While sitting and queuing for hours to have a legal abortion, she felt scared and confused.
Some girls were crying, some left the facility because they felt alone, and the staff didn’t care about their feelings or stories.
It was “just another abortion”.
This was the experience of a young woman who underwent an abortion at a local hospital this year. She asked to remain anonymous for her safety.
“I first had to go to the clinic, and they did an HIV test. The clinic will ask if you are sure but you sit there for a long time, like half a day, they don't do much – they just confirm you are pregnant, give you a referral letter, then you go (to hospital) on that date and just wait.
“It was scary because I had to do it all alone, and I longed for some kind of support, seeing how nervous the women around me were. For me it was hard.
I'm not sure if it was the system or me. The hospital staff were not necessarily rude but they didn't care to hear your story. For them it was just you having an abortion.
“They were almost robotic in what they say to all the women. You just sit in different rooms waiting for nurses to tell you what to do, but what you really need is someone to talk to,” the young woman said.
The national Department of Health confirmed that from March 2022 until April this year, South Africa recorded 132 280 deliveries for girls aged 10-19, compared with 19 174 terminations for the same age group over the same time period.
Fifteen to 19-year-olds accounted for 128 783 deliveries, while 10 to 14-year- olds accounted for 3 497 deliveries, the department said.
The Western Cape Health Department last year recorded 2 347 termination of pregnancies in the 10-19 year-old-age group, while in 2023 to date, 1 028 terminations have been performed.
Public interest law centre Section27 successfully launched an urgent application recently on behalf of a pregnant minor who was denied access to termination of pregnancy services at a primary public health-care facility in Gauteng.
The organisation argued that the minor’s right to reproductive health services, bodily autonomy and access to health care services was violated when the primary healthcare facility failed to refer her to a tertiary health-care facility.
A paralegal at Section27, Kholofelo Mphahlele, said: “There are not enough services, and (doctors) are experiencing a shortage in contraceptives.
“The government has designated health-care facilities to provide abortions. Information is not easily shared with the young women on how they can obtain an abortion.
A surge of unsafe abortion providers is available online and on street poles, and if registered facilities refuse to provide the service, young women are forced to seek out these illegal providers.”
Young women also faced stigma from not only family and partners or friends, but also health-care personnel who refused to provide termination of pregnancy services, or even embarrassed them at the facility, she said.
“Young women also don’t have information on where they can get abortion services in terms of public facilities. Gatekeepers such as security guards and secretaries at health facilities also turn women away because of their own beliefs, even though the facility is designated to provide abortion services.
“Any woman can consent to have an abortion. They can go to a designated health facility that offers abortion services for free in the public health sector. There are also facilities in the private sector, such as Marie Stopes, that offer safe abortion services at a price. Any pregnant girl or woman, regardless of age, can consent to an abortion.
A minor may be advised by her health-care provider to consult her parents or guardian. However, the ultimate decision to terminate remains the right of the pregnant girl or woman,” Mphahlele said.
Dr Margit Endler, a consultant in obstetrics and gynaecology at Karolinska Institutet in Sweden and an adjunct senior researcher at UCT’s School of Public Health, said the right to abortion was a fundamental part of reproductive rights.
“Women must be able to control what happens to their bodies. The alternative to legal abortion is illegal and unsafe abortion, not fewer abortions. South Africa has liberal laws but in practice abortion remains inaccessible, particularly in rural areas. Barriers include geographic distance, cost of transport and lack of services and trained staff, but a huge shadow hanging over access is stigma,” she said.
Endler added that stigma “deflates and demoralises” staff who work in abortion clinics, and delays women and girls in seeking care.
“One estimate is that about half of all abortions for these reasons occur backstreet. Telemedicine, i.e. getting abortion guidance and support through telecommunication (telephone centre or online health service) and medication from a local pharmacy or pick-up point is an expanding option of care that would suit South Africa very well.
“This is a safe and effective option that is appreciated by women, and suits all women who are sure of how far (along) they are in their pregnancy (at or below 10 weeks from their last menstrual period) and have no complicated medical conditions (primarily bleeding disorders) – in which case surgical abortion is safer,” she said.