Women’s right to choose an abortion, or not, is one of the main issues of concern on which the current leadership contest in the United States could turn.
There we have seen concerted efforts by anti-abortion groups to chip away at the right by finding gaps in practice or law.
In South Africa the anti-abortion lobby is following the same strategy. We had to pass the Choice on Termination of Pregnancy Amendment Act a second time last month. This came after Doctors For Life secured a Constitutional Court ruling that the consultation process running up to the adoption of the law in 2004 was incomplete.
At the public hearings at the end of last year, anti-choice lobbyists again questioned why women should have access to safe and legal abortion — even though the principal 1996 Act was not under discussion.
Some lobbyists put forward an idyllic vision of the family. This is contradicted by the realities of the lives of particularly young, poor and rural women whose bodily autonomy is frequently denied. Many women are in violent relationships or are confronted with unplanned pregnancy as a result of coercive circumstances such as rape.
Even where people practise family planning, no contraceptive method is completely effective. With extreme levels of poverty continuing, many women simply cannot afford another child. I have heard women say things like ”I would rather lose my life than continue with this pregnancy” because they foresee the deepening of their economic hardships.
These are some of the reasons why abortion statistics remain the same in most countries, whether it is legal or not, according to the World Health Organisation. But where abortion is legal, it is safe and women survive — where it is illegal, it is unsafe and women die or suffer complications.
Also, women do not have equal access to the right. Most of those dying today from abortion-related causes are black. Thus, some 66 400 preventable deaths occurred in poor countries in 2003 compared with about 100 in wealthy countries.
Furthermore, how committed is our continent to women’s rights, given that Africa is the only region that recorded an increase in maternal deaths from 29 800 in 2000 to 36 000 in 2003? Where abortion laws are restrictive, women die.
The apartheid era Abortion and Sterilisation Act No 2 of 1975 was repealed because it denied most women access to safe and legal termination of pregnancy (TOP).
A Medical Research Council (MRC) study showed that of the 44 686 women who presented with incomplete abortions at public health facilities in 1994, 34% had serious complications such as sepsis and 425 died. Again, almost 100% of these women were black.
Are those who oppose abortion suggesting that only certain sections of society (white and/or affluent people) may have access to safe abortion?
Because of the Choice on Termination of Pregnancy Act No 92 of 1996, we have witnessed a 91% reduction in deaths from unsafe abortion, which translates into at least 4 250 lives saved in the last decade (based on the MRC’s 1994 findings).
At present, no women are dying in the first trimester of pregnancy.
But obstacles still place the right to choose an abortion out of the reach of especially the most vulnerable women. About 25% of women access abortion only in the second trimester. Distribution of services remains uneven with rural women having little or no access.
The amendment Bill that was passed last month is aimed at addressing these problems by accelerating the designation of facilities through devolving authority to MEC level.
Firstly, facilities will be inspected to determine compliance before approval. To further protect patients from unscrupulous practitioners, the Bill makes it an offence for a TOP to be performed at an unauthorised facility.
Secondly, the amendments increase the pool of trained service providers by extending TOP training to registered nurses. Thirdly, statistics will be collected to monitor access and quality.
The Bill was adopted in the National Assembly with an overwhelming majority. In doing so, our Parliament reiterated women’s inalienable right to make choices about their bodies and the state’s duty to provide women with services to actualise this choice — whether they are rich or poor, black or white.
Mosotho Gabriel is the country director of the non-governmental organisation Ipas South Africa