Two lines, a plus sign or a smiley face on a home pregnancy test signals a crossroads in the life of a woman. For many, it is the beginning of a highly anticipated journey marked by a flurry of antenatal visits, shopping sprees, baby showers and gender reveal parties that culminate in the birth of a baby. But not every woman chooses that journey nor should she be forced to take it.
Abortion is one of those terms like HIV/AIDS, STIs or homosexuality so shrouded in stigma that impedes women from making the best decision for their circumstances and bodies, and, indeed, their lives. While it has been legal to terminate a pregnancy on demand in South Africa since 1 February 1997 as long as the foetus is younger than 20 weeks (Choice on Termination of Pregnancy Act, No. 2 of 1996), the truth is lack of access to education, information and facilities inhibit a pregnant woman’s options.
In our quest to dig deeper into the facts, challenges and rights surrounding this highly controversial issue, we sat down with Whitney Chinogwenya, the marketing manager of Marie Stopes South Africa. The Marie Stopes International women’s healthcare centre is a non-governmental organisation (NGO) founded in 1976 that operates in 38 countries. Marie Stopes South Africa was founded in 1993 and there are currently 18 locations across seven South African provinces: Gauteng, Eastern Cape, Western Cape, Northern Cape, Free State, KwaZulu-Natal and North West.
According to their South African website, their work is closely aligned with government at various levels, through contracting, training and alignment to the Contraception and Fertility Planning Policy, the National Strategy on HIV/AIDS, TB and STIs and, increasingly, the Integrated School Health Policy. And yet there are still many challenges when it comes to funding and societal acceptance.
The facts about abortion
Abortion on demand is available on an informed consent basis to girls and women of all ages at the different service providers across the country, up to and including 20 weeks of pregnancy. Beyond 20 weeks, it can only be performed at a state hospital where a medical practitioner considers there to be a risk to the woman’s life, or there is malformation of or danger to the foetus.
“About 10 abortions are conducted daily at Marie Stopes South Africa in Sandton, with about 3 000 per month nationwide.”
One of the biggest misperceptions in SA is that abortion is mostly sought by teenagers and young adults. The truth, says Chinogwenya, is that the most common age range of their clients is 25 to 32. These women often haven’t considered starting a family yet due to their career pursuits or relationship status. As a rule, their clients are not required to reveal their reasons for terminating a pregnancy, but Chinogwenya says that they often share their stories in the comfort of pre-care counselling sessions.
About 10 abortions are conducted daily at Marie Stopes South Africa in Sandton, with about 3 000 per month nationwide. Consultations include pre- and post-care, and are conducted confidentially. No identification document is required (meaning that citizens and non-citizens can be helped), but clients are assigned a reference number.
Before an abortion, the woman undergoes a urine test to confirm the pregnancy, as well as a scan to determine gestation. She will then be counselled on her options – if she is accompanied by her partner, both will be counselled and then she will be counselled on her own to ensure that she isn’t subjected to undue influence.
Chinogwenya shares examples of how some women are forcibly dragged or pushed to their centre, but this goes against their policy of informed consent and they will not perform a procedure under duress. As it happened, we were witness in the car park to a man high-fiving and fist-bumping a woman who, by her solemn demeanour, had likely had a procedure that morning. While this would certainly only have been done with her consent, it brought home the realisation that women often don’t have the emotional support they require from their partners or families.
Abortion procedures can be medical or surgical
Medical termination (up to nine weeks) involves the administration of a drug regimen, where one dose of tablets is given to the woman at the facility under the supervision of a nurse and a second dose is to be taken a few hours later at home. The first dose thins the cervix, while the second dose induces contraction of the uterus and the pregnancy will end as if a menstrual period – just heavier and longer. This is not to be confused with the “morning after pill”, which is not an abortion pill but an emergency contraceptive that can be taken up to 120 hours (approximately five days) after unprotected sex to prevent a pregnancy.
After nine weeks, a woman undergoes surgical termination, which must be booked for another day if the examination is in the afternoon. The foetus is vacuumed out of the uterus in a procedure that has to be performed by a nurse or midwife (if over 12 weeks, a medical doctor must perform the abortion). It can take up to 10 or 15 minutes and doesn’t involve anaesthesia, unless a woman requests conscious sedation (a sedative combined with an anaesthetic). These procedures are usually performed in the morning so that the woman can recover for a few hours under care before being sent home – and it is always advised that somebody collect her.
