The number of abortions compared with the high number of deliveries for children aged 10 to 19 has raised questions about the experiences of young women trying to access reproductive services.
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 were performed.
There were just 45 terminations of pregnancy in this age group between January and May at the one City facility that offered the service – the Site C Youth Clinic, while 141 were recorded at the clinic for the year 2022, according to community services and health Mayco member Patricia van der Ross.
Compared with births, nearly 4 000 children aged 10-19 had delivered babies in the Western Cape within just five months of this year, with last year’s figure at 10 686 births over 12 months.
While the country had one of the most progressive legal frameworks for abortion, it was not uncommon for women and girls to struggle to access safe abortion services, according to Ilitha Labantu, which works to promote the rights of women and children.
“A key reason for this is late recognition of unplanned pregnancy, and this is commonly associated with lack of information about sexual and reproductive health and rights. A contributing factor that also needs to be looked at when comparing the number of deliveries and the number of terminated pregnancies, is the experiences of women when they request abortions at clinics or abortion centres.
This aspect appears to be understudied and may lead to obstruction of care and deter young women from exercising their right to abort,” said the organisation’s spokesperson, Siyabulela Monakali.
Health Department spokesperson Mark van der Heever conceded that not all health workers were willing to be involved in this service, but they were obligated by law to inform the client of her rights and had to refer them to a health worker or facility.
“Young mothers are encouraged to book early at the maternity unit as soon as they are aware of the pregnancy for the benefit and health and safety of the mom and her unborn child. To avoid an unwanted or unplanned pregnancy at a young age, our facilities offer emergency contraceptives during the week, weekends, and after hours as well as various family planning methods when the adolescent becomes sexually active.
“If your pregnancy is unwanted or unplanned, you have the option to terminate (abortion). Trained professionals are available to provide free, non-judgemental information and support on your next steps at our clinics. Women are advised to go for safe, legal abortions rather than backstreet abortions that are likely to endanger their health and their lives,” he said.
The Site C Youth Clinic is the only City of Cape Town clinic where a trained professional nurse can assist clients seeking a termination for up to 12 weeks of pregnancy, the City said.
“By law, children younger than 12 years of age can only be seen for medical services (including a termination of pregnancy) if a parent or guardian is present to give consent. Girls aged 12 years and older may sign consent to a termination of pregnancy.
“At the Site C Youth Clinic teenagers seeking a termination of pregnancy are seen by a trained professional nurse for counselling, an HIV test and an ultrasound to determine the period of gestation.
If the teenager is 12 or less weeks pregnant, the professional nurse will explain the procedure as well as the consent form. After the termination of pregnancy, the client will be seen for a follow-up assessment, counselling and the administration of a contraceptive method of their choice.
“If the teenager is more than 12 weeks pregnant, she is referred to the Khayelitsha District Hospital for a second trimester termination of pregnancy.
The City is mindful of the fact that many young people may find it daunting to visit a family planning clinic. This is one of the key reasons why, in the past decade, the department has worked tirelessly to create youth-friendly spaces for young people,” Van der Ross said.
Abortion Support South Africa, an organisation that helps women with abortion pill access by prescription, said there was no complete and accessible list of abortion facilities in South Africa.
The organisation’s Victoria Satchwell said: “Women report mistreatment by health-care and clerical staff at clinics; it is not uncommon that a patient is apprehensive to visit a clinic for fear of ill treatment.
Women experience incorrect referrals, long waiting periods (pushing them beyond gestational age limits), rejection, stigmatisation, and poor-quality of care.
“This is particularly true for vulnerable groups, such as youth, poor or rural women, sex workers, and those living with HIV. Delays result in a high proportion of abortions being done later in pregnancy, with greater associated health risks. The government has many competing priorities and we have an overburdened health-care system with a unique disease load. In many contexts women and minority health falls by the wayside when a health-care system is stressed.”