A young girl falls pregnant and hides the fact from her parents, fearing their opprobrium. She visits a back-street abortionist, where an unsterile knitting needle is inserted into her vagina. Days later she is hospitalised for severe sepsis of the uterus. The teenager will never bear children again. She is one of the lucky ones.
The challenging reality of access young girls have to termination-of-pregnancy services is acknowledged in a report by the national Department of Health, detailing the first seven years of abortion legislation in South Africa.
The report focuses on the Choice on Termination of Pregnancy Act, implemented in February 1997 and amended in 2004.
Overall, women under 18 constitute only 11% of those using the service, with the majority aged 18 and older.
”The minor-consent provision in the Act serves as an important mechanism through which to protect young women from unsafe and illegal abortions, which may place their own lives and health in danger,” reads the report. It emphasises a decline in abortion-related complications among women since the advent of the legislation.
Staff attitudes
According to Professor Rachel Jewkes, director of the Medical Research Council’s (MRC) gender and health research unit, staff attitudes are ”generally” inhibiting teenagers from seeking abortion.
She said teenage abortion seekers are ”verbally abused and humiliated by staff” and find it hard to get into services because of a ”small quota” of places, or because they are a bit late and second-trimester abortions are not available.
”Also, teenagers often just deny it and hope the pregnancy will go away or try to self-medicate … they are afraid of being punished if the family find out they are pregnant,” said Jewkes.
The World Health Organisation (WHO) estimates about 46-million pregnancies around the world are terminated through induced abortion each year, with about 19-million occurring illegally, often performed in by unskilled providers in insalubrious conditions.
The WHO estimates that annually 68 000 women die from complications arising from unsafe abortions, 99% of them living in developing countries.
In addition to those who die from unsafe abortions, tens of thousands suffer chronic and sometimes irreversible health consequences, including infertility.
South Africa and Tunisia are the only two African countries providing abortion on request, with South Africa the only country on the continent allowing for an abortion on socio-economic grounds.
”I felt immense relief,” said a Cape Town woman, requesting anonymity. ”Finding out I was pregnant was a real shock, mostly because my husband and I are going through a divorce and only had sexual contact once in six weeks. We had both agreed that having a child now was not in the best interest of either of us, or the child … I knew immediately that I should opt for a termination.”
Deaths
Comparing a 1994 research estimate and 1998-2001 mortality data, Jewkes said — depending on the true figure of the 1994 estimate — an optimistic 91,1% reduction in deaths from unsafe abortions has occurred since South Africa’s abortion legislation took effect.
The 1994 MRC study found that 44 686 women were presenting with incomplete abortions each year at public health facilities. A total of 425 women, of whom 99% were black, died as a result of unsafe abortions. The total annual cost to the state for treating complications due to incomplete abortions was estimated at R18,7-million during 1994.
Commenting on second-trimester terminations — from the 13th to 20th week of gestation — the Department of Health’s report finds that in some cases the Act is only partially implemented; for example, in instances of rape and foetal malformation.
”There was resistance to providing second-trimester services on the basis of socio-economic reasons and a high degree of reluctance to perform procedures above 16 weeks gestation,” reads the report.
Although some medical practitioners are of the opinion that termination-of-pregnancy services are helping women, abortion is generally seen as ”low level” work that keeps specialists from ”more important” work.
Conscientious objection is largely individual as opposed to institutionally based, with poor staffing in gynaecology wards another contributing factor to poor second-trimester service provision.
Health professionals
Commenting on the plight of health professionals working in abortion services, an official told the South African Press Association: ”The work is often seen as extra work; health workers are reluctant to participate out of fear of what their families, peers and communities would think and say. This and the lack of extra remuneration are some of the factors that have led to the unwillingness of staff to be trained in abortion services.”
The report finds a significant proportion of designated facilities throughout South Africa do not offer second-trimester services. This is because of resistance by doctors to offer such services and/or a lack of understanding of the barriers women face in seeking first-trimester services.
However, an annual increase was noted over the seven-year period as more women made use of induced abortions, with a total of 344 477 abortions recorded at public health facilities nationally from February 1 1997 to January 31 2004. — Sapa