Reproductive justice's newly vocal champion
On Tuesday night, Social Development Minister Bathabile Dlamini gave a speech which may not get the attention it deserves. It has been exceedingly rare in recent years for a South African politician to stand up and unequivocally, unapologetically affirm a woman's right to have an abortion. This week, Minister Dlamini has done just that.
When was the last time you heard a South African politician give an unqualified statement in support of abortion? When Nelson Mandela died last December, we were reminded - thanks to posthumous character attacks from right-wing religious groups - just how outspoken Mandela was in advocating for a woman's right to decide on abortion. It's become substantially rarer since.
Of course, it wasn't just Mandela who oversaw the passing of 1996's Choice of Termination of Pregnancy Act. An interesting report by GenderLinks credits consistent pressure from ANC women and civil society; the commitment of first Health Minister Nkosazana Dlamini-Zuma to the issue; and the championing of the bill by Dr Abe Nkomo, the chair of the Parliamentary portfolio committee on health.
With one of the most liberal pieces of abortion legislation in the world in place for going on two decades, the abortion battle in South Africa might seem a relic of a bygone era. But as the Daily Maverick reported last year, that's not the case in practice. Academics and health advocates say that abortion in South Africa is often shrouded in silence because it is still considered so contentious. Less than half the designated abortion services that the government is supposed to be providing are actually available to women today. Little wonder that flyers advertising the services of illegal abortion providers continue to paper the lampposts of South African cities, putting the health of South African women in grave danger.
It is against this sombre background that non-governmental organisation (NGO) Ipas, which works to end preventable deaths from unsafe abortions, is holding a conference aimed at assessing the landscape of reproductive rights in South Africa, 20 years after democracy.
"From Ipas's point of view, we want to see access to safe abortion," Ipas South Africa country manager Karen Trueman told the Daily Maverick on the eve of the conference. "We want to see an end to the lamppost [illegal abortion] flyers. The services which should be providing abortions, but are not, should be doing so, using trained healthcare providers."
Abortion is a thorny issue, guaranteed to win you enemies on either side (though the pro-lifers can be much scarier). The otherwise generous Gates Foundation won't fund abortion initiatives, for instance. South African politicians often fudge the issue as much as they can in public, with the Democratic Alliance (DA) having allowed its members a vote of conscience on the matter.
And then out rides Social Development Minister Bathabile Dlamini with a keynote address to the Ipas conference that brooks no debate. Dlamini didn't even talk about a woman's "right to choose". She spoke about "reproductive justice" instead, because how can we legitimately talk about "choice" in contexts of drastic social deprivation?
If abortion rights were not seen as part of a wider struggle for women's economic empowerment and social justice, Dlamini said, "what we call 'choice' may just become an elitist individualised response to reproductive rights which would still be mainly for the middle classes and the rich".
Sketching the landscape of the last twenty years, Dlamini pointed out that the liberalisation of abortion laws saw the annual number of abortion-related deaths in South Africa fall by 91%. And while there is much alarmist talk about the number of abortions South African women are having, it's a counter-intuitive truth that countries with liberalised abortion laws experience lower abortion rates.
Quoting 2008 figures, Dlamimi suggested that Southern Africa has the lowest abortion rate of all African sub-regions, in keeping with an international trend: "The recourse to abortion is lower in countries where abortion laws are less restrictive." Dlamini acknowledged that more liberal abortion laws also tend to be found alongside better sex education and access to other forms of contraception.
But she didn't shy away from the work still to be done.
"It is concerning that currently only 47% of designated [South African abortion] facilities are operational," Dlamini's speech spelled out. Ipas'w Trueman confirms that the NGO's research suggests this figure is accurate - "as correct as we can possibly get it," Trueman says.
A shortage of facilities is not the only factor preventing women from seeking out legal abortions, Dlamini said. She also pointed to "the still prevailing negative attitudes of health workers who stigmatise those who present themselves for services".
This unfortunate reality is backed up by abortion provider Marie Stopes's reports from their clients, which suggest that "public sector nurses frequently chastise clients…for being sexually active, for being 'irresponsible', and for choosing to terminate the pregnancy rather than give birth".
Trueman cautioned, though, that the effects of sheer overwork could sometimes manifest as moralistic judgment. "Healthcare providers are under a lot of strain in terms of service provision across the board, not just abortions," Trueman said. "If you've just got one facility providing services for a large area which has a large number of clients - some facilities can do 300 [abortions] a month. [Healthcare providers] are very tired and that can also impact on how they are perceived and present themselves."
Dlamini said they would be looking into ensuring that all designated facilities were operational, and that "values clarification and social context training" were reintroduced for health sector worker.
It's not just the perceived judgment of nurses and doctors that is unhelpful, Dlamini warned. She said that her fellow politicians should also be careful about their public pronouncements on abortion.
"Part of the stigmatisation is the fact that sometimes we as politicians, too, tend to talk about 'repeat abortions' as a problem when there is insufficient evidence of this being a large-scale problem," Dlamini said.
This statement in particular may have caused cheers at the conference, because it refers to a line we've heard trotted out by politicians time and time again: that South African women are using abortion as a form of contraception.
In 2011, Department of Health spokesman Fidel Hadebe said that the government was alarmed that abortion legislation was being abused: "It was intended as an avenue to allow women to use when there is a need. What we see today, where women seem to be using it as a form of contraception, is totally wrong," he said.
Last July, Health Minister Aaron Motsoaledi was reported as saying that young girls were having abortions instead of attempting to avoid pregnancy.
In February this year, Motsoaledi said the same thing while launching new contraceptive implant Implanon in Tembisa: that abortion has become a "contraceptive method" for many teenagers.
Women's health experts have repeatedly said that this claim is simply not backed by evidence. "Our figures are not showing women using abortion as contraception," Trueman confirmed. Dlamini's public countering of the allegation will hopefully go some way towards dispelling the perception.
Reproductive justice should take into account not just access to abortion but also a range of other sex-related aspects. Dlamini said that the government was committed to improving access to contraception and sex education, while access to Early Childhood Development Services and the Child Support Grant would be "universalised" to provide poorer women with "a real 'choice'" about whether to continue with a pregnancy or terminate it.
Dlamini's speech concluded by giving one of the most resounding affirmations of the ANC's belief in abortion rights that we've heard for many years - even if it was under the auspices of taking a dig at the opposition.
"In the run-up to the 2014 elections, the Catholic Family News put out a 'Biblical Issues Voters Guide 2014' where they compared the different stances of the various political parties," Dlamini said. "In the guide, the DA is quoted as stating, 'to be pro-choice, does not mean we are pro-abortion. It is the constitutional right of women to make choices about the very private matter of reproduction'".
In Dlamini's book, this isn't strongly stated enough.
"Within the framework of reproductive justice, the ANC and the ANC government has always been and will always be pro-abortion in the sense that we realise that it is but one of the reproductive experiences of women that needs to be enabled," the minister concluded.
Marion Stevens, coordinator of Women in Sexual and Reproductive Rights and Health (WISH) Associates, who was present at the conference opening, described Dlamini's address as "a breath of fresh air".
Stevens said: "For a minister to acknowledge some of the challenges we have, and to see right away what we need to do in terms of improving access to abortion is incredibly important."
Naturally, the timing of Dlamini's speech is significant. "Nobody's going to talk about abortion before elections," Stevens says. With the votes safely counted, let's see if the actions match the words.
This column appeared on Daily Maverick.