On 31 October, 1996 South Africa passed one of the most progressive termination of pregnancy
laws in the world. The Choice on Termination of Pregnancy Act 92 of 1996 (CTOP Act) is based
on principles of social justice. Through this Act, the State bound itself to ensuring that the right
of reproductive choice is practiced under safe conditions. The foundation of the Act is womens
reproductive choice a woman can obtain the termination of a pregnancy (TOP) upon request
in the first twelve (12) weeks of pregnancy, and through to twenty (20) weeks on medical and
socio-economic grounds. After twenty (20) weeks, induced abortion is allowed if the pregnancy
threatens the womans life or when there is physical or mental abnormality in the foetus. The
CTOP Act has its foundation in the rights of freedom and equality enshrined in South Africas
Bill of Rights and Constitution.
South Africas CTOP Act has been characterized as a legal breakthrough for womens health
and the most liberal abortion law in Africa3. Although figures on women suffering non-fatal
health problems resulting from induced abortions outside of the health services are difficult to
obtain, there is evidence that women are still presenting with incomplete abortions at health
facilities across South Africa.
A variety of personal, societal and health system factors have been put forward as contributing
to women seeking abortion outside of the health services, thus exposing themselves to injury,
disability and even death. These factors include some of the following: negative community
and health worker attitudes lack of knowledge of specific details and benefits of the Act not
knowing which facilities provide the service and stigma associated with abortion.
Harrison et al report very low levels of community and health worker support in rural KwaZulu
Natal for abortion on request. In the rural community studied abortion was seen as being contrary
to normative behaviour and thus not supported, while it seemed to be supported in the case of
rape or incest or to save a womans life. Interestingly, Harrison et al found that health workers
in this community did not object to providing care to women with incomplete abortions.
Due to the sensitivity and stigma associated with seeking induced abortion, whether legal or
outside of the health services, there is a paucity of data on womens reasons for doing so. It is
thus imperative that womens unmet needs in relation to termination of pregnancy services be
further investigated within the context of South Africas enabling legal TOP framework.
The need for research on abortion services was raised in 2004. The research proposal was
developed and submitted for ethical approval in 2004. Hence the background data provided in
the research proposal and in this section on the background and study motivation provides data
available up to 2004.
The ethical approval process delayed the start of the study until 2005. This delay was largely
due to the contentious issue of the intention on the part of the research to interview minors
accessing abortion services without the interviewers having to obtain parental consent for the
interviews with these minors. This ethical issue was resolved with a proviso that the interviewers
would encourage the participating minors to discuss their willingness to be interviewed firstly
with their parents but would not insist on parental consultation if the participating respondent
was unwilling to discuss participation in the research with her parents. Fieldwork thus only
began in 2005 and was completed in 2006. |
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