By Dineo Mokwena
Once a woman has decided to have an abortion, the process should not be challenging. Unfortunately, because of stigma, restrictive legislation, and limited resources, finding a safe abortion clinic is not an effortless task. It is important to know what to look for when seeking safe abortion services in South Africa, as the law permits them up to 12 weeks on request, after which one needs to fulfill certain conditions. This piece seeks to give a few pointers on what to avoid when looking for safe abortion, and how to distinguish between the legal and illegal service providers.
It is important to know what the South African Law says about Abortion Providers
As of 1997, the law states every woman can have an abortion under 12 weeks. The beauty of this law is that it allows for safe abortion providers to offer these services, but unfortunately, due to various barriers, there are still many unsafe abortion providers. After 12 weeks, women have to fulfill one of these conditions in order to access a legal abortion:
- The physical or mental health of a woman is at risk
- The discovery of severe mental and physical deformities in the fetus
- If the pregnancy results from incest or rape
- If a woman feels like her social or economic status does not allow her to continue with the pregnancy.
In addition, a woman under 12 weeks gestation does not have to disclose any reason for wanting the procedure.
There are many unsafe abortion providers in South Africa. According to the World Health Organisation (WHO), the risk of dying from an unsafe abortion was the highest in Africa, and 3 out of 4 abortions in Africa and Latin America are unsafe. [1] The Guttmacher Institute states that in 2014, at least 9% of maternal deaths in Africa resulted from unsafe abortions. [2] According to the HEARD 2015 fact sheet, almost 50% of abortions are done outside of legal health facilities. [3]
Many unsafe providers are outright obvious about offering an un-safe service, while others blend into the health care system very well. Although it may seem difficult to differentiate between a safe and unsafe abortion clinic, there are straightforward ways to make the distinction.
Look out for these signs to spot an unsafe abortion clinic:
WHO defines unsafe abortions as a termination of pregnancy performed by persons lacking the necessary skills or performed in an environment that does not meet health and safety standards for medical procedures. This definition has evolved as the WHO has also recognized self-managed abortions as a safe means to terminate a pregnancy, much of which you can learn under our guide to medical abortions at home.[4]
According to the Choice on Termination of Pregnancy Act of 1996, a medical doctor or a midwife/nurse can only perform abortions if they have gone through the required training. [5] A surgical abortion can only take place in public facilities designated by the Department of Health to perform abortions, or in a licensed private facility.
According to the SRJC (Social Reproductive Justice Coalition), an unsafe abortion clinic could have one or many of these characteristics:
- Provide no landline- only a cell phone number.
- Not advertise their physical address and
- May request an upfront payment for the services, offering no other payment methods such as the use of a card machine or an electronic payment. An unsafe provider may not want to discuss treatment methods over the phone or offer any information for questions you may have.
- They could also offer termination outside the constraints of the law. [5]
A safe abortion clinic should be able to provide you with the healthcare workers name or registration number for you to verify with the Health Professions Council of South Africa (HPSCA). Bhekisisa has also created a video that explains how to spot an unsafe provider. In addition, safe2choose counselors provide real-time referrals to safe abortion services.
What is a safe abortion procedure option for me?
There are 3 types of abortion procedures depending on gestational age, namely Medical Abortions, Vacuum Aspiration, and Dilation and Evacuation (D&E)
Medical abortions are available for up to 12 weeks. Medical abortions require two different drugs: mifepristone and misoprostol. Misoprostol is used to induce an abortion. An unsafe abortion Provider may provide two of the same or similar-looking pills. The best way to know if it is safe is if you receive it in its original package. In South Africa, it is available under the generic name Cytotec.
You should apply the same care when looking at misoprostol and ensuring that the two pills do not look the same. Mifepristone is a white pill that blocks hormones needed for the pregnancy to continue. The generic name in South Africa is Mifeprex. Sometimes a healthcare worker will provide you with a combination pill (both misoprostol and mifepristone) under the generic name Mifegyne. There is also the possibility of receiving Misoprostol only to conduct a safe abortion. As this pill is much easier to find, there is a high likelihood that medical providers will use this route.
The tablets can only be provided to you by a healthcare professional at a clinic, public hospital, or private hospital rooms. Most providers will start the process by administering the first pill during your visit, and any further treatment can be taken safely from the comfort of your home. Abortion pills are only available with a prescription from a doctor or nurse.
Self-managed abortions are becoming increasingly common. Reproaction defines a self-managed abortion as a termination that occurs outside a medical setting. [6] There are several countries where a woman can access medical abortions without the direct supervision of a medical professional. She will receive her medication along with instructions on how to use it, and post-abortion care assistance. Medical abortions are perfectly safe at home with minimal risks involved.
Manual Vacuum Aspiration (MVA) is performed up to 12 weeks and a D & E (dilation and evacuation), is available for up to 20 weeks. These are both same-day procedures that require a nurse or doctor. An in-clinic abortion will be completed in the healthcare facility, with no treatment taken at home to assist in the termination process. A healthcare worker may give or prescribe pain medicine and/or antibiotics to prevent infection.
How much your safe abortion will cost:
Abortion clinics in South Africa are not generally expensive, although private providers may charge more than the average. Public hospitals only offer in-clinic abortions for free.
In private facilities, medical abortions can cost anything from R600 to R2000. MVA costs slightly more, topping R4000. A D&E starts at R4000 and can increase to R6000, including conscious sedation. Some facilities (private or licensed NGO’s) offer abortions at various prices according to the economic status of the person in need.
Unsafe abortion providers sell medical abortion pills from R300, with some offering a 30% or 50% student discount.
Not much information is available online about where to find a safe abortion in South Africa, but platforms such as safe2choose and Bhekisisa provide amazing resources. The Bhekisisa abortion map is a great tool for those seeking the service and is updated frequently, and safe2choose has an online counseling service where you can receive assistance with navigating an abortion. The National Department of Health also has a list of public hospitals equipped to provide abortion services, however, this resource is not updated as frequently as the Bhekisisa map.
Finding a safe service should be the easiest part, but more often than not, it can lead women into dangerous situations.
For more assistance and information about abortion services in South Africa, please visit safe2choose.org. You can also directly email our counselors at info@safe2choose.org. You can also find valuable information on our social media @safe2choose on Instagram, Facebook, and Twitter.
Sources:
- WHO, Preventing Unsafe Abortion (2020). https://www.who.int/news-room/fact-sheets/detail/preventing-unsafe-abortion
- Guttmacher Institute (2018). https://www.guttmacher.org/sites/default/files/factsheet/ib_aww-africa.pdf
- HEARD, Country Fact Sheet: South Africa, Unsafe Abortion (2018). https://www.heard.org.za/wp-content/uploads/2016/06/south-africa-country-factsheet-abortion-20161.pdf
- WHO, Self-management of medical abortion (2020). https://www.who.int/reproductivehealth/self-care-interventions/medical-abortion/en/
- Choice on Termination of Pregnancy Act (1996). https://www.parliament.gov.za/storage/app/media/ProjectsAndEvents/womens_month_2015/docs/Act92of1996.pdf
- Reproaction, Understanding, and Advocating for Self-Managed Abortion. https://reproaction.org/campaign/self-managed-abortion/