With the world marking International Women’s Day this week, women in South Africa might find themselves asking what benefits 10 years of democracy have brought them — especially in the important area of reproductive health.
“Women have different levels of access to reproductive health services at a range of levels,” says Martha Molete, communication officer at the Planned Parenthood Association of South Africa (PPASA).
She says urban women generally have better access to health care than their rural counterparts. However, women in rural areas are undoubtedly more aware of their contraceptive options than they were a decade ago.
“Sexuality and life skills education has been introduced in the schools and the Department of Health and a number of NGOs have run many successful campaigns on a range of issues on sexual and reproductive health,” says Molete.
Similarly, the PPASA manages a programme that involves health workers walking from village to village giving contraceptive advice and services, even in the remotest areas.
Molete says South Africa faces a significant problem in that the female condom was not widely available. This condom offers women substantial control over their reproductive health, as it can be inserted a few hours before sex and is more effective than a male condom. The social and economic impact of HIV/Aids had also taken a toll on health-care infrastructure and budgets.
In addition, Molete voices concern about what she describes as an international shift to the right on the issue of reproductive rights — with the United States, in particular, attacking pro-choice organisations and promoting abstinence-only education. A gag rule is currently in place that prevents US family planning aid for foreign countries from going to any organisation that offers women abortions.
“South Africa is one of the few countries in Africa that has legalised termination of pregnancy. Thousands of women in Africa die each year due to backstreet abortions and the resulting complications,” says Molete.
South Africa reformed its laws seven years ago to provide abortion free of charge at state facilities. In certain areas however, implementation has lagged some distance behind policy.
Lucky Barnabas, a person living with Aids who works as an advocate in communities in the KwaZulu-Natal province, says most women do not know that abortions are available and legal. Those who make their way to hospitals often find the process less than efficient.
“Many women I meet have tried to get abortions but are unnecessarily delayed because of long waiting lists. Then, they miss the second trimester — which makes abortion unsafe,” notes Barnabas.
Researcher Anso Thom, in a report done for international women’s health NGO Ipas, says South Africa’s 1997 Termination of Pregnancy Act stipulates that abortion services must be made available upon request to a woman during the first 12 weeks of pregnancy (the first trimester).
Abortion during the second trimester is considered if a medical practitioner is of the opinion that the pregnancy would pose a risk to the woman’s physical, mental or social well-being — or is a result of rape or incest.
Barnabas says a number of HIV-positive women who seek abortion have reported being sterilised without their permission.
“These young girls are sterilised even though there is nevirapine available.”
Nevirapine is a drug that prevents mother-to-child transmission of the HI virus that causes Aids.
A 2002 Ipas report makes a similar observation: “Stigmatisation of women living with HIV/Aids, including the belief that they should not have children, also poses significant obstacles. For example, they may also encounter discrimination when seeking pregnancy and abortion-related care in the health services of many countries.”
It further states that women living with HIV/Aids encounter numerous obstacles in preventing unwanted pregnancies, including a lack of information concerning the most appropriate contraceptive methods.
However, “very little research has been done concerning the impact of unsafe abortion on women living with HIV/Aids in comparison to HIV-negative women, although adverse health outcomes may be worse for them”.
The report, Reproductive Choice and Women Living with HIV/Aids, was based on research and interviews conducted in Australia, India, Kenya, South Africa and Thailand.
According to Thom, more than a quarter of South African women have accessed abortion since the introduction of the Termination of Pregnancy Act. However, there are still huge gaps when it comes to awareness and standardising services across the country — particularly rural areas.
For its part, the PPASA believes that one of the keys to successful implementation of the Termination of Pregnancy Act lies in having men support partners who choose to make use of abortion services. This is why the organisation has launched a Men as Partners initiative that uses education and training programmes to highlight the role of men in reproductive health issues.
“The programme uses life skills workshops, which include sexuality, gender, male and female sexual health, relationships, sexual violence and domestic violence,” says Molete. Thus far the programme has been used successfully in prisons, hostels and various communities. — IPS