In Johannesburg, getting rid of an unwanted pregnancy is as easy as ordering a chicken burger.
A ”Dr Maria” is advertising her services on street poles in the inner city, promising: ”Quick Same Day Abortions 100% Guarantee [sic] Safe & Pain Free”.
When the Mail & Guardian posed as a prospective client, Dr Maria suggested we meet her at the Nando’s chicken restaurant in Braamfontein.
This comes against the backdrop of a police raid in January on what was termed a ”makeshift hospital of horrors” in an old office block in the inner city. City officials and metro police found an assortment of medical equipment, including gynaecological tools, drugs to induce labour, used condoms and blood-stained gloves. Other tenants in the building said they had found a foetus next to a dustbin.
Eleven people were arrested for carrying out illegal abortions. A single person appeared in court, but the charges were dropped due to insufficient evidence.
Now the abortionists are back in business, and posters with phone-number tear strips are appearing on walls and poles in the inner city.
There is silence, secrets and obfuscation around abortions. A prospective client may be referred to as someone who is ”sick”, or who has ”a problem”. Even at the Marie Stopes clinics, staff speak of the ”Products of Conception” (their capitals) being ”expelled”.
Women who opt for illegal abortions say the ”doctors” don’t ask questions and they can’t risk running into someone they know at a legitimate clinic.
Mosotho Gabriel, director for international women’s health NGO Ipas in South Africa, says: ”The reality is that a woman will do anything she can once she has decided that she doesn’t want to continue with the pregnancy.”
She feels many women still don’t know their sexual reproductive rights. ”Women don’t know that they have a constitutional right to choose not to have babies that they are not willing to have, and as a result they go to backstreet abortionist to have their pregnancies terminated.”
”There is also the element to confidentiality in the backstreet abortions. The ‘doctors’ don’t ask too many questions and they don’t work in a community clinic where everyone will know what the women did. This is, unfortunately, still the best option for many women,” says Gabriel.
Appointment
Dr Maria instructs us: ”Call me when you get to Nando’s. I will come fetch you from there.” Upon arrival, a woman with hard eyes approaches us: ”Are you the ones who called the doctor? You don’t want a baby, heh?”
She says the doctor is still busy at her surgery and we’ll need to wait for her. She takes us to the Metro Hotel around the block, where we take the dingy stairs to room number four, on the third floor.
Feeling nervous, we ask to use the toilet, and the assistant says she can’t leave one of us alone in the room. She takes us to the toilet and we pass a woman with a baby on her back. This woman, it turns out, is Dr Maria.
”Who is the sick one? I prefer dealing with the person who has the problem. It’s fine if you don’t mind but this is usually a secret,” says the ”doctor”, a chubby woman in her 30s. ”Like I told you on the phone, I am Maria from Kenya and I can help you. I see that you are scared but it’s OK because I will not force you to do this. It’s your choice. It’s not painful at all, the pill is natural.”
She says she has been performing abortions ”for long now”, and that she has ”seven years’ experience from Kenya and I have been doing it for three years in South Africa”, adding: ”I see that you are scared, but I promise you nothing will happen to you. You just take the pill and wait for it to work. After eight hours blood will come out, a lot like when you have your period.
”I am qualified in what I do. I studied in this field in Kenya and I specialise only in it, but I have a lot of contacts where I refer my clients for family planning and other things. If I were to specialise in another field, I would have to go and learn.”
”You won’t die from mine, I promise you, you won’t. I have helped many people and nothing has happened since. As we speak now, there are six girls sitting in my surgery waiting for their eight hours and then they will go. I even have some of them sending me messages … let me show you,” she says, handing us her cellphone. ‘Thank you very, very much. You have saved my future,” reads an SMS.
Dr Maria continues: ”I don’t only have young people coming here. I also have old people coming to have abortions here because they are too scared to go to the hospitals. This thing is for strong people. I had an abortion myself when I was 18. I wasn’t scared because I am a strong person.
