Pregnancy - your right to choose

Soon after the first democratic elections in South Africa in 1994, the Choice on Termination of Pregnancy (CTOP) Act of 1996, which, for the first time, legalised abortion, was passed.

In terms of this legislation, women may request abortions up to the 12th week of pregnancy. After this, up to the 20th week, abortions may be performed if, in the opinion of a medical practitioner, continued pregnancy will pose a threat to the woman’s physical or mental health, the foetus is likely to be severely physically or mentally abnormal, the pregnancy resulted from sexual abuse, rape or incest, and finally, if continued pregnancy will significantly affect the woman’s social or economic circumstances.
After 20 weeks, termination may be performed only if two doctors (or a doctor and a registered midwife) determine that continued pregnancy would endanger the woman’s life, result in severe malformation of the foetus or pose a risk of injury to the foetus. The Act also promotes the provision of non-mandatory counselling before and after abortions are performed. Importantly, minors are counselled to notify their parents or guardian, but do not need to obtain consent from the latter.

The abovementioned sub-section of the Act has caused some controversy. The Christian Lawyers Association filed a suit in the Pretoria High Court in 2003, arguing that the sub-section was unconstitutional (in 1997 several Christian groups failed in their constitutional challenge of the CTOP Act in its entirety). They argued their case on the basis that ‘the most fundamental duty of both the government and the Courts is to defend the vulnerable. There can be few more vulnerable members of society than the adolescent girl who suddenly falls pregnant” (www.cla.org.za). They wanted the sub-section to be replaced with one in which the adolescent is required to seek consent from her parent or guardian and have 30 minutes’ mandatory counselling in which graphic details of terminations and their long-term consequences are outlined. Their appeal was dismissed.

Aside from the perennial moral issues that accompany the abortion debate, to what extent were the Christian Lawyers Association’s concerns about adolescents justified?

In the first five years after the CTOP Act was introduced (up to the end of 2002), quantitative data were collected on the number of terminations of pregnancy (TOP), gestational age and the age of women undergoing terminations. In this period 12% of women undergoing terminations in the eight provinces in which age-related data are available were minors. In terms of the proportions of pregnancies that end in TOP, it was found that the TOP rates for teenagers were significantly higher than those for older women. These statistics indicate that voluntary abortions are an important factor in adolescent reproductive health in South Africa.

Since the introduction of the CTOP Act, some studies have been conducted on the experiences of abortion amongst adolescents. These indicate that adolescents experience turmoil concerning their decision to terminate their pregnancy, mostly keep their pregnancy and their decision to abort a secret from their parents, experience physical distress in relation to the actual procedure, and experience emotional pain after the procedure. On a more positive side, it has been mooted that adolescents may experience emotional maturation and growth through the process of termination of a pregnancy.

However, the extent to which these factors are unique to adolescents is not clear. As these studies did not provide any control group (i.e. older women undergoing abortion), it cannot be said for certain that adolescents differ in any significant way in their experiences of abortion than do older women. Indeed, international research suggests that all women have difficulty with coming to a decision to abort and share this information with only a select few. What has been challenged in some of the international literature is the extent to which women (including adolescents) experience emotional pain or psychological disturbances after an abortion. While some researchers believe that women experience the equivalent of post-traumatic stress syndrome after abortion, others say women may display no negative consequences and indeed may feel a sense of relief around the resolution of an unwanted pregnancy.

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