SA: Women must make own choices on abortion

By Vuyo Makapela

Cape Town, 27 November: When Charmaine a 22 years old female arrived at the social work department accompanied by her boyfriend (Sam) he wanted to her terminate her pregnancy. Charmaine reported that she did not want as she had one before due to health reasons which involved high blood pressure. However, in this case she was planning to keep her current pregnancy

The social worker enquired about whose decision it was. Charmaine was hesitant to answer and she responded it was her boyfriends’ decision. At this point the social worker highlighted to the couple that, the decision is solemnly dependent on the mother to be.

This was Sam’s decision because as he responded Sam “I have enough children with my wife at home”. It turns out Sam is married and he only told Charmaine about wife and kids when he discovered that Charmaine was pregnant. The social worker re-emphasised to Sam that termination pregnancy cannot be provided to Charmaine based on the fact that he wants her to have it and that he wants to take the easier way out of his responsibilities.

The social worker advised Charmaine appropriately and made necessary referrals to ensure that she gets the attention she needed. The social worker ensured that Charmaine has other safety measures in her community and family as Sam was adamant that she is not allowed to go back to their apartment if she is not terminating the pregnancy.

In a separate case, Vanessa, a 23 year old young woman discovered that she was pregnant. She spoke to her boyfriend and he asked her what she intended to do? Although the boyfriend was willing to take care of the baby Vanessa had made a decision. Vanessa could not keep the baby as she has no one to help her with the child and she wants to finish school as well. When Vanessa went to the hospital and she was referred to a social worker for pre-counselling session. The social worker asked Vanessa why she wanted to terminate her pregnancy when there were so many people who want to have children? Vanessa had no answer for the social worker as she felt judged and she was heart broken already over her decision of wanting to terminate her pregnancy. The social worker calculated her possible gestation period based on when last did she had her periods. The social worker however, did not send Vanessa for a scan to verify the gestation period. Vanessa was dismissed and told to come back on a later return date.

Upon return she was told by the social worker that she cannot have TOP as she was now 14 weeks pregnant. According to the social worker Vanessa could only obtain TOP if she was 12 weeks and under in her gestation period. Vanessa went home heartbroken, and had to go to a private clinic to obtain the TOP. She then resolved to private illegal clinic. She was assisted on the same day that she went.

These scenarios bring attention some of the factors that contribute to unsafe Termination of Pregnancy (TOP). Many women and girls in South Africa suffer in silence when families and partners infringe on the sexual reproductive health rights when they are pregnant. Their families or partners feel that the choice is theirs to dictate what happens to a woman’s body. Termination of pregnancy is often forced on these young women and young girls. Families and partners often take them to the hospital to request termination of pregnancy (TOP) on their behalf.

Legally this is not allowed as Section 5 of the choice on termination of Pregnancy Act 92 of 1996 stipulates that 5(2) “no consent other than that of the pregnant woman shall be required for the termination of pregnancy”.  Some go as far as obtaining the pills from unregistered practitioners.

Some girls keep their pregnancies not knowing what to do or how to go about obtaining legal TOP. As a result, they end up buying pills which has negative consequences for them especially if their pregnancy is advanced in gestation.

Often the ending is not good for some women and girls as they end up in hospital for womb evacuation. Now some doctors are pro-legal TOP, this mean some women end up in police cells for illegal TOP or murder depending on the gestation period. TOP education must be included in the sexual reproductive health training (family planning). Currently, it is not included and one may hypothesise that, this is partially because TOP is not family planning and should not be seen as one. Furthermore in many peoples conservative beliefs influences what is taught and shared especially in the education system which leaves especially girls not knowing what to do or where to seek assistance. Families, partners, an even those affected also often lack information, access to resources and visibility of services and service providers which contributes negatively to women’s SRHR

In the case of Vanessa and Charmaine their Voice and Choices to, to decide on the Sexual Reproductive Health and Rights (SRHR) were infringed upon.

Moreover, there are psychological effects on all these women. Unfortunately, majority of them are scarred for life as families do not understand the impact of imposing their beliefs on them. The other fact is that, in some of these communities counselling sessions are not readily and freely available to these young women. If any counselling is available at all is the one for pre-termination of pregnancy. This was evident in an interview with one of the illegal service providers. They mentioned nothing about counselling sessions for the young women who are their clients. They only provide information on how to take the termination of pregnancy pills.

However, illegal service providers for termination of pregnancy have become the go to place it is easy to get help.  They no longer provide only Misoprostol they provide antibiotics as well which are to be taken a day or two after the termination of pregnancy pills. Hypothetically this does decrease post infection chances. The post infections are often the reason why some young women end up in hospital after their termination of pregnancy.

In order to address these challenges advocacy and education is needed at both macro and micro levels of interventions. Educational and advocacy interventions need to take a multi-sectorial and interdepartmental approach. This relationship maybe easy to forged in some communities as mobile clinics are already doing school visits to bring contraceptives in some community schools.

A national approach with the aim of living no one behind needs to be adopted.  We need mobile clinics visible and consistent in all the communities for easy access to service. Introduction of these is crucial especially for rural communities where people have to walk long distances to access health care services. In these villages mobile clinics will need to be frequent perhaps twice a week, to cater for general sicknesses and have a specific day for family planning education inclusive of termination of pregnancy processes and awareness.

*The stories were derived from interviews which were conducted with those who are affected by either illegal TOP and safe and legal TOP. The selection criteria: was, one had to be pregnant and seeking safe and legal TOP. The participants had to come to the hospital voluntarily. Also they needed to be beneficiaries in a local hospital that provided safe and legal TOP. It is important to note that the interviews were done for counselling purpose not for research purpose. However, participants gave permission for the use of their stories provided their identity would be concealed which was part of the contracting process. Also, they were not interested in being recorded at that time but they were open to recorded via notes taking.

Vuyo Makapela is a Social Worker. She also mentors young women . This article is part of the Gender Links  16 Days News Service #VoiceandChoice Campaign. Photo courtesy by Jake Naughton accessed from  Pulitzer Centre