As an NGO, Marie Stopes South Africa doesn’t receive any state funding and relies on donations, as well as payment for all procedures. However, millions of dollars in US donations have been lost to Marie Stopes International as a result of the Global Gag Rule (or Mexico City Policy) enforced by President Donald Trump at the beginning of his presidency, which prevents any US organisation from funding foreign NGOs that offer abortion services.
It is for these reasons that Marie Stopes South Africa has to charge their clients. These costs vary depending on the location of the facility to subsidise less-advantaged communities, and free procedures are considered on a case-by-case basis.
At the Sandton centre, for example, abortions range from approximately:
- R1 850 for under nine weeks;
- R2 500 for under 12 weeks;
- R4 000 for over 12 weeks, with an additional R800 for optional conscious sedation.
Abortion and the black market
Only 40% of the mandated state facilities currently offer abortion services, so access becomes a genuine problem. Add to this the potential cost, which is not exorbitant but can be a limiting factor for many women, as well as the exposure or intimidation when approaching a clinic, and you have a soft target for the black market.
In fact, 52% of abortion services in SA are performed by the black market. Illegal abortion alternatives prolifically plastered on sign posts, walls and waste bins offer “quick, pain-free abortions” on the other end of a cell phone number. Call them and you will be directed to meet anywhere from a taxi rank to a shop front to make a quick exchange of cash for pills.
It is a lottery as to whether or not these pills are the real deal – some can be dangerous concoctions, while others are merely ineffective over-the-counter pain meds leading to an unsuccessful abortion and driving a desperate woman to an even darker place. Her pregnancy now beyond the stage of a legal medical termination, she may seek out unprofessional, unsterile surgical services which can leave her with an infection resulting in sterility or even death.
It’s legal, so why are there still challenges?
The obvious way to prevent these tragic outcomes is to prioritise women’s health and rights, destigmatise the process, and make it as widely available as possible. If it falls under their purview, why then do so few state facilities offer it?
According to Chinogwenya, recruitment of skilled staff is severely undermined by the lack of qualified professionals. Abortion is included in the medical curriculum, but it is more often than not glossed over and merely confirmed that the procedure is legal. Reluctant professors mean that few medical students get to actually study and train in surgical techniques, and while professionals who are conscientious objectors are encouraged to refer their patients to a legal abortion practitioner, many don’t.
When it comes to stigma, Chinogwenya says that many of their clients travel distances to have their terminations performed in other communities to keep it a secret. Perhaps it’s time we introduced the facts about abortion age-appropriately into the sexual education programmes at school, along with contraception, STIs and HIV/AIDS. A girl who is educated and informed about her rights and options will be better equipped to make choices when it comes to her own body and sexuality.
Where do we stand on rights?
Despite the abortion law preamble “recognising the values of human dignity, the achievement of equality, security of the person, non-racialism and non-sexism, and the advancement of human rights and freedoms which underlie a democratic South Africa”, women continue to face misogyny and societal and religious judgement.
Teenagers and young women are slut-shamed, career women are deemed sexually irresponsible or selfish, and rape survivors are victimised yet again when they choose to terminate. Chinogwenya talks about the protests outside their various centres.
In Cape Town, for example, the Marie Stopes South Africa centre in the CBD is confronted daily with pro-life protestors who can demonstrate right in front of the entrance as this is public property. The Sandton centre is a house located in the suburbs, which at least affords staff and clients a buffer between them and any objectors. Even so, there are regular Saturday morning demonstrations here and one protestor even knits baby booties to give to women entering the premises.
South Africa has one of the most progressive constitutions in the world. The same constitution that protects our right to peaceful demonstration enshrines our right as individuals to freedom of choice. However, as long as men dominate positions of political, religious and social power, determine policy and make decisions for women and not with them, their voices cannot truly be heard.
One of the Marie Stopes South Africa staff members has drawn her line in the sand. She is often confronted as to how she can be a faithful Christian and support abortion, to which she simply replies: “I’m pro the life in front of me.”