Abortion in South Africa

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Abortion in South Africa is legal by request (no reason needs to be provided) when the pregnancy is under 13 weeks. [1] It is also legal to terminate a pregnancy between weeks 13 and 20 if the continued pregnancy would significantly affect the woman's social or economic circumstances, poses a risk of injury to the woman's physical or mental health, there is a substantial risk that the foetus would suffer from a severe physical or mental abnormality, or the pregnancy resulted from rape or incest. If the pregnancy is more than 20 weeks, a termination is legal if the foetus' life is in danger, or there is a likelihood of serious birth defects. [2]

Contents

Abortion is provided for free at government hospitals providing the request is made at a primary healthcare clinic and a referral letter provided to the facility performing the procedure. [2] Abortion is provided for a fee at private clinics. Marie Stopes South Africa and Abortion Support South Africa provide telemedical abortion services across the country.

History

Pre-colonial South Africa

Abortions and infant exposure were common and widespread practices in pre-colonial South Africa amongst the Bantu-speaking people and the Khoisan people. They understood personhood as beginning long after birth and they believed that young infants "..are but water, they are but a womb," and thus it was taboo to mourn for or give normal burial rites to natural miscarriages, stillbirths and other infant deaths. [3] During times of deprivation, infanticide was permitted to preserve resources, especially amongst the Khoikhoi and the San who were nomadic and could not care for more than two young children at a time. [4] It was common practice amongst the Bantu-speaking people to kill twins and deformed children or infants with albinism. [5]

According to Hugh A. Stayt, author of a 1931 ethnographic book about the VhaVenda people called The Bavenda :

The fear of a woman who has had an abortion is deeply rooted in the mind of every MuVenda; he is firmly convinced that should he have sexual intercourse with such a woman he will die of consumption. So great is the fear of this disease that a man will not inherit his brother's wife if that brother has died of consumption, as he fears that such a union would bring a similar fate upon himself. In spite of this dread on the part of the menfolk abortion is by no means uncommon, often being brought about, with the help of a medicine-man, by women who have committed adultery and become pregnant by some man other than their husbands. A man suspecting such an occurrence will, unknown to his wife, consult a medicine-man. If his suspicions are confirmed he will demand the name of her seducer and make the offender pay the usual fine for adultery. After any abortion, before the man will again have sexual intercourse with his wife, he will take her to a medicine-man, where they undergo a purification ceremony together. [6]

In his book, History of the Basuto about the Basotho, David Frédéric Ellenberger wrote:

Monaheng, had twin sons by his first wife before he left Tebang, which was a name given to the country north of the Vaal where his ancestor Motebang lived for some generations. Possibly Motebang took his name from that country. According to a barbarous custom then in vogue, one of these children should have been destroyed, so that the other might thrive the better; and the old men of the tribe wished to have it so in this case. But the infants were such fine healthy children and so alike that the parents refused to comply with ancient custom, and they were both allowed to live; but in order to pacify or to escape the notice of the evil spirits who might thereby have been offended, they were given names of contempt. The elder was called Mokheseng (" scorn him") and the younger Monyane (" one of no account "). [7]

Post-colonial and Apartheid era

Abortion was first legalised in South Africa under the Abortion and Sterilization Act, 1975 (Act No.2 of 1975). [8] This law stated that women could access pregnancy terminations if; continuing the pregnancy could be life-threatening or cause serious health issues, continuing the pregnancy could be of severe risk to the woman's mental health, the child is likely to be born with significant irreparable physical or mental defects, or, the foetus was conceived by means of rape or incest. [9] This was later overridden on 1 February 1997, when the Choice on Termination of Pregnancy Act (Act 92 of 1996) came into force.

