64,000 women still die every year as a result of backstreet abortions

In South Africa, a woman of any age can get an abortion by simply requesting with no reasons given if she is less than 13 weeks pregnant.

If she is between 13 and 20 weeks pregnant, she can get the abortion if:

• Her own physical or mental health is at stake
• The baby will have severe mental or physical abnormalities
• She is pregnant because of incest
• She is pregnant because of rape
• She is of the personal opinion that her economic or social situation is sufficient reason for the termination of pregnancy.

If she is more than 20 weeks pregnant, she can get the abortion only if she or the foetus’ life is in danger or there are likely to be serious birth defects.

Abortion is legal in South Africa

Since November 1996 women legally have the right to access abortion in South Africa up to the 20th week of pregnancy, according to the Choice on Termination of Pregnancy Act (amended 2008).

Up to 12 weeks of pregnancy an abortion can be performed by a registered nurse/midwife/clinical associate; after 12 weeks an abortion must be performed by a medical doctor. After the 20th week this type of abortion can only be performed at a hospital preferably by a gynaecologist.

The Choice on Termination of Pregnancy Act recognises that the right to decide whether or not to have children is fundamental to women’s physical, psychological and social health. It calls for universal access to reproductive health care services which should include family planning and contraception, termination of pregnancy, and sexuality education and counselling services.

The Act promotes reproductive rights and extends freedom of choice by affording every woman the right to choose whether to continue with a pregnancy or have an early, safe and legal termination of pregnancy, according to her individual beliefs and circumstances.

Despite the right to safe, legal abortion being enshrined in law, unsafe, illegal abortions needlessly injure and even kill women in South Africa every year. Around 5 000 maternal deaths are recorded every two years due to illegal abortions. According to World Health Organization (WHO), 64 000 women die annually worldwide due to backstreet abortions and around seven million women survive but with long term complications.

While the Choice on Termination of Pregnancy Act has reduced mortality and morbidity resulting from unsafe abortion, illegal abortion remains popular. Unsafe abortion is notoriously difficult to quantify. In South Africa, high rates of maternal morbidity and mortality, including from uterine sepsis, point to the persistence of unsafe, illegal abortion. Women continue to terminate unwanted pregnancies as they always have: away from the glare of public censure, in the shadows of the reproductive arena. These unsafe, “backstreet” abortions are easily prevented if more women are informed of their rights.

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What is backstreet?

“Backstreet” is a term that can be misleading because today many unsafe, illegal providers appear somewhat legitimate posing behind slick marketing and flashy websites promising a “cheap, safe and painfree” abortion. This includes those that: use the poor quality medication, do not have proper training to do the procedure, offer abortions after 20 weeks of pregnancy as well as anyone performing abortions in a place that is not designated by the department of health.

Why do women still go for backstreet abortions?

Women in South Africa seek abortions outside hospitals and clinics for various reasons. A qualitative study by the WHO on abortion services in the Western Cape showed that, providers’ reluctance to be involved in different aspects of abortion provision led to complex and fragmented levels of service provision in many healthcare facilities.

Some studies have shown that women may not know where to access safe abortions, or fear stigma from their communities, judgemental staff at the facilities and concerns over confidentiality and cost. Although public health facilities are legally required to provide abortion on request, public-sector nurses frequently chastise patients, particularly younger women, for being sexually active, for being “irresponsible”, and for choosing to terminate the pregnancy rather than give birth.

Some patients have also reported being turned away from public hospitals because the facility has reached its weekly abortion quotas or does not provide the service at all. Street marketing also plays a role in promoting illegal providers. Women see walls and lamp posts plastered with advertisements claiming to offer “safe”, “pain free”, “quick”, and “cheap” abortions. The proliferation of this advertising, and the fact that it is posted in public spaces such as taxi ranks and shopping centres make many women believe they are accessing a legitimate service.

Complications of backstreet abortions

Backstreet methods may lead to serious complications, infections causing prolonged absence from work, permanent infertility and, in the most heart-breaking cases, even death.

Immediate complications from unsafe abortions may include:

• Severe bleeding
• Uterine perforation
• Tearing of the cervix
• Severe damage to the genitals and abdomen
• Internal infection of the abdomen and blood poisoning.

Medium term complications may range from reproductive tract infections and pelvic inflammatory disease to chronic pain.

Late complications may include a slightly increased risk of infertility and ectopic pregnancy, miscarriage or premature delivery in subsequent pregnancies.

Avoid providers that:

• Supply abortions services outside the constraints of the law (after 20 weeks pregnancy), outside of public hospitals or other designated centres.
• Operate in unsafe and unsterile areas, do not have a clinic (physical building).
• Just have a cellphone number and offer to meet you on a street corner.
• Cannot give you their Health Professions Council of South Africa registration number.
• Use dangerous methods such as injecting poisonous liquids into the womb
• Inserting objects intended to dislodge the foetus or issuing tablets that are not prescribed by a doctor.
• Tell you they can administer medical abortion after the ninth week of pregnancy.
• Do not perform physical examinations, take a medical history or provide a test/scan to confirm the stage of the pregnancy.
• Do not follow basic infection prevention, such as wearing latex gloves, having running water and clean linen and having separate bins for medical waste disposal.
• Do not provide all your unplanned pregnancy options and offer counselling.
• Do not offer follow up appointments and contact information in case of problems or questions.

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What are safe abortions?

Medical abortion allows for the termination of a pregnancy using medication (pills/tablets) only. It is available for women who are between four and nine weeks pregnant. The length of the process is different for each woman but usually takes a few days. It involves pre-care counselling and a clinical examination with a post abortion check-up appointment. There are two different types of pills taken within 24 hours of one another for maximum effectiveness. Counselling is important because women have a right to choose and the clinical examination determines how far the pregnancy is and also whether there are any medical history issues to be aware of.