is. These illegal practices are so overt with their marketing, you could easily mistake an illegal operation for a legit clinic. ‘Don’t be fooled by the term “backstreet abortion”,’ says Thompson. ‘These individuals are getting more slick, putting up legitimate-looking websites and even offering delivery services. But women need to know it’s not safe to simply buy medical abortion pills without having a proper consultation and assessing the stage of their pregnancy. It’s not safe to have a surgical procedure done outside of a proper medical facility.’

Most shocking of all is that these unlicensed clinics will perform late-stage abortions beyond the legal 20-week limit – sometimes all the way up to 40 weeks. When we called one of these clinics purporting to be seven months pregnant – eight weeks past the legal period for a safe abortion – the person on the phone confirmed they terminate pregnancies up to eight months. ‘We have pills and we have an injection, and we have other methods because you’re a bit far,’ they said. ‘But it’s okay, I can do it for R1 500 cash. You will come in at 9am and you will be finished at 5pm. You won’t feel a thing.’

The health risks of late-term abortions can’t be underplayed. At best, the medication is ineffective; at worst, it can lead to infertility, ectopic pregnancy, miscarriage or premature delivery in subsequent pregnancies. ‘The medication given for these later abortions is only safe for early pregnancies, according to the World Health Organization,’ says Thompson.

So why are so many women risking backstreet procedures when, by law, they’re entitled to a safe alternative? ‘Many women struggle to access services, whether it be because their local clinic isn’t operating or the costs are prohibitive, or because they fear judgment from the medical staff,’ says Thompson. Despite progressive laws to the contrary, abortion still remains a taboo subject in South Africa, with all of the associated stigma. ‘Stigma is at the root of many of the abortion challenges we face,’ she explains. ‘It often impacts a nurse or doctor’s willingness to provide abortion care, limiting available services – especially free, public-sector services. It also makes women afraid to access an abortion at a formal facility. Backstreet providers may not be safe, but because they operate on a business model of money for abortion pills, women seek them out thinking it’s simpler.’

By changing mobile numbers and operating out of secret locations, backstreet clinics manage to avoid detection by law enforcement. The clinic we called refused to give out its location on the phone – we were told to call a mobile number from outside the Carlton Centre in Johannesburg and wait for someone to meet us and escort us to the clinic.

It’s a bleak picture – one that can only change when attitudes towards abortion change. The conversation needs to come out of the backstreets and into the open, says Thompson. ‘Awareness is key. Abortion isn’t rare or unusual; one in three women will have an abortion in her lifetime. The more we do to speak openly about it and normalise the experience, the easier it will be for women to hold healthcare providers accountable for offering quality, nonjudgmental services.’

But breaking the abortion taboo is a terrifying concept, especially for women in traditional, inner-city communities where underage pregnancy is rife and where abortion is regarded as a dirty word among older generations – something Mina**, 23, from Port Elizabeth has seen first-hand. ‘Most traditional members of the Xhosa community I’m from are religious, so abortion is an absolute no-no,’ she says. ‘Abortion is seen as evil and immoral – as murder.’

But the alternative – facing life as an unmarried mother – can be daunting for a young Xhosa girl. ‘Pregnancy for an unmarried mother is shameful for her family,’ says Mina. ‘Some traditional members of the community might kick their daughter out of home or school – or, as soon as you give birth, you have to give the baby to the father’s family, with little to no contact allowed until you can make your own money and visit the child and provide for it.’

As a result, several of Mina’s peers have sought out illegal abortions. She explains the appeal of a hush-hush, no-questions-asked backstreet procedure: ‘The people who work in the local [legal] clinics are from the community – they know your parents and family, and you can’t trust them not to tell. An illegal abortion offers secrecy and anonymity. Also, because of the stigma associated with a pregnancy outside of marriage, many girls bury their heads in the sand about a pregnancy and only choose an abortion when they’re too far along to have it done legally. Most illegal abortion providers won’t ask too many questions about how far along you are.’

Changing the status quo is not easy, says Thompson. ‘But the reality is that illegal abortions are having a negative impact on women’s health and, in the worst cases, even their life. We need to ensure that women know where they can seek out safe services, so we’re working with several partners in the sexual and reproductive health sector to develop a national directory of safe providers.’

In addition to working with provincial health departments to improve access to care – including training for providers and ensuring facilities designated to provide services are operating and doing so consistently – Marie Stopes is working with police to clamp down on illegal services. But that in itself is risky. ‘Crackdowns on unsafe abortion pose a risk of driving women desperate to terminate unwanted pregnancies even deeper underground,’ says Thompson. ‘We need to be very clear about who is doing something wrong here. Women seeking unsafe abortions are often doing so out of misinformation and desperation, and we should be careful not to stigmatise them further. The criminals are the people providing surgeries and unregulated medications in undesignated environments – not the women themselves.’

* Marie stopes International statistics (2012)

** Name has been changed

Help! I’m Considering An Abortion

Get the care and help you need.

Get the right counselling and advice

  • LifeLine offers counselling to expectant mothers and those wondering whether abortion is an option. (0861 322 322; Lifelinesa.co.za)
  • Struggling with anxiety or depression as result of being pregnant unexpectedly, or following an abortion? Call the South African Depression and Anxiety Group. (011 234 4837; Sadag.org)
  • The Family and Marriage Society of South Africa also offers counselling, and is a good resource for grief support following an abortion. (011 975 7106)

Find a local government clinic

To have a free abortion, the request must be made at a primary healthcare clinic, where the pregnancy will be confirmed, counselling provided, an appointment made, and a referral letter be given to a facility where the procedure can be performed.

Visit a local clinic to begin this process and be referred to the right healthcare practitioners. By law, any appointments and requests must be kept confidential by the professionals you speak to.

Or try private, if you’d prefer

Marie Stopes clinics are government-approved health facilities that specialise in family planning and safe abortion. Fees are charged in accordance with a client’s income bracket. (0800 117 785; Mariestopes.org.za)

What about the morningafter pill?

The morning-after pill can be taken up to 72 hours after intercourse. It can’t be used to facilitate an abortion after this time frame. If you miss the 72-hour window, you’ll need to enquire about an abortion at your primary healthcare clinic. Morning-after pills are available over the counter at pharmacies, and cost about R70. A pharmacist may not legally sell the pill to anyone under the age of 14 without a doctor’s prescription, or without a parent or legal guardian being present.

Are you pregnant as a result of rape?

  • People Opposing Women Abuse offers counselling as well as legal support. (083 765 1235; Powa.co.za)
  • Rape Crisis offers advice, counselling and emotional support. (Rapecrisis.org.za)

Report illegalabortion practitioners

Report someone anonymously to the authorities by telling your doctor or nurse, or giving the details of the practitioner to the police. You can also report someone directly to the Department of Health on 012 395 8000 or 021 466 7260.

Read 6 Things You Should Tell Your Gynae

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