”It is better because you are only a month pregnant because some people come here when they are, like, five months pregnant and the pill still works, because it is naturally made for women who can’t push during labour. From six months I don’t do abortions because a fully developed baby might come out. What will I do with a crying baby?”
A matter of money
Dr Maria charges R450 for the pill and says her clients are welcome to sit in her office and wait for it to take effect — after an estimated eight hours. Others, such as students, however, swallow the pill and then go to their classes.
By contrast, a medical abortion costs about R1Â 600 at any of the 21 Marie Stopes clinics in South Africa. In 2007, Marie Stopes carried out on average 2Â 680 abortions every month, of which just more than 100 were girls younger than 18. The Department of Health says a total of 81Â 900 legal abortions were carried out in 2006, and there were almost 90Â 000 undertaken in 2005. Statistics on illegal abortions, though, seem non-existent.
On clients’ first visit to a Marie Stopes clinic, they undergo a scan to determine the foetus’s age. They are then given counselling on termination options, which includes a medical and a surgical option.
The medical procedure involves taking a single tablet orally. The drug, Mifepristone, makes the foetus ”non-viable”. After 48 hours, another four tablets are taken orally, and this drug, Misoprostol, encourages expulsion of the foetus. According to Jock Strachan, Marie Stopes spokesperson, ”the Products of Conception should [then] be expelled and the termination complete”.
The surgical procedure involves ”manual vacuum aspiration”, which costs about R460, depending on where you live. ”Our policy is to provide a service to as many people as possible, so we increase the price for more affluent areas to decrease the price in the other areas,” says Strachan.
In the manual aspiration, a pump creates a gentle vacuum that empties the contents of the uterus.
According to Ipas, many healthcare centres still use the sharp curettage (or dilatation and curettage) method.
Its website describes this as ”dilating the cervix and using a sharp metal instrument to scrape the uterine walls. During the procedure, the woman usually receives general or regional anaesthesia or heavy to light sedation. Because of increased risk of complications, sharp curettage should only be used when neither vacuum aspiration nor medication abortion is available.”
‘They cleaned me inside’
A young woman who we will call Sibongile woke up at 4.30am on a winter’s morning in 2005 so she could get to the Chiawelo Termination of Pregnancy Clinic before 8am to abort what would have been her third child.
Being a mother to a three- and a five-year-old was hard enough for her at the time. ”I had to abort that baby. There was no other way, I mean, I didn’t have a job and I had to rely on my mother for financial support and I didn’t want to add an extra burden to her,” she said.
At 6.45am, she joined the queue of about 10 others girls at the clinic’s maternity ward. ”I couldn’t afford to be scared of having the abortion. The thought of bringing another child on to this Earth scared me more, so I went ahead with it with that thought in my head,” she says.
”I remember seeing girls younger than me there. A lot of teenagers go to Chiawelo to have their abortions done because it’s free and their boyfriends don’t have money. There was no question about whether I would have an abortion or not; the question was whether I would do it at Marie Stopes or Chiawelo TOP Clinic because I had no money.”
She adds: ”The nurse gave me an injection and about after 45 minutes I was taken to a room where some round thing was put in my vagina and the I felt like my womb was being removed from my body. It was worse than labour.”
A need for anonymity is central to many young women’s decision to turn to fly-by-night abortionists.
Nokwazi, a teenage student at the University of the Witwatersrand, says while she knew she could get an abortion done legally at the campus clinic or at a hospital, she couldn’t run the risk of being seen by fellow students, or anyone else she or her parents knew.
”I paid R450, as I wanted an anaesthetic. However, they said the doctor had left with the key to the cupboard where the anaesthetic was kept and they could not open the cupboard, so I felt everything they did to me as they cleaned me inside.
”I jumped and they told me I should stop or they might scrape my womb and I wouldn’t be able to have kids again.”