Leave women in the lurch

by someone from the community.

“Women use many different ways to terminate a pregnancy or attempt to terminate a pregnancy outside of the formal health system.”

Amnesty International, the global human rights organisation, recently released a briefing report on unsafe abortion in South Africa. The research found that only 260 of the 3880 public health facilities in the country carried out abortions.

This shortage, the 2016 Journal of Southern African Studies article states, “undermines women’s access to safe abortion service, and fosters the reliance on clandestine abortion providers”.

Harries says the situation is exacerbated by “the plethora of online advertisements” that make it increasingly difficult to differentiate between people who carry out legal abortions and illegitimate ones.

This was the dilemma Bhengu would face seven years after her first abortion, when she wanted to terminate another pregnancy.

“I found out I was pregnant in June last year. By then I was already four months along,” she says.

Her fiancé had lost his job several months earlier, so Bhengu, who works for a nongovernment organisation, was the sole provider for her family of four.

“My partner said he would support any decision I took because, financially, I was a single parent.”

Bhengu knew she wouldn’t be able to support another child, so once again she decided to have an abortion. Only this time she was going to make sure she went to a real doctor.

“I searched on the internet because I figured that the doctors on the internet would be real — unlike the ones who advertise in newspapers,” she says. “The first call I made was to Marie Stopes, but they told me the abortion would cost R3800. I earn only R4 000 a month.”

Marie Stopes is a nonprofit organisation that provides donor-subsidised sexual and reproductive health services at lower rates than most private facilities.

Prices range from R1050 to R5000, according to the organisation’s Whitney Chinogwenya. The further along a pregnancy is, the higher the cost.

“Our prices differ between first and second trimester as the second trimester procedures require a trained doctor to provide the service. In some cases, clients also need an anaesthetist,” says Chinogwenya.

Bhengu, who was already 16 weeks pregnant, discovered that her local clinic had a month-long waiting list.

“I kept on looking and found ‘Dr Pinky’; she charged me R1 200.”

In August, Bhengu went to “Dr Pinky’s” consultation rooms in the inner city. “I trusted her because she gave me counselling. She asked why I wanted to do this; if I had told anyone about my choice. She also told me the advantages and disadvantages of having an abortion.”

Bhengu remembers thinking: “This place is much better than where I went before.”

The “doctor” told her about the drugs she was going to receive and what they were for.

“After that she took six of the pills and broke them in half. The ‘doctor’ said these would induce the abortion. She told me to insert six in my vagina and to put six under my tongue when I got home.”

At this point, Bhengu became suspicious and asked whether the procedure shouldn’t be done in the doctor’s office.

“Dr Pinky” told Bhengu: “We don’t do everything here. You’ll just come [after taking the pills] and I will clean you after this [abortion] has happened.”

Although misoprostol is used in the later stages of the second trimester, this drug alone is not enough to complete the termination, says Mhlanga. It softens and opens the cervix so that other drugs can cause the uterus to contract and expel the fetus without causing injury to the cervix. It is for this reason that second trimester abortions are carried out in hospital. After the expulsion of the fetus, the remaining contents are removed with forceps and a manual vacuum aspirator.

Bhengu remembers that “nothing happened when I took the medication. I started getting labour pains but there was no blood.”

The next day, Bhengu went back to “Dr Pinky”, who gave her six more pills. “I took them because I had already paid for the service,” she recalls. “But the pain got worse. My stomach was racing. It felt like the baby was fighting.”

That night Bhengu was rushed to a private doctor’s practice. The doctor had her admitted to hospital, where he performed a surgical abortion and explained to her that she was meant to have had that procedure done in the first place.

“He said I could have died.”