Why are so many newborns and foetuses being abandoned in landfills and velds in SA? We asked leading forensic pathologist Shakeera Holland what her team found. (Nicole Ludolph)
They were wrapped in plastic or foil or a piece of clothing, tucked inside a backpack or pulled from a burnt pile of rubbish. Those were some of the ways the remains of newborns and foetuses were found before being taken to the Diepkloof Forensic Pathology Service in Soweto.
Although discoveries like these rarely make the news, they are a regular occurrence. The bodies are found in open veld, public toilets and landfills across South Africa.
To help figure out why, researchers from Wits University gathered data about the remains that landed up at the Diepkloof facility from 2020 to 2021 and in 2023. They hope by tracking where the bodies were found and the causes of death, they will better understand why so many women take desperate measures instead of seeking legal and safe abortions.
Studies show this is extremely rare in countries like Germany (150 cases over 15 years) or Denmark (11 cases over 12 years). Meanwhile, research published in 2014 in the South African Medical Journal (SAMJ) found about 1 658 cases in Mpumalanga and Gauteng alone from 2009 to 2011.
Of the 158 cases in the Diepkloof facility studied, 68 were found to be non-viable, which means they would not be able to survive outside of the mother; 29 were stillborn — when a foetus dies in the womb after 20 weeks of pregnancy. In a third of the cases, the cause of death couldn’t be determined because the bodies were severely mutilated or were too badly decomposed.
The researchers — Rachel Gill, Roxanne Thornton and Shakeera Holland — believe the high number of non-viable cases could be linked to illegal abortions, something backed up by the SAMJ study.
Their initial findings point to a lack of information and education about abortion and inadequate medical care, which reproductive health specialists agree are the main reasons women are driven to unsafe abortion providers.
In a recent episode of Bhekisisa’s monthly TV programme, Health Beat, we spoke to Holland, who heads up forensic medicine and pathology at Wits University and leads investigations of unnatural deaths in eight forensic pathology facilities in Gauteng — the busiest region in the country, which handles about 28% of all the unnatural death investigations in the country.
Mia Malan spoke to her at Soweto’s forensic pathology service facilities in Diepkloof. This interview was edited for clarity.
Mia Malan: How many abandoned foetuses and newborns are found?
Shakeera Holland: We don’t have accurate statistics about this because there is no digital database of unnatural deaths in the whole of South Africa. What we do know is that we have about 70 000 unnatural deaths in South Africa, and of those, we estimate that approximately 2% are abandoned neonates [newborns in the first few weeks of life] and foetuses.
MM: In the study you supervised at the mortuary, where were the remains of these abandoned foetuses and newborns found?
SH: The majority of the time, the remains are left where it is convenient, and probably where people think they won’t be found easily. So usually in open veld, landfills and dumping areas. It’s less common to find them in toilets in shopping centres and other public toilets.
MM: Is there a difference in the number of female remains versus male remains?
SH: Most of the foetuses in our study were male. And most of our paediatric deaths happen to be more commonly in boys than girls — and this is what we see in international studies as well.
MM: What do your autopsies show? What are the causes of death?
SH: The most common cause that we see are non-viable foetuses. This means that the foetuses haven’t completed sufficient time in the pregnancy for them to survive outside of the mother.
We also see a lot of stillbirths. These are babies that have completed enough gestational time in the mother to be considered viable, but they’re not born deceased. In a minority of the causes we see trauma, and that can either be accidental or homicidal — but this is in very few cases.
MM: What are the most common causes of the trauma?
SH: A lot of the common causes are head injuries, and a few are related to suffocation, and we’ve maybe had one or two where there’s sharp force injury. For example, the foetuses or neonates have had their necks cut.
MM: Why did you do the study?
SH: We see these cases of abandoned neonates and foetuses every day. You see newspaper reports about these cases, but they make it seem as if they never happen.
In fact, they are happening every single day. I had a student that was particularly passionate about the topic and wanted to look at what is exactly going on in this area, and hopefully spark research in other places, because we don’t know much about it.
MM: So when a foetus or neonate lands here, what happens to it?
SH: They undergo a medical and legal post-mortem examination, which includes an autopsy. That autopsy includes any investigations that are necessary to determine the cause and circumstances of death. Once that is completed, we compile a post-mortem report.
That report then goes to the South African Police Service for further investigation, for them to decide whether or not there needs to be prosecution in this case and what happens to the remains. In foetuses that are less than 26 weeks the remains are discarded as medical waste. Neonates of 26 weeks and older are buried as paupers if nobody claims the remains, which means the state assumes the cost of the burial.
MM: Do you have enough doctors to conduct these autopsies?
SH: At present, our doctors are doing between 500 to 600 post-mortems per doctor per year. The ideal amount would be about 250 because we need to take into consideration that the process is not just doing autopsies. In fact, the doctor has to do the autopsy then compile a meticulous report that needs to stand up in court.
MM: We have more than 1 000 unemployed doctors in this country. Why can’t you use them?
SH: We do not have enough funded posts for doctors, even though we do have a lot of doctors who would like to come and work in our service.
MM: Have you got a specific policy intervention you’d like to see?
SH: That’s exactly why we do these studies. We’re hoping that if we are able to shine a light on where the problems lie, we are able to give a basis for policy development to show where intervention is necessary.
I think it’s very sad that the law provides for women as young as 12 to have access to contraception without parental consent if the child has a clear understanding of the process. But I feel like perhaps girls do not know enough about it, or they are not getting safe access to the service — and it’s the same with termination of pregnancy. So it’s a lack of knowledge perhaps, or perhaps it’s a lack of access for these young women.
This story is based on the Health Beat TV programme, “Why are thousands of babies dumped each year in SA instead of being safely aborted?,” which was broadcast on 29 March on eNCA. View the full programme on Bhekisisa’s YouTube channel.
If you are seeking information about abortion services, Where to Care has a list of providers in South Africa, which is regularly updated.
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.