Mail & Guardian

Mooted law ‘could drive abor­tion un­der­ground again’

- Nelisiwe Msomi Women's Health · Abortions · Health Care · African Christian Democratic Party · South Africa · Africa · KwaZulu-Natal · United States of America · World Health Organization · Christian Democratic Party · Cheryllyn Dudley

A pro­posed Bill by the African Chris­tian Demo­cratic Party could en­dan­ger le­gal abor­tions in South Africa, doc­tors have warned.

The ACDP’s amend­ment to the 1996 Choice on Ter­mi­na­tion of Preg­nancy Act would re­quire women to un­dergo ul­tra­sound scans. Health­care work­ers would be legally man­dated to af­fix scan pho­to­graphs of the fe­tus to a pa­tient’s con­sent form be­fore she signed it.

The Bill’s ul­tra­sound re­quire­ment is not only likely to drive women into the hands of il­le­gal abor­tion­ists, it is also ma­nip­u­la­tive, says Indira Goven­der, the KwaZulu-Natal rep­re­sen­ta­tive of the Ru­ral Doc­tors As­so­ci­a­tion of South­ern Africa.

Ul­tra­sound ma­chines, and the health­care work­ers trained to use them, are of­ten only found at ma­jor hos­pi­tals and not at clin­ics, which is where most peo­ple seek out care, she says.

Un­able to have the scans they need for le­gal abor­tions, women could be forced into dan­ger­ous back­street op­er­a­tions: “[Abor­tion­ists] don’t care about the con­se­quences — they are ba­si­cally drug deal­ers in the com­mu­nity,” Goven­der says.

And, she main­tains, forc­ing peo­ple to look at ul­tra­sounds be­fore ter­mi­nat­ing a preg­nancy is noth­ing more than an or­ches­trated “guilt trip”.

“These are tac­tics that are used in the United States by the an­tiabor­tion groups. They try to make women sec­ond-guess their choices through guilt and shame by show­ing them pic­tures of a fe­tus.”

But ACDP MP Ch­eryl­lyn Dudley ar­gues that the pro­posed amend­ment would en­sure that women make in­formed choices about hav­ing an abor­tion.

Cur­rently, South African law al­lows women to choose whether they would like pre-abor­tion coun­selling, ex­plains the Mpumalanga health depart­ment’s ob­stet­rics and gy­nae­col­ogy spe­cial­ist, Ed­die Mh­langa.

He says health work­ers shouldn’t try to sway a per­son’s choice when they coun­sel a woman, but should in­stead talk about pos­si­ble com­pli­ca­tions and al­ter­na­tives.

“[As a health worker], you give them in­for­ma­tion so that they can make an in­formed choice, but they have al­ready made the choice,” he says.

Mh­langa is widely cred­ited with help­ing to pass the 1996 Act that in­creased ac­cess to le­gal abor­tions. He says the ACDP op­posed the Act’s in­tro­duc­tion then and is now threat­en­ing to take the coun­try back to the days when women — par­tic­u­larly poor and black women — died in droves from il­le­gal abor­tions.

“The woman makes the de­ci­sion ac­cord­ing to her own cir­cum­stances. We should not be plac­ing fur­ther bar­ri­ers [that will take us] back to the apartheid era, where African women or poor women who could not af­ford pri­vate doc­tors … were ex­cluded. We saw quite a large num­ber of those women dy­ing from the com­pli­ca­tions of back­street abor­tions,” he re­calls.

Prior to 1996, le­gal abor­tions could only be car­ried out in cases of rape, in­cest or when the mother’s health was at stake. All le­gal abor­tions had to be ap­proved by three doc­tors and most were lim­ited to white women, ac­cord­ing to a 2003 ar­ti­cle pub­lished in the Bri­tish Med­i­cal Bul­letin.

Says Mh­langa: “I am one of seven ob­ste­tri­cians in the pub­lic ser­vice in Mpumalanga. I work in the ru­ral ar­eas in Mpumalanga. Women in un­der-re­sourced ar­eas are the ones to whom they [the ACDP] want to deny ac­cess to [abor­tions].”

Abor­tion-re­lated deaths fell by 90% in less than a decade af­ter the 1996 Act was in­tro­duced, re­searchers pointed out in the South African Med­i­cal Jour­nal in 2005. To­day, the World Health Or­gan­i­sa­tion recog­nises the pro­vi­sion of safe, le­gal abor­tions as a way to curb ma­ter­nal deaths.

The ACDP’s pro­posal would also end a woman’s abil­ity to re­quest an abor­tion based on so­cioe­co­nomic grounds af­ter 13 weeks and the right to ter­mi­nate later-term preg­nan­cies at 20 weeks in cases where, for ex­am­ple, fe­tuses had se­vere de­for­mi­ties. The ACDP ar­gues that a 20-week fe­tus would be vi­able, or ca­pa­ble of liv­ing out­side the womb, and that most med­i­cal prob­lems would be fix­able. Mh­langa and Goven­der say that view is not rooted in re­al­ity.

“Nowhere in South Africa will one de­liver at 20 weeks a fe­tus and then that fe­tus sur­vives,” says Mh­langa.

Goven­der ex­plains that, al­though it is pos­si­ble to cor­rect some birth de­fects late in preg­nancy, this kind of sur­gi­cal skill is scarce in the coun­try: “You can count the num­ber of pae­di­atric sur­geons on your one hand that are avail­able in the pub­lic sec­tor.”

Dudley main­tains that the Bill re­flects pub­lic opin­ion: “A sig­nif­i­cant num­ber of peo­ple feel that the orig­i­nal leg­is­la­tion was forced on South Africans. They don’t ac­tu­ally feel that they had any part in bring­ing it into be­ing.”

Al­though some small stud­ies have sur­veyed the at­ti­tudes of health­care work­ers to abor­tions, no large-scale re­search has been done into the views of South Africans.

Pub­lic com­ment on the Bill closed on Wed­nes­day, and it will be de­bated in Par­lia­ment be­fore be­ing opened up for pub­lic dis­cus­sion again. It could take years for the Bill to be­come law if en­acted, Dudley says.

Mean­while, Mh­langa sug­gests that, if the ACDP wants to con­trib­ute to­wards re­pro­duc­tive rights, it should ed­u­cate con­gre­ga­tions about fam­ily plan­ning and join the fight against il­le­gal abor­tions.

He says: “We are all pro-life; we are all about life. We pri­ori­tise the woman’s life.”

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