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The challenges of accessing abortion clinics

An illegal abortion clinic was closed during a blitz operation by Msunduzi Municipality on Ginman Lane and Knipe Street in Pietermaritzburg. Picture: Msunduzi Municipality.

An illegal abortion clinic was closed during a blitz operation by Msunduzi Municipality on Ginman Lane and Knipe Street in Pietermaritzburg. Picture: Msunduzi Municipality.

Published Oct 19, 2022


Johannesburg - Pregnancy can be an exhilarating time for many while for others, it sinks them deep into depression, with the children at times unwanted.

For those women who feel they are not ready for the responsibility that comes with parenting, abortion becomes the only option or at times, the only solution.

But that comes with its dangers. There are thousands of backyard facilities in the country which tend to put the lives of those very same women in danger. They tend not to follow the guidelines and time frames allowed for the safe termination of a pregnancy.

The Department of Health has urged people to use their facilities to terminate pregnancies instead of resorting to bogus abortion clinics. However, the department will need to pick up its socks as only 367 facilities in the entire country reported providing abortion services in the previous financial year, whereas 2643 facilities qualified to do so but did not.

While the Eastern Cape has the highest number of facilities, only 46 out of 1011 performed the procedure. The minimal usage of these facilities shows the inaccessibility of safe public abortion facilities. 58% of South African women resort to backstreet clinics because they fear being victimised and denied access to the procedure by healthcare workers.

This ongoing problem continues to grow despite South Africa's abortion laws protecting women who decide to terminate their pregnancies. The Choice on Termination of Pregnancy Act (CTOPA) stipulates that all women have the right to an accessible abortion in a government hospital or clinic, and no healthcare worker has the grounds to refuse the service as they would be contravening the act.

Even with the CTOPA in place, some women still resort to dumping their babies or seeking assistance from bogus clinics promising them safe abortions. Since 2018, the South African government estimates that 260 000 illegal abortions occur annually. Underlining this inaccessibility is an incident of a 23-year-old KZN mother who handed herself over to the police after leaving her child in a field a week ago.

The child had a handwritten note with her that implied the mother tried to give her up for adoption but did not get assistance in time, and she might have been denied access to the termination of the pregnancy procedure. The stigma surrounding abortion makes it difficult for women to access their medical right to terminate an unwanted pregnancy. Section 27 attorney Sibusisiwe Ndlela said abortion shaming results from factors such as cultural and religious beliefs and institutions.

“When abortion was liberalised in our law, the social aspects remained intact. Much work was not being done to reinforce that the right to abortion is, first and foremost, about bodily integrity. It is about women’s right to control their body and reproduction.”

Affordability is another reason why women choose to have illegal terminations. Depending on the gestation stage and preferred termination method, a safe abortion at a price can cost anything from R2 000 to R 5 500 at a certified private clinic. The organisation said it has encountered horror stories of women being denied access to the medical service.

“In fieldwork in Eastern Cape in October 2021 and May 2022, we uncovered that the abortion providers at Mthatha Gateway Clinic required women to provide reasons for seeking an abortion and then refuse to provide the service if the woman’s reason did not meet their satisfaction."

"Additionally, they instructed women to return to their families and partners and discuss the pros and cons of abortion. This type of 'directive counselling' is expressly prohibited under section 4 of the CTOPA,” added Khanyisa Mapipa, another Section 27 attorney.

Expanding on Mapipa, Ndlela said the organisation has engaged with the National Department of Health to make pregnancy termination more accessible and less stigmatised. She explained that Section 27 recently wrote an open letter to the Deputy Minister of Health to ask him to do more than march to tackle the scourge of unsafe abortions.

“We have also been trying to lobby the department to introduce self-managed abortion, which uses abortion medicines outside of a healthcare facility to terminate a pregnancy. We engaged with some provincial departments as well. In the case of the Eastern Cape Department of Health (ECDOH), we have been engaging them since at least 2019 on the barriers in health facilities in that province that prevent women from accessing abortions. These issues include the lack of second-trimester abortion facilities in that province. Regrettably, the ECDOH have made no effort to engage with us meaningfully,” said Ndlela.

Addressing the public in the Eastern Cape during the illegal abortion awareness campaign in May, the Deputy Minister of Health, Dr Sibongiseni Dhlomo, said an estimated 5 million women are hospitalised worldwide annually for the treatment of unsafe abortion-related complications such as heavy bleeding and sepsis.

“As the department of health, we have never stopped the provision of sexual and reproductive health services, even during the hard lockdown period of Covid-19. Although it is the collective responsibility of all sectors of the community to condemn and expose places of illegal abortions, and never allow them to advertise on your street poles and perimeter walls,” he said.

In his speech, Dhlomo urged patients to report healthcare workers who are hostile towards them for wanting to terminate. In his remarks, Dhlomo encouraged patients to report healthcare workers who are hostile towards them for wanting to terminate. Departmental spokesperson Foster Mohale said the department has different platforms, which include committee members, suggestion boxes, and mom Connect, to report challenges they face with the health workers in these facilities.

He said the department has also embarked on a value clarification and mind transformation workshop, highlighting the penalty cited in the CTOPA.

"The Department of Health is working on integrating Sexual and Reproductive Health and Rights (SRHR), including termination of pregnancy, with broader SRHR program/services. Started with

development of National Integrated SRHR policy, furthermore, the Department of Health has developed a comprehensive SRHR training curriculum so that women can be treated comprehensively," Mohale said.

In its efforts to get rid of illegal abortion clinics, the department will conduct a march against all the backstreet abortion facilities in all provinces. Mohale said the department aims to educate and provide information to the public about where safe abortion is provided, by whom and who is eligible to prove termination of pregnancy according to CTOPA.