Social barriers, staff attitudes push women to use illegal abortion providers
Women face a litany of real-world barriers to accessing termination of pregnancy services through the public health system, leaving illegal providers as the only options.
JOHANNESBURG - The United Nations Population Fund in its State of World Population 2022 report, launched in Durban last month, described the prevalence of unsafe abortions as a “public health emergency”, estimating that seven million women a year in developing countries are hospitalised as a result.
Even with some of the most liberal abortion laws in the world, including for free, safe termination of pregnancy services, South African women and girls continue to contribute to that number, with the latest Saving Mothers report identifying unsafe abortions as avoidable factors in 25% of all maternal deaths resulting from miscarriages.
This is a result of a litany of real-world barriers to accessing termination of pregnancy services through the public health system.
Something that public interest law clinic Section27, which has a focus on abortion access issues, has been lobbying for, is for the state to introduce self-managed abortion. This is where abortion medicine is taken without the direct supervision of a health professional but with adequate information being provided on exactly how to do it, what to expect and what to look out for and, importantly, a number to contact if anything goes wrong.
The latest Choice on Termination of Pregnancy guidelines, published in 2019, provide for a hybrid version of this and when the organisation contacted the department last year, attorney Sibusiwe Ndlela, who works in the Section27 health team, said that they were told that a new “self-care” package was in the pipeline.
But, she said, that when they followed up this year, they were told that the department had more pressing issues to deal with.
A pervasive problem is the negative attitude of healthcare providers, who try and talk women and girls seeking abortions out of them or demand their partners’ or parents' consent, or simply refuse to serve them.
Speaking to Eyewitness News, Deputy Health Minister Sibongiseni Dhlomo said that with young girls being met with resistance even when seeking preventative contraception options, it was no wonder they were then turning to illegal abortion providers when pregnant.
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He said that the state was aware of the challenges experienced by the youth, in particular, when trying to access public health services.
"We want to give them the benefit of the doubt, that what they are saying about some of our health facilities is actually correct - that they are not youth user friendly and therefore they are either reluctant or not able to access health service when they come as young people," he said, adding that this had a knock-on effect down the line.
"We are saying the first finger is pointing at us, where we are then being judgmental to say: 'go call your grandmother, go call your priest, let me discuss this first with your mother to check whether she’s aware you're here wanting family planning methods' … If we are helpful to that young person it speaks volumes about our service to another young person that girl will speak to. But if we are not … that girl - 18-years-old next year - fast forward when she falls pregnant, she won’t come to our facilities and ask for assistance," he said.
He said that the department had a campaign focused on adolescent and youth-friendly services, which already saw 1,700 health practitioners specially trained.
Ndlela and her colleague, Thembi Mahlati, painted a grim picture of the situation on the ground.
Mahlati mans Section27’s advice desk and speaks to women and girls on a regular basis who have been denied the access to safe, free abortion services they’re meant to have through the public health system.
"It’s teenagers, it’s older women, it’s even married women who are going through this, who are not accessing their rights," she said.
She recounted story after story of clients who were turned away from state facilities because abortion services simply weren’t on offer there because they didn’t have their partner's permission or that of a parent; or who, after eventually managing to find a facility that could and would assist them, were placed on lengthy waiting lists that would see them pass the 20-week cut-off point for most abortions before they could access the service. Many of them ended with these women and girls resorting to illegal providers.
Ndlela spoke of women sleeping outside facilities in the Eastern Cape to secure abortions and said she didn’t believe that the state could not meet demand.
"They aren’t making sure there are enough personnel who are manning those designated facilities or providing adequate equipment and medicines to service the demand," she said, describing some of the barriers as institutional.
"There’s also a social barrier because abortion is still taboo. You can understand why some women, if they’ve been denied access to an abortion so many times, end up resorting to a clandestine facility."
Asked about how she viewed government’s role in addressing the issue, Ndlela said it was simply to give effect to the law.
"And what that means is adequate budgets. It means monitoring designated facilities and making sure that they’re providing the services, that they’re adequately staffed, that they have enough equipment. It means attending to the barriers."