Misinformation
during pre-abortion counselling, Jabulile Mavuso explains. Mavuso obtained her doctorate and is a researcher at the Critical Studies in Sexualities and Reproduction (CSSR) unit at Rhodes University. Her research analyses the experiences of 30 women and four health workers at three Eastern Cape public health facilities.
One of the surveyed hospitals had a relationship with a local pregnancy crisis NGO, where nurses would take the patient history and the NGO’s volunteers would then conduct the “options counselling”, she says.
Some of the women interviewed in her research described the counselling as directive. Abortion was framed as dangerous, immoral and irresponsible, and women were directed towards adoption and parenting instead.
She explains: “Volunteers would, for instance, tell women the NGO could look after the baby for a period of six weeks or until the woman was financially ready to take care of the child. Parts of the services that these kinds of organisations offer are vital, but the problem lies in their approach which involves providing information that is both biased against abortion and inaccurate.”
Abortion under certain circumstances has been legal in South Africa for more than 40 years. But until 1996, women needed to get approval from two independent and largely private physicians — and, in some cases, a magistrate — to get a termination, says a 1998 Guttmacher Institute report. The law made it especially difficult for black women to access abortion services.
The Choice on Termination of Pregnancy Act — which came into law after apartheid ended — significantly expanded the circumstances under which abortion is legally per- mitted. It allows anyone the right to an abortion during the first 12 weeks of pregnancy. The procedure can be performed by a midwife, a trained registered nurse, a general practitioner or a gynaecologist. Doctors can also surgically terminate pregnancies between 13 and 20 weeks if, for instance, the pregnancy poses a danger to the woman’s health or socioeconomic status, or is a result of rape or incest.
The law specifies that counselling before and after a termination is not compulsory and should happen only at the woman’s request. But the law is explicit: this counselling should be non-directive. Mavuso explains: “Counselling [before an abortion] should be done in a way that doesn’t persuade a woman into a particular course of action. It must provide information on the options available for the woman depending on their circumstances.”
In August last year, the African Christian Democratic Party (ACDP) proposed amendments to the Act. The changes included mandatory counselling before and after termination, the showing of ultrasound images and outlawing abortions after 13 weeks in the country. ACDP MP Cheryllyn Dudley told Bhekisisa this would promote informed consent.
But the health portfolio committee in Parliament rejected the proposed amendments in September.
These changes were an attempt to decrease South African women’s access to abortion services, says the chairperson of the Sexual and Reproductive Justice Coalition (SRJC) Marion Stevens. “Antiabortion Christian organisations have been trying to change the abortion laws in South Africa for many years,” she says.
“They use pregnancy crisis centres as a way to keep women out of abortion clinics. Our government hasn’t paid enough attention to providing safe abortions, and these organisations are using this to their advantage.”
The provision of safe abortions to young women and sex workers is one of the goals under the country’s latest national HIV plan. But there are no guidelines for who should counsel or how counselling should happen, says the national department of health’s spokesperson Popo Maja.
The health department teaches health workers abortion counselling during its 10-day termination of pregnancy training package. “The department is in the final review stage and the guidelines [on abortion including counselling] will most probably be available by the end of September,” he says.
Meanwhile CSSR and SRJC have devloped their own guidelines which state that counselling should happen without judgement, and counsellors must respond to the concerns raised by patients, instead of introducing their own views while giving unconditional support to patients.
Public interest law organisation Section27 says it’s difficult to say whether what organisations such as Amato are doing is illegal.
“If there is evidence that the counselling is directive, in theory, one could argue that this has the effect of preventing a lawful termination. If this is the case, the person responsible could be charged,” Section 27 lawyer Ektaa Deochand explains.
“However, proving that the directive counselling led to the prevention of an abortion would be extremely difficult in the absence of extenuating circumstances.”
Deochand says patients may have more luck reporting healthcare workers involved to their managers or the Health Professions Council of South Africa.
Istare at the dark brown fetus model Verster placed in the palm of my hand. It looks like a small, black baby. It’s about two centimetres long, has a face and visible limbs. It even has 10 toes.
“That’s your baby,” she says. Fetuses are about one-and-ahalf centimetres long at nine weeks of pregnancy, says US-based medical research organisation Mayo Clinic.
Using models and images of fetuses is a tactic that’s widely used by the anti-abortion movement, a 2015 study published in the Culture, Health & Sexuality journal states. This constructs the fetus as “independent from the pregnant woman”, explains Mavuso. It also positions pregnant women as mothers who need to nurture and protect the fetus.
One counsellor interviewed in Mavuso’s study did not see presenting fetal models to women as manipulation. The counsellor felt it was necessary because the models are accurate and “life size”, and the graphic and concrete illustration of the fetus as a person will help dissuade women from terminating their pregnancy.
Mavuso explains: “Counsellors felt that sharing images and information about fetal development was necessary to ‘save’ the fetus and ‘save’ the woman from aborting by positioning them as a mother and therefore a protecter and nurturer of the fetus.
“You don’t know who this child is going to be when they grow up,” Verster says. “How is it [that it is] in your hands to make a choice to cut off that child’s potential in life?”
I don’t respond, but Verster looks me straight in the eye.
“Think about Madiba … His mother could have said ‘no more children’ and we would have never had a Madiba,” she says.
Again, I’m speechless.
Eventually, I tell Verster what I think she wants to hear. “I think I will keep the baby.”
She smiles and asks to pray for me. We join hands and bow our heads. “Lord, you have brought Lerato here today. May she sit with you and talk to you about her future and may you guide her in all her choices … In Jesus’s name, I pray. Amen.”