South Africa’s Illegal Abortion Problem-Liberal Laws. Limited Access.

Photo: Staying Alive Foundation

Words: Jo Elliott

South Africa in 2020 has one of the most progressive abortion laws in the world. With abortions available up to 12 weeks on request, and between 13–20 weeks in certain conditions, its abortion law is one of the most liberal in Africa. Only Mozambique and Tunisia also have abortion available on request up to 12 weeks.

The law in South Africa is more in line with most European countries, which largely offer abortion on demand during the first trimester, than it is with the law in the rest of Africa.

However, despite the country’s liberal abortion law, illegal abortion is still incredibly prevalent in the country. Advertisements for illegal abortions litter lampposts and buildings across the country. The specific percentage of illegal abortions is unknown as the figures aren’t widely available.

Why, then, in a country with an abortion law that is lauded as one of the most liberal in the world, is illegal abortion an issue?

Lack of clinics

Although the legislation is there, one of the biggest issues for South African women is physical access to the services. An Amnesty International report from 2017 on barriers to safe and legal abortion found that of the 505 facilities which are meant to provide abortion services, only 264 of these provide both first and second trimester abortions.

Whitney Chinogwenya, Marketing and Brand Manager for Marie Stopes said of access to abortion services: “Where people can access the services is actually very limited. Whether it’s the government facilities or private places, there’s just not enough abortion providers here in South Africa. Obviously that stems from the stigma that comes from abortion provision. There’s a lot of facilities that are not providing the service because of people’s opinions and thoughts around it. Then there is also a lack of trained professionals. There are not a lot of nurses or doctors that are actually trained to provide the service. So that then impacts the amount of facility providers because not everyone can have a trained provider.”

The places where services can be accessed are also quite sparsely placed across the country. For women in rural areas, their nearest clinic could still be quite far away.

Barriers To Access

Even where women are able to access a clinic, they can still face obstacles to receiving abortion services. Women can be turned away from clinics and told that they do not offer these services, even when they do. This can occur multiple times and the reasons for this are not always explained. For abortion, immediate access is key. Being passed around different clinics can mean that women miss the 12 week cut off point, where abortion is still available on request.

Nasreen Solomons, an attorney at Women’s Legal Centre, said:

“It’s that sort of sending women from pillar to post, they kind of get pushed and pushed and pushed within that time-sensitive period. And then when access becomes so dire and so necessary, they don’t know where to go then.”

Abortion is a time-sensitive issue and many clinics have waiting times for appointments. The longer it takes a woman to find a clinic both willing and able to do the procedure, the more likely it is that she may end up outside of the time limit for an abortion on request. She will then have to go through the whole process of finding a clinic again. This time it will be more difficult though, as fewer clinics offer second trimester abortions.

Deceiving Crisis Pregnancy Centres

There is also the issue of crisis pregnancy centres: some clinics that look like abortion clinics are actually not. These are places which look as if they offer abortions, but actually what they aim to do is convince women not to terminate their pregnancies and they can look quite convincing. So if women first access these clinics, they then once again have to go through the hurdles of finding a clinic that actually does provide the abortion that they are seeking.

Once clinics are accessed, women face further barriers with providers refusing to offer the service due to expressions of conscience. This is not allowed under the Choice of Termination of Pregnancy Act, introduced in 1996.

Nasreen said: “There is no provision in the Choice of Termination of Pregnancy Act that allows for health practitioners, midwives, or registered nurses to refuse access or provision of abortion services on the basis of conscience claims.”

Under Section 10 of the Act, anyone who prevents access to termination is guilty of an offence. If convicted, they could face a fine and up to six months imprisonment.

Lack of Information

There is a lack of information for South African women about the services that are available to them and their rights when it comes to accessing abortions. This barrier needs to be overcome, even before they physically access the clinic. Yes, the internet is available, but realistically not everyone can access it. As Nasreen said, “There’s definitely a gap in what women know and how women get information. The digital age is fantastic, but it works on the assumption that everyone has access.”

For legal abortions, women have to go looking for the information. It is not something that is readily available. In contrast, the illegal abortion advertisements are much easier to access. They cover walls and lampposts across the country, offering phone numbers to call to access abortions.

Whitney believes that this lack of information makes women vulnerable. Because the information is not there before they need it, they turn to the first available option.

She said: “They have to go looking, and only when they need the service. So I think this is then what makes women vulnerable to the illegal providers, because that’s the information that is readily accessible and what happens in a termination is that it’s usually an urgent thing. You wouldn’t want to wait. Once they make the decision, it’s easier, or better for them to just go for the accessible option. Instead of digging around and trying to find the information. I think if the information was well known and at the tips of everyone’s fingers, then it would be easier.”

Education

It all comes down to education. More attention needs to be given to sex education in schools, including women’s rights when it comes to abortions. This would mean everyone would be aware of what their rights are.

Non-governmental organisations (NGOs) do already offer sexual education services. However, it should not be completely down to these organisations to provide services that are meant to be offered by the state.

As Nasreen said: “Why have we left it to NGOs to pick up this initiative to educate. Should it not be supplemental? As opposed to an initiative from the get go, or one that does what you think that state would do. All you’re doing is adding more, versus actually doing what needs to be done.”

Abortion is not an isolated issue. More focus on sexual education, both in schools and in communities, would improve knowledge of contraception. This would reduce unwanted pregnancies and in turn reduce the need for abortion. It’s all tied together. Yet there is a tendency to treat abortion as something that is disconnected from other aspects of sexual health.

As Nasreen said, “It’s all intimately connected, and I think sometimes people lose sight of that.”

Stigma

Topics like abortion and sexual health, however, are still highly stigmatized. To tackle issues like illegal abortion, we also need to tackle the stigma surrounding them. If we are unable to even talk about it, then the problem will remain. Stigma is a major reason why women will seek out illegal abortions in the first place. They don’t want to face judgement from others over their choice. Nasreen says:

“People aren’t willing to do anything about it, let alone talk about it.”

That’s really the crux of the issue here. There’s a lack of will to discuss the issue and make the necessary changes so that women are actually able to access the rights that the progressive law around abortion in South Africa promises.

Whilst barriers to accessing legal abortions remain in place, South African women will still turn to dangerous illegal abortions. As Whitney said, “We know that if a women wants to terminate a pregnancy, they will terminate.”

Women in South Africa have the right to a safe, legal abortion. It is our responsibility to make sure that they are able to fully access that right.

Originally published at https://capechameleon.co.za on March 10, 2020.

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Jo Elliott

Jo Elliott

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