Inadequate abortion services
Left with little choice, women turn to illegal abortionists to terminate their pregnancies
The young woman started undressing while the man prepared the medication, breaking one tablet in half. She took off her jeans and her panties and lowered herself on to the mattress on the floor.
The man put on a pair of white surgical gloves, then got down on his knees at the foot of the makeshift bed. He slowly pushed the tablets into her vagina.
The 23-year-old woman was lying in a flat in downtown Johannesburg. She stared motionlessly at the ceiling.
“It wasn’t painful, just uncomfortable,” she recalls. “But I had no choice.”
An overpowering smell of incense filled the room. The woman remembers: “It looked like a place where they worked with muti.”
The man explained the procedure. He was going to give her medication. “Some of the pills I would have to drink at home, the others he would insert inside my vagina.”
The woman pauses.
“I got his number from an advert in the newspaper. It said: ‘Safe, painfree, same-day abortion’.”
Earlier that day Buhle Bhengu, who chose to not to use her real name, arranged to meet the man from the advert in Lilian Ngoyi Street.
She followed him up the dark staircase of a derelict building to the room where he would perform her abortion.
The medicine he gave her would induce the abortion, he explained. The second set of pills he told her to drink with water at home would “cleanse her womb”.
In South Africa a combination of the drugs mifepristone and misoprostol can only be used for performing an abortion for up to nine weeks in pregnancy, according to health department guidelines.
But because mifepristone is about R500 a tablet, many of the clandestine and the official providers use misoprostol only, says Eddie Mhlanga, an obstetrics and gynaecology specialist.
“Misoprostol is given vaginally and then later orally. The vaginal tablets soften the cervix and the oral dose of misoprostol cause the uterus to contract more and expel the fetus.”
After 14 weeks it is necessary to give misoprostol, followed by a drip with oxytocin to stimulate the uterus to expel the fetus. Thereafter the woman has to have manual vacuum aspiration in theatre. Bhengu was 20 weeks pregnant. In South Africa, a legal abortion can only be performed by a midwife, a registered nurse trained for the procedure, a general practitioner or a gynaecologist.
Bhengu doesn’t know whether the man had medical qualifications. She knew him only as Peter. would be collected.
Although abortions in South Africa are legal up to 20 weeks of pregnancy, second trimester abortions (between 13-20 weeks) have to be performed surgically by a registered general practitioner or gynaecologist. The law states that surgical abortions must be done in facilities that have an operating theatre, nurses and doctors as well as the appropriate medication in case of an emergency.
Because she had Caesarean deliveries previously, there was a greater risk of her womb being torn and that is why the termination needed to be performed in a hospital, says Mhlanga.
“If only I had gone to the clinic,” says Bhengu, “I would not have seen what I saw that night. But I was scared the nurses would judge me.”
A2016 study in the Journal of Southern African Studies estimates that one in five pregnancies around the world ends in abortion. But “unsafe abortion is notoriously difficult to quantify” and, according to the study, “there is a dearth of statistics on illegal abortion in South Africa”.
Yogan Pillay, the deputy director general in charge of maternal and women’s health in the national health department, says no data is collected on illegal abortions because this would be “logistically impossible”.
But Jane Harries, director of the women’s health research unit at the University of Cape Town, argues: “A lot of people don’t want to access [use] the public sector [facilities], although the actual procedures are safe, because of the stigma or the way they’re treated by staff or out of fear that they might be recognised