Despite the termination of pregnancy being legal and offered at public and private health facilities, many women and girls still resort to backstreet abortionists
Lerato Ramolotsi and Nokubonga Ramolotsi, both aged 16, decided to participate in a recent march highlighting illegal abortions after a schoolmate died when she tried to terminate her pregnancy by ingesting rat poison.
“She wanted to abort the baby because children at school were teasing her,” Lerato told the Mail & Guardian during the march.
“She didn’t tell anyone, and just asked her friend to accompany her to the shop. I think she bought Rattex, thinking she was aborting her baby, but she ended up killing herself.”
She is just one of many women and girls that resort to unsafe and illegal backstreet abortions despite the procedure being legal. Illegal abortions often result in severe health complications and in some cases, death.
Despite the country’s progressive reproductive health legislation, there is still a societal stigma to having an abortion, said Jewelle Methazia, a research manager at the nonprofit Ibis Reproductive Health, which works to advance sexual and reproductive autonomy.
“We also have very few facilities that are actually offering safe services in the public sector, so that is a major issue, and with that comes the issue of people not knowing where to go, and when they do know where to go, there are only a few trained and willing providers in those particular facilities,” Methazia said.
To mark International Abortion Day, on 28 September, activists from a number of organisations including Ibis, Sonke Gender Justice, Section27 and the Sexual and Reproductive Justice Coalition marched in central Johannesburg and replaced the posters advertising illegal abortions with stickers that provide information on where to have safe procedures.
According to the Choice on Termination of Pregnancy Act, all women have the right to a free abortion at a government hospital or clinic during the first 12 weeks of pregnancy.
The procedure can also be performed from the 13th up to the 20th week if the medical practitioner, after consulting the woman, believes the continued pregnancy poses a risk of injury to her physical or mental health; there is a substantial risk that the foetus would suffer from a severe physical or mental abnormality; or the pregnancy resulted from rape or incest.
The Act says women of all ages have the right to terminate a pregnancy. Girls under the age of 18 can be accompanied by a trusted adult for support, but provisions will be made for them if they are not accompanied by an adult.
There are more than 500 public health facilities across the country where women and girls can have a safe abortion, but socio-economic barriers still exist.
During the march, a person working in such a public facility in eThekwini, who asked not to be named, told the M&G how nurses in some of the facilities shame and embarrass young girls and women seeking abortions.
In one instance, she saw a nurse opening the Bible and quoting verses to a girl to dissuade her from terminating her pregnancy. In some cases, women are turned away and told to come back on another day.
There are no concrete recent statistics to illustrate the seriousness of unsafe abortions in South Africa, said Nikita Mynhardt, of Marie Stopes, a nonprofit organisation that provides sexual and reproductive healthcare services, including pregnancy terminations. She cited a World Health Organisation report which said 25 million unsafe abortions take place globally each year, with a significant portion occurring in Africa.
“In South Africa, despite legalisation, thousands of women still resort to unsafe providers annually,” she said.
A 2017 study by the research and policy NGO Guttmacher Institute estimated that 50% of abortions in South Africa were illegal or unsafe. It said women turned to unsafe providers because of the lower cost and the anonymity offered. These illegal providers distribute unmonitored medication, often without requiring personal details such as the patient’s name.
“The lack of medical oversight significantly increases the risk of complications, such as infections, incomplete abortions, and even death,” Mynhardt said.
Ibis’s Methazia said research by her organisation showed there was a resource gap between the number of facilities offering abortions, and the number of people in those facilities that can perform the procedures.
Socio-economic barriers also usually get in the way.
“We know that the public sector provides services that are free, but the private sector does not. But a public sector that might be offering [abortions] might not be in your neighbourhood and you might have to travel far to access that service which brings in the cost of travel,” Methazia said.
In certain rural and underserved areas, access to abortion services is extremely limited, Marie Stopes’s Mynhardt said.
“Women may not know where to go or may have to travel long distances to reach a facility, further increasing the cost and effort required. Lack of accurate information about abortion services can drive women toward illegal providers who often advertise more discreetly, giving women the illusion of privacy and immediacy,” she said.
Rural areas in provinces such as the Eastern Cape, Limpopo and KwaZulu-Natal, tend to have higher rates of unsafe abortions, Mynhardt added, driven by the scarcity of public health clinics that offer abortion alternatives, and the ever present fear of stigmatisation.
Complications from backstreet procedures include incomplete abortions, where part of the foetus remains in the uterus, leading to heavy bleeding or infection, which can be life-threatening if left untreated or damage to reproductive organs.
The person working in a facility in eThekwini said they often deal with incomplete abortion cases after the patient went to a backstreet abortionist to buy pills.
“If a woman does not want to have a child … it’s either ‘I’m going to deliver and kill the baby, or I’m going to find things that’s going to make sure that this baby doesn’t live’,” she said.
Speaking at the march, Victoria Satchwell, the executive director at the nonprofit Abortion Support, which provides information for self-managed abortion, said having a safe termination symbolises that “we can make choices in our lives, that we can shape how our lives play out”.
“I’m talking about the young person who has an abortion because she wants to carry on going to school and she doesn’t feel like she’s going to have time to look after a baby and finish her schooling,” she said.
“But I’m also talking about a mother who terminates an unwanted pregnancy because she’s already got two children and she doesn’t have the financial resources or the emotional resources to care for another child. I’m also talking about the person who just doesn’t see themselves as being a parent, they don’t want to have a child, which is many of us.”