Dr Dulcy gives health advice
YOUR CHOICE: WHAT’S SAFE AND WHAT’S NOT – DR DULCY GIVES YOU THE FACTS
Be wary of illegal services.
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 (a) her own physical or mental health is at stake, (b) the baby will have severe mental or physical abnormalities, (c) she is pregnant because of incest, (d) she is pregnant because of rape, or (e) she is of the personal opinion that her economic or social situation is sufficient reason for termination.
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. So yes, since November 1996 women definitely 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 performed by a registered nurse/midwife/clinical associate; after 12 weeks an abortion must be performed by a trained medical doctor. After the 20th week this type of abortion can only be performed at a hospital preferably by a gynaecologist. Therefore an abortion is considered safe if performed by a registered medical professional in a ‘designated facility’ such as a clinic.
Medical professionals need to be registered with the Healthcare Professions Council of South Africa (HPCSA) and have undergone special training to provide safe abortion services. The Department of Health has to accredit clinics to provide abortion services for them to be a “designated facility”.
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 SA every year. Around 5 000 maternal deaths are recorded every two years due to illegal abortions.
According to WHO 64 000 women die annually worldwide due to backstreet abortions and around 7 million women survive but with long-term complications.
There is limited formal data on the subject; the number of deaths caused by unsafe abortion is likely far higher than recorded. While the 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: in the shadows of the reproductive arena. These unsafe, “backstreet”abortions are easily prevented if more women are informed of their rights.
WHO 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.
In fact, an illegal abortion provider is anyone who does not have the training, professional qualifications and clinical environment to provide a safe abortion.
This includes those people that use the wrong or 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 World Health Organisation 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 abortions on request, public-sector nurses frequently chastise clients, 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
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.
WHAT SAFE ABORTION METHODS ARE AVAILABLE? Medical Process
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, during which women experience symptoms similar to a miscarriage.
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 such as high blood pressure. It is very safe, has a low failure rate and is the preferred option for many women.
Surgical Procedure
Surgical abortion involves for a nurse (up to 12 weeks of pregnancy) and a doctor (from 12 to 20 weeks) providing a straight-forward, same day procedure in a clinic or hospital.
It also involves pre-care counselling and a clinical examination after which the procedure is performed using a gentle suction method to remove the contents of the uterus.
The further along the pregnancy, the longer the procedure may take as the doctor will need to provide medication that helps to dilate the cervix.
Procedures that are very close to 20 weeks can be painful, so presenting early for an abortion is very important.