Clinics battle stigma

Though termination of pregnancy is legal in South Africa, the stigma associated with abortion still heavily afflicts both the women who exercise their right to take up that option and the nurses who provide the service.

Natalie Bailey has been a nurse at the Marie Stopes clinic in Cape Town for nearly two years. One of the challenging things about working there is that “everyone thinks that all we do are abortions”, she said.

“They are not aware of the other services we provide, such as HIV testing and counselling, family planning, pap smears, ultrasounds and now male circumcision.”

Bailey said they face harsh judgements from both their clients and the public. “Some people in the community call us murderers and ask us how we do what we do.
Clients are also afraid of being seen coming in or walking out of the clinic. When we talk to them before or after their abortion they tell us to just provide them the services they came for so they can leave. They do not want to be seen here or be associated with us.”

Marie Stopes South Africa (MSSA) is a sexual and reproductive health (SRH) organisation established in 1994. Though commonly known for providing termination of pregnancies, MSSA provides a range of other services, including female sterilisation, vasectomies, blood pressure testing, male circumcision, pregnancy tests, counselling, contraception, pap smears, gynaecological check-ups and HIV testing.

With 29 centres in Gauteng, KwaZulu-Natal, Free State, Western Cape, Eastern Cape and Mpumalanga, MSSA services thousands of people around the country every year.

“In 2007 nationally we serviced approximately 283 000 people with a wide range of sexual and reproductive health (SRH) services,” said Laila Abbas, national spokesperson. “Of these services, our stats indicated that we served a total number of 32 156 clients for terminations. This equates to approximately 2 680 clients per month and 103 clients per day nationally.”

With the vast majority of clients coming from the poorest and most marginalised communities, MSSA structures prices to accommodate clients, Abbas said. “We operate on differential prices [so] that the prices charged in the affluent areas subsidise the communities that are economically marginalised.”

Despite South Africa’s liberal abortion laws, not all state medical institutions are equipped to perform terminations safely.

Buyiselwa Zondi is a maternity nurse who used to work for a local clinic in Estcourt in KwaZulu-Natal.

“I’ve seen some terrible things happen to women,” she says. “At our clinics we did not have all the facilities for terminations: we could only do them using the medical abortion pill. “We gave the patients the pill and sent them home to take it. Once they start feeling pains or start bleeding we advised them to rush to their local clinic. If they lived too far from a clinic or hospital they had to deal with what comes out all on their own.”

Abbas said that in the past three years MSSA has seen a marginal increase in the number of clients—from 9 228 in 2006 to 11 976 in 2008. The growth can be attributed to MSSA’s increased number of centres, Abbas said. Women are also becoming slightly more aware of their rights and choices. She said clients range in age from 12 to 45, with an average age of 21. Children 12 years and older do not need their parents’ consent to have an abortion.

But youthful pregnancy is a concern, said Abbas. “We have noticed an increase in pregnancies among girls under 18. The number of teenage clients has gone up from 1% nationally 10 years ago to 4%. We need to come up with a proper sexual education system for children. As good as the education system as a whole is, it does not cater for the sexual education that children need.”

Bailey said seeing children as young as 13 at the clinic can be heartbreaking. “A 13 or 14-year-old is still a baby. When they come for an abortion you can see life being disrupted, especially when they are rape victims, which is often the case. It’s worse for me when we can’t help them: most rape victims come too late, after 21 weeks, and we have to turn them away because by law we cannot perform abortions on them after that time.”

She said the majority of the clinic’s clients are accompanied by their partners, which is an encouraging sign of people being more supportive and accepting.

“Sadly, though, I think the stigma will be there forever.”

Despite all the difficulties, Bailey said she believes in the work she does. “I’m doing it with pride. I am providing a service to my community. At least here they can have a safe abortion, giving them an opportunity to have another baby if they want to, unlike the unsafe backstreet abortions.”

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