Amid continuing controversy, abortion this=20 week becomes legal, but many units will be=20 unable to offer the service. Jim Day=20 reports=20
MANY provincial health departments have=20 been caught ill-prepared for the=20 introduction this week of legalised=20 abortion.=20
The new Choice on Termination of Pregnancy=20 Law comes into force on Saturday, and the=20 health ministry on Tuesday listed hospitals=20 designated to offer abortions.
But inquiries by the Mail & Guardian show=20 that lack of resources and resistance among=20 staff will prevent many designated units=20 from immediately offering the service. The=20 number of designated hospitals in some=20 provinces is also limited.
In most provinces, abortions will only be=20 available at major hospitals. Many=20 provinces expect the roll-out to community=20 level to take months, if not years.=20
Officials also have no clear picture on=20 likely numbers. Figures range from 200 to=20 500 for every 1000 live births a year,=20 based on international experience – ”but=20 that’s just a thumb-suck,” says Carol=20 Marshall, Gauteng’s chief director, health=20 programmes.
A string of designated facilities contacted=20 by the M&G refused to comment on their=20 preparations, and did not even want their=20 names mentioned, fearing they would be=20 swamped by abortion-seekers.=20
Provinces such as Gauteng, Northern=20 Province and the Western Cape have dozens=20 of hospitals listed as abortion providers.=20 Officials at some, however, said they were=20 still waiting for guidelines.
The service will be less accessible in=20 other provinces. Only four public hospitals=20 in the Eastern Cape will offer abortions.=20 The province said this week it had yet to=20 secure support among the hospitals’ various=20 stakeholders, let alone finalise=20 preparations. Only two hospitals in the=20 Northern Cape – Kimberley and Gordonia – =20 will offer the service.=20
Preparations in the Northern Cape have been=20 slowed because many health workers do not=20 want to be involved, said Carvie Madikane,=20 the province’s deputy director for=20 maternal, child and women’s health.
”We’re not sure people are going to accept=20 termination of pregnancies. I’m talking in=20 terms of health workers,” she said. ”There=20 was definitely strong resistance.”
Nevertheless, she expects six facilities=20 throughout the province to be offering=20 abortions by the end of the year.
In the meantime, a woman in an outlying=20 area can receive a pregnancy test at a=20 local clinic; the provincial health=20 department will then provide an ambulance=20 to transport her to one of the two=20 hospitals to terminate the pregnancy, said=20 Madikane.=20
The two Northern Cape hospitals should be=20 able to meet the demand, although it may be=20 difficult, as she expects ”quite a number=20 of patients”. Health workers will have to=20 decide who receives abortions first, with=20 more advanced pregnancies getting priority.
In the Free State, abortions will only be=20 available in Bloemfontein for the time=20 being, Dr Craig Househam, the provincial=20 health department’s deputy director=20 general, said. He expects it to take a=20 couple of years before abortions are=20 available in all 14 health districts in the=20 province.
Helen Rees, a consultant with the national=20 department’s directorate on maternal child=20 and women’s health, said estimates range=20 from 208 to 520 abortion requests per 1000=20 live births. She estimates women in Soweto,=20 where she works at Baragwanath Hospital,=20 will have 120 to 250 abortions a week.
Marie Adamo, the deputy director for=20 reproductive health in the Western Cape,=20 estimates there will be one abortion=20 request per 10 live births. At that rate,=20 her province will see 7000 to 8500=20 abortions a year.
The new law states that any woman less than=20 12 weeks pregnant may end the pregnancy,=20 and women up to 20 weeks pregnant may get=20 an abortion for a number of reasons,=20 including knowledge that the baby would=20 have severe abnormalities or the woman’s=20 belief that her economic or social=20 situation makes an abortion necessary.
One health consultant estimated an abortion=20 in the first 12 weeks of pregnancy in a=20 clinic would cost R100 to R200. Later=20 abortions, which are more complicated and=20 must be done in a hospital, will cost far=20 more.
The new law also allows nurses and some=20 other medical professionals to perform=20 abortions, provided the woman is less than=20 12 weeks pregnant. That non-doctors will be=20 performing the procedure is one of many=20 arguments pro-life activists raise to=20 resist the legalisation of abortion.
‘They’re bringing the back-street=20 abortionists right into the hospitals,”=20 said Dr Claude Newbury, a former general=20 practice doctor who now serves as president=20 of Pro-Life South Africa. He cited the=20 Hippocratic oath, religious scripture,=20 rulings made at the Nuremburg trials=20 against Nazis and doctors’ training in=20 embryology as reasons against abortion.
He said hundreds of doctors have pledged=20 not to take part in abortions. He was also=20 trying to persuade doctors to ignore the=20 section of law that demands they inform=20 women of where they can get an abortion,=20 lest the doctors become ”accomplices to=20 murder”.
The abortion controversy peaked this month=20 in Durban, where dozens of Christian=20 fundamentalist demonstrators forced a=20 family-planning clinic to shut its doors=20 temporarily during a protest over alleged=20 ”early abortions” two weeks ago.=20
The anti-abortion group Christians for=20 Truth picketed outside the recently opened=20 central Durban premises of the Marie Stopes=20 clinic before attempting to lay charges=20 against it.
Durban South African Police Services=20 communications director Bala Naidoo said=20 the group had asked for charges to be laid=20 against the clinic for allegedly providing=20 abortions in the final weeks before the=20 service was made legal.
Marie Stopes Durban Clinic manager Luise=20 Grisdale said she regretted that patients=20 had been unable to access contraceptive and=20 other services during the demonstration.=20 ”We had to lock our doors due to the=20 protest,” she said, adding this was the=20 first time the organisation had had to=20 close its doors, despite operating clinics=20 in Johannesburg, Soweto and Cape Town.