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Abortion services in South Africa
Elizabeth Clarke
2000-06-09

Abortion services in South Africa face two major problems: bringing the service to those already most under-served, and at the same time respecting the rights of health workers not to be involved in terminations of pregnancy.

Parliamentary Committee hearings on abortion took place on 7/6/00. Two years after the Choice on Termination of Pregnancy Act was passed in 1996, 69 894 terminations were reported to have been performed (How far are we? Assessing the implementation of abortion services: A review of literature and work in progress. Varkey and Fonn. Published by HST, 2000). 

There are two main groups to consider when reviewing the past four years. The first is the women themselves who desire terminations. The primary aim of the new legislation was to provide women with the safe option of a legal abortion in the case of an unwanted pregnancy. The women who most stood to benefit from this were those who could not afford safe alternatives outside the public sector to terminate their pregnancies. However, four years after the passage of this legislation, it is questionable whether these women are in fact deriving any benefit from this new policy. 

Most of the terminations that had been reported by 1998 had occurred in Gauteng (49%). The fewest had been performed in the North West (1%). Since Gauteng is arguably the wealthiest and most urbanised province in South Africa, it seems that access to health services is again weighted in favour of previously advantaged areas of South Africa. In rural areas such as the Eastern Cape, 38% of women have to travel over 100km to reach a facility providing the service. Of all the designated public health facilities currently providing the service, 99% of these are hospitals and the only two community health care centres which do are situated in Gauteng. Clearly if the right to abortion on demand is to be extended to all South African women, steps need to be taken to ensure that the poorest and most vulnerable women can act on this right equally.

The second group of people that must be taken into account in a review of termination of pregnancy in South Africa, is the health workers themselves who are required either to perform the abortions or to refer women to facilities where terminations are performed. At the Parliamentary Committee hearings on abortion which took place on 7/6/00, strong feelings were expressed by anti-abortion groups that doctors and nurses were being required to subjugate their personal moral and religious beliefs to those of the State. Doctors for Life told the committee's hearings on abortion that medics who were obliged to violate their beliefs in this way suffered from post-traumatic stress syndrome, drug and alcohol addiction, and had even committed suicide (SAPA, 7/6/00). Psychology researcher Sheila Faure told the committee that nurses at times were distressed and confused by their own ambivalence towards abortion, and many of them struggled with this work. Some of them felt guilt arising from the conflict between their own moral values and beliefs, depression resulting from cumulative stress, and fear of harassment from anti-abortionists. Spokespeople from two of the pro-life organisations represented said that health workers should not be required to participate in termination procedures whatsoever, and that this should even include referring women to facilities where terminations are performed. (Refusal to refer women on was one of the obstacles to access to terminations discussed by Varkey and Fonn above). 

Thus health services are faced with a difficult dilemma - to provide abortion services to all women who require it, most of all to those who are powerless and vulnerable, but at the same time to protect its health workers and respect their values and beliefs about this highly sensitive issue. 

Read the publication How far are we? Assessing the implementation of abortion services: A review of the literature and work in progress at http://www.hst.org.za/research/AssAbort.htm

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