Gabriel argues that the Amendments to the Choice of Termination of Pregnancy Act(2008), is an attempt to make important services more accessible to women. She calls on all South Africans to support the needs of others.
Why should women have access to safe and legal abortion? This question still seems unclear to some South Africans more than a decade after we adopted the Choice on Termination of Pregnancy Act, Act No 92 of 1996.
It is important to state that, according to the recent World Health Organisation (WHO) the statistics of women having abortions remain the same in most countries, whether legal or illegal. The only difference is that where abortion is legal it is safe and where it is illegal it is unsafe and leads to maternal deaths and complications.
According to a new report by the Guttmacher Institute and the WHO, a staggering 66,400 women died in poor countries in 2003 due to abortion- related causes; while only 100 women died in wealthy countries. Most disheartening is that Africa is the only region in the world that recorded an increased figure of 36,000 maternal deaths when compared to the 2000 estimate of 29,800. This data clearly indicates that where you have restrictive abortion laws women are dying like flies.
In South Africa, the Abortion and Sterilization Act No. 2 of 1975 was repealed because it denied the majority of women in South Africa equal access to safe and legal termination of pregnancy and resulted in the widespread use of unsafe and illegal back-street abortion, with negative consequences for women’s health and their lives. Most of the women dying were black, and poor, and this is still the case on a global scale.
A compelling argument for abortion law reform was the 1994 Incomplete Abortion Study by the Medical Research Council (MRC) in South Africa. According to that study; 44 686 women presented with incomplete abortions at public health facilities, 34% had serious complications and 425 women died as a result of illegal abortion in that year. Almost 100% of these women were black. The annual cost to the state for treating the complications that arose was estimated to be R18 700 000.
Given this unequal access and denial of choice for women during the apartheid era: Are those that oppose abortion suggesting that only certain sections of our society (white and/or affluent people) may have access to safe abortion while the majority may not?
Improving Women’s lives
The passing of the Choice on Termination of Pregnancy Act 92 of 1996 decriminalised abortion. The choice to terminate an unplanned pregnancy is now a legitimate reproductive health service and a fundamental human right. It affords all women, irrespective of age, location and socio-economic status, the right to terminate a pregnancy within the first 12 weeks of gestation on request, and thereafter under particular circumstances. As a result, we have seen an enormous reduction in women’s suffering.
In 1999, the Department of Health commissioned a study to evaluate the health impact of the Choice on Termination of Pregnancy Act. The study found that the number of patients with high morbidity had almost halved in 2000. The majority of cases had no signs of infection on admission. There had also been a significant downward trend in women dying from complications of unsafe abortion.
The most significant finding to date has been a comparison between the 1994 study and the government’s 2002 – 2004 Confidential Enquiry into Maternal Death, which found a 91% reduction in deaths from unsafe abortion. If we use the MRC study’s finding of 425 women dying in 1994 because of unsafe abortion, it means we have saved 4,250 lives over the last decade since the implementation of the Choice on Termination of Pregnancy Act in February 1997. Presently no deaths are recorded of women in the first trimester of pregnancy (that is, up to 12 weeks).
It is evident that the act has been extremely successful in advancing women’s health and rights. We are now known as the country which is saving the lives of its mothers. Because of the South African experience, Ethiopia liberalised its law in 2005 and, in international forums, Mexico is touting us as an example to be followed. South Africa has become a model for Africa by turning the abortion law into a reality for many women and reducing the unnecessary deaths of our mothers, daughters and sisters.
Obstacles – Facilities
In 2004, the South African Parliament passed an amendment act to address obstacles which women still face in realising their reproductive rights. For example, statistics show that 25 percent of women only access an abortion in the second trimester (that is, after 12 weeks of pregnancy).
Government facilitates access
In the main, the amendments to the 1996 act are geared towards increasing women’s access to safe termination of pregnancy services and better governance of these services. Firstly, this is done by accelerating the process of designating facilities. In terms of 1996, designation had to be approved by the national health minister, a process which could take between six months and three years. In terms of the CTOP Amendment Act (2008), it will be done by provincial health MECs that will take three to six months.
A review of implementation conducted by the Department of Health in 2007 found that 70% of services were located at secondary levels of care. Distribution of services remains uneven across provinces, with women, particularly in rural areas, having little or no access.
The designation of services at a provincial level adds impetus to the target set by the Department of Health that 70% of primary health care and community health centres should perform TOPs. Under the 2004 amendment act, the Gauteng Department of Health has designated all Community Health Centres as TOP facilities. Similar initiatives are underway in other provinces. Secondly, while designation is devolved, facilities will be inspected to determine compliance with the conditions and requirements that must be met before a facility is authorised to provide services. IPAS South Africa has promoted the need for greater compliance and meticulous practice in an effort to protect the vulnerability of women from unscrupulous practitioners. To broaden women’s access to safe and quality abortion services, we support the amendment which makes it an offence for a TOP to be performed at a facility that is not approved for this purpose.
Thirdly, the amendments increase the pool of trained service providers by extending termination of pregnancy training. In addition to registered midwives who have undergone the prescribed training, registered nurses will be trained for a period of three months to equip them to also render first trimester services.
Fourthly, to improve access and the quality of care rendered to women seeking to terminate their pregnancy the submission of accurate statistics becomes an imperative. By making the submission of statistics mandatory and prescribing both the frequency and submission process of statistical collection the amendment provides another mechanism for the management of TOP services. Women have an inalienable right to make choices about their bodies. The state has a duty to provide women with services to make a choice on whether to access safe abortions or not.
Lack of choices for women
The realities of people’s lives refute the idyllic vision of ‘the family’, which some anti-choice lobbyists presented during the recent public hearings. Particularly young, poor and rural women are often in positions where choice in relation to bodily autonomy is denied. Many women find themselves in violent relationships and/or are confronted with unplanned pregnancy that results from coercive circumstances such as rape.
Moreover, even where people practise family planning, no contraceptive method is completely foolproof. With extreme levels of poverty continuing, many women simply cannot afford to have another child. They will even say ‘‘I would rather lose my life than continue with this pregnancy’’ because they foresee the deepening of their economic hardships. How fair is it to a new child and to the existing children to bring another mouth into a family that is already suffering from hunger?
Support the needs of others
It is important for South Africans who do not support this legislation to separate their own beliefs and values from the needs of others. The constitutional imperatives that underpin the Choice on Termination of Pregnancy Act are the right to equality, freedom and security of the person, access to healthcare and information, the right to freedom of religion and belief and to freedom of expression. As we overcome years of denying choice and human rights, we have a moral obligation to protect, uphold and advance the exercise of full human rights to all South Africans.