Making it real: The challenge of implementing South African abortion laws

By Kanyisa Booi

In 2017, we celebrate the 20th anniversary of the enactment of the Choice of Termination of Pregnancy (CTOP) Act, which has equipped the South African legislation with one of the most progressive abortion laws in the world. However, according to a study conducted by HEARD, from the University of KwaZulu-Natal, 50% of abortions still happen outside of legal healthcare facilities and most of the time in unsafe environments.

To mark the 28th of September, known as the International Safe Abortion Day, the Sexual and Reproductive Justice Coalition (SRJC) called together a group of organisations and interested parties to be part of a conversation about safe abortion access and referral systems in South Africa.

Access to safe abortion in South Africa

Fem was there, as well as representatives from One in Nine Campaign, Global Health Strategies  and Amnesty International South Africa. Among the speakers main concerns were the need for referral systems, providers mapping and medical protocols. The concerns were raised within the South African and Indian context, regarding the countries specific laws and conditions of access to safe abortion.

In India, like South Africa, abortion is accessible up until 20 weeks with consideration of special circumstances. However, according to Global Health Strategies, the notion of right is very different from South Africa. There are many gatekeeping mechanisms preventing Indian women to access abortion, such as age and marital status. The law, whose function is to protect children, unintendedly becomes a stumble block.

The Indian law states that if a girl under the age of 18 requests an abortion, it is required for the medical staff to open a case of sexual assault as sex below 18 years old is illegal. Health practitioners who come across such cases in hospitals are reluctant to provide for the services. This is because they fear being prosecuted whether the pregnancy was the consequences of a sexual assault or not. This leads to many young women choosing the illegal route which can be unsafe.

In South Africa, though abortion is a right, women are facing many barriers with only 318 hospitals out of 3888 offering abortion services. Public facilities predominantly use the manual vacuum aspiration, a surgical abortion method which means women must book the procedure in advance.

One in Nine Campaign regretted the fact that in many areas of South Africa, such as in kwaThema, there are no public clinics offering abortion services. Women are then referred to hospitals.

This adds stress on the medical resources, increases the waiting list and delays the access to the procedure, which leads to many women going over the legal gestational age limit and being refused the services. What value is that referral then? Abortion must be seen as a primary health care need.

At the activity, Fem highlighted the importance of a qualified referral process, that places the woman’s best interests first. This means that if health professionals conscientiously object to assisting the woman, they have a legal responsibility to refer her.

Abortion providers should understand that it is a vulnerable time for the woman concerned and treat her with empathy. This is a trait that unsafe abortion providers have mastered where a woman feels understood and they get speedy, anonymous services without judgement.

Stemming from this interaction with unsafe providers, the Ministry of Health in South Africa says that every 8 minutes a woman dies due to complications caused by unsafe abortions.

It is evident that education about safe abortion is critical. Medical abortion for early pregnancy should be used as the primary method. When following the right steps, the World Health Organization (WHO) states that it is safer than other methods and also requires much less human resources.

The South African Government needs to regulate conscientious objection and prevent women from being denied basic rights. In harmony with the progressive abortion laws from our country, there needs to be infrastructure developments so to have enough facilities for women to access safe abortion.

Education about plan C (abortion pills) should be prioritised in a country where 13% of child births are from teenage girls. It is necessary for abortion providers to be more visible so that in times of need women know where to go. The Fem platform is critical in making sure that we connect women to all sexual health choices.

About Fem – Connecting you to sexual health choices

Fem supports the right of every woman to make safe and informed decisions about her body, most specifically the decision to have an abortion. We focus on the practical issues that are often overlooked by existing healthcare systems: privacy, transparency, convenience, cost, and supportive environments.

Fem is an SMS platform that refers women to safe and legal abortion service providers in their area, quickly and privately. The user simply sends the trigger word ‘Fem’ to the short code 30705 via SMS, and receives a referral SMS to a legal and safe health facility in their area.

To access all our products SMS for free the word “Fem” to 30705.

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