Before legalisation in 1975, abortion was prohibited throughout the country, however some white women, could request private doctors to perform a dilation and curettage, on the grounds that the continuation of pregnancy threatened the woman's mental wellbeing. [8] This was generally not an option for women of colour, due to the Apartheid regime, meaning the choice by doctors to carry out this procedure was both a personal and professional risk. [10] Black women and those of mixed heritage often had to rely on "backstreet" abortions or their own efforts to terminate pregnancies, often resulting in severe injuries and fatalities. [11]

The Choice on Termination of Pregnancy Act which came into force in 1997 now allows all women to access abortions in their first trimester, [8] and on the above-mentioned terms after week 13 of the pregnancy. [2]

The law

In South Africa, a woman of any age can get an abortion on request with no reasons given if she is less than 12 weeks pregnant. Minors will be advised to consult their parents, but it is up to the individual to decide whether or not to do so. Equally, a woman who is married or in a relationship with a longterm partner, will be advised to consult them, but again, that decision is for her to make. Exceptions to this, are if the woman is severely mentally ill or in a state of continuous unconsciousness, where consent of a spouse, parent or legal guardian is required. [12]

The Constitution does not explicitly mention abortion, but two sections of the Bill of Rights mention reproductive rights. Section 12(2)(a) states that, "Everyone has the right to bodily and psychological integrity, which includes the right... to make decisions concerning reproduction," while section 27(1)(a) states "Everyone has the right to have access to... health care services, including reproductive health care." In the case of Christian Lawyers Association v Minister of Health, an anti-abortion organisation which challenged the validity of the Choice on Termination of Pregnancy Act on the basis that it violated the right to life in section 11 of the Bill of Rights, the Transvaal Provincial Division of the High Court dismissed this argument, ruling that constitutional rights only apply to those who are born, and not to foetuses. [13] [14]

Health workers are under no obligation to perform or take active part in an abortion if they do not wish to; however, they are obligated by law to assist if it is required to save the life of the patient, such as in an emergency situation. [15] A health worker who is approached by a woman for an abortion may decline if they choose to do so, but are obligated by law to inform the woman of her rights and refer her to another health worker or facility where she can get the abortion. [2] Most abortion centres will provide pre- and post-abortion counselling, something which women can legally demand, however it is not a legal requirement that abortion centres provide it without request.

Midwives with the correct training can provide abortion services throughout the first trimester, however beyond the 12th week of pregnancy, only doctors can carry this out. [15] Despite this, nurses can administer medication and lead patient management throughout these procedures. In 2008 amendments were made to the legislation to ensure that nurses given the required training, could also perform such procedures. [15]

Inequalities and Implications of Abortion

Post-Apartheid South Africa remains separated by interlinking inequalities, which go beyond race to geography, culture, education, wealth and so on. Not only do these inequalities prevent women from accessing abortions, but they also prevent women from being educated about them.

Geographical inequalities

Whilst all women in South Africa are entitled to abortions, in reality geographical factors often act as implications in accessing them. Favier et al [15] found that urban women had better knowledge of their rights and of how to find local services, as well as being in closer proximity to abortion services.

Racial inequalities

Historically, white women had better access to abortion services, either by means of private doctors as previously mentioned, or due to their finances which allowed them to travel to England and the Netherlands to undergo such procedures. [15] With the passing of the 1975 law, black women were still unable to access safe abortion services, as they were not allowed to use White hospitals under Apartheid laws. [11] A 1994 study showed that 90% of women admitted to hospital following incomplete abortions were black, and so were all those who died from illegal abortions. [15] Both historically and currently, black women face the worst consequences of illegal, unsafe and legal abortions. [15]

Financial inequalities

In South Africa, there is no singular healthcare system, but both a public and private system which work alongside one another. [16] 80% of the population rely on the public system, yet only 20% of doctors work within it. This results in significant health inequalities as a result of wealth, with middle and upper-class citizens receiving excellent healthcare, and those relying on the public system experiencing inadequate resources, poor levels of privacy and significant overcrowding. [16] Unfortunately this reflects the access to abortion services, where women who cannot access local abortion services due to a lack of staff willing to perform procedures, forcing them to rely on private services beyond their financial reach. [15]

Cultural implications

Many women choose to undergo informal or "backstreet" abortions due to fears of facing social stigma by health workers. [17] This is often the case for sex workers who may believe that the privacy and anonymity of such a procedure outweighs the potential health risks. This displays the attitudes of many people in South Africa, who describe women seeking abortions as sinful, unfit for marriage and even witches. [18]

Within South Africa, a substantial 80% of the population rely on traditional medicine, with this figure rising to 90% in rural areas [16] for both cultural and economic reasons. [19] Steenkamp found that 18 plant species have been recorded to be used by traditional healers in South Africa to induce the termination of a pregnancy. [19]

Age

Mchunu et al indicate that several studies have identified the predictors of unsafe sexual practices during the early adolescent years, such as individual, sociodemographic, familial, and relational characteristics, poverty, cultural and family patterns of early sexual experience and lack of school or career goals. [20] This shows us how a combination of the above mentioned factors can result in increased premature sexual encounters and thus abortions, disproportionately affecting some more than others. Adolescent pregnancy reduces educational attainment amongst young women, resulting in poorer life prospects, and the likelihood of little abortion education, allowing the cycle to continue. [20]

Statistics

See also

Related Research Articles

<span class="mw-page-title-main">Abortion in the United Kingdom</span>

Abortion in the United Kingdom is de facto available under the terms of the Abortion Act 1967 in Great Britain and the Abortion (No.2) Regulations 2020 in Northern Ireland. The procurement of an abortion remains a criminal offence in Great Britain under the Offences Against the Person Act 1861, although the Abortion Act provides a legal defence for both the pregnant woman and her doctor in certain cases. Although a number of abortions did take place before the 1967 Act, there have been around 10 million abortions in the United Kingdom. Around 200,000 abortions are carried out in England and Wales each year and just under 14,000 in Scotland; the most common reason cited under the ICD-10 classification system for around 98% of all abortions is "risk to woman's mental health."

Late termination of pregnancy, also referred to politically as third trimester abortion, describes the termination of pregnancy by inducing labor during a late stage of gestation. In this context, late is not precisely defined, and different medical publications use varying gestational age thresholds. As of 2015, in the United States, more than 90% of abortions occur before the 13th week, 1.3% take place after the 21st week, and less than 1% occur after 24 weeks.

<span class="mw-page-title-main">Abortion law</span> Laws that allow, prohibit, or regulate abortion

Abortion laws vary widely among countries and territories, and have changed over time. Such laws range from abortion being freely available on request, to regulation or restrictions of various kinds, to outright prohibition in all circumstances. Many countries and territories that allow abortion have gestational limits for the procedure depending on the reason; with the majority being up to 12 weeks for abortion on request, up to 24 weeks for rape, incest, or socioeconomic reasons, and more for fetal impairment or risk to the woman's health or life. As of 2022, countries that legally allow abortion on request or for socioeconomic reasons comprise about 60% of the world's population. In 2024, France became the first country to explicitly protect abortion rights in its constitution, while Yugoslavia implicitly inscribed abortion rights in its constitution in 1974.

Reproductive rights are legal rights and freedoms relating to reproduction and reproductive health that vary amongst countries around the world. The World Health Organization defines reproductive rights as follows:

Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence.

Abortion in Australia is legal. There are no federal abortion laws, and full decriminalisation of the procedure has been enacted in all jurisdictions. Access to abortion varies between the states and territories: Surgical abortions are readily available on request within the first 22 to 24 weeks of pregnancy in most jurisdictions, and up to 16 weeks in Tasmania. Later-term abortions can be obtained with the approval of two doctors, although the Australian Capital Territory only requires a single physician's approval.

<span class="mw-page-title-main">Sexual and reproductive health</span> State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life. Sexual and reproductive health is more commonly defined as sexual and reproductive health and rights, to encompass individual agency to make choices about their sexual and reproductive lives.

<span class="mw-page-title-main">Women in South Africa</span>

It is thought that multiple ethnic groups in South Africa have long-standing beliefs concerning gender roles, and most are based on the premise that women in South Africa are less important, or less deserving of power, than men. Some view African traditional social organizations as male centered and male dominated. One prevailing caricature of Afrikaner religious beliefs includes a strong emphasis on the theoretically biblically based notion that women's contributions to society should normally be approved by, or be on behalf of, men. Claims are even made of modern sexism and Christianity being introduced into South Africa by the ancestors of the Afrikaner diaspora.

Abortion has been legal in India under various circumstances with the introduction of the Medical Termination of Pregnancy (MTP) Act, 1971. The Medical Termination of Pregnancy Regulations, 2003 were issued under the Act to enable women to access safe and legal abortion services.

Abortion in Namibia is restricted under the Abortion and Sterilisation Act of South Africa (1975), which Namibia inherited at the time of Independence from South Africa in March 1990. The act only allows for the termination of a pregnancy in cases of serious threat to the maternal or fetal health or when the pregnancy is a result of rape or incest. This law has not been updated since, and attempts to liberalise it have been met with fierce opposition from religious and women's groups.

Abortion in Turkey has been legal on request since May 27, 1983. Abortion is legal up to 10 weeks of pregnancy, and in special circumstances the time threshold can be extended if there is danger to the woman's life or the life of the fetus. During the ten weeks, an abortion is allowed for the following reasons: the pregnancy threatens the woman's mental and/or physical health, the fetus would be physically or mentally impaired, if the conception occurred through rape or incest, and economic or social reasons. The woman's consent is required. If the woman is under the age of 18, then parental consent is required. If the woman is married, the consent of the husband is also required. Single women over the age of 18 can choose to have an abortion on their own.

Abortion in Denmark was fully legalized on 1 October 1973, allowing the procedure to be done electively if a woman's pregnancy has not exceeded its 12th week. Under Danish law, the patient must be over the age of 18 to decide on an abortion alone; parental consent is required for minors, except in special circumstances. An abortion can be performed after 12 weeks if the woman's life or health are in danger. A woman may also be granted an authorization to abort after 12 weeks if certain circumstances are proved to be present.

Abortion in Greece has been fully legalized since 1986, when Law 1609/1986 was passed effective from 3 July 1986. Partial legalization of abortion in Greece was passed in Law 821 in 1978 that provided for the legal termination of a pregnancy, with no time limitation, in the event of a threat to the health or life of the woman. This law also allowed for termination up to the 12th week of pregnancy due to psychiatric indications and to the 20th week due to fetal pathology. Following the passage of the 1986 law, abortions can be performed on-demand in hospitals for women whose pregnancies have not exceeded 12 weeks. In the case of rape or incest, an abortion can occur as late as 19 weeks, and as late as 24 weeks in the case of fetal abnormalities. In case of inevitable risk to the life of the pregnant woman or a risk of serious and continuous damage to her physical or mental health, termination of pregnancy is legal any time before birth. Girls under the age of 18 must get written permission from a parent or guardian before being allowed an abortion.

Abortion in Zimbabwe is available under limited circumstances. Zimbabwe's current abortion law, the Termination of Pregnancy Act, was enacted by Rhodesia's white minority government in 1977. The law permits abortion if the pregnancy endangers the life of the woman or threatens to permanently impair her physical health, if the child may be born with serious physical or mental defects, or if the fetus was conceived as a result of rape or incest. Nevertheless, an estimated 70,000+ illegal abortions are performed in Zimbabwe each year.

Foeticide, or feticide, is the act of killing a fetus, or causing a miscarriage. Definitions differ between legal and medical applications, whereas in law, feticide frequently refers to a criminal offense, in medicine the term generally refers to a part of an abortion procedure in which a provider intentionally induces fetal demise to avoid the chance of an unintended live birth, or as a standalone procedure in the case of selective reduction.

The Choice on Termination of Pregnancy Act, 1996 is the law governing abortion in South Africa. It allows abortion on demand up to the twelfth week of pregnancy, under broadly specified circumstances from the thirteenth to the twentieth week, and only for serious medical reasons after the twentieth week. The Act has been described by the Guttmacher Institute as "one of the most liberal abortion laws in the world".

<span class="mw-page-title-main">Abortion-rights movement</span> Social movement advocating for legal access to abortion

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Abortion is illegal in Bangladesh under most situations, but menstrual regulation is often used as a substitute. Bangladesh is still governed by the penal code from 1860, where induced abortion is illegal unless the woman is in danger.

Abortion in Thailand is legal and available on-request up to 20 weeks of pregnancy. Abortion has been legal up to at least 12 weeks of pregnancy since 7 February 2021. Following a 2020 ruling of the Constitutional Court which declared a portion of the abortion statutes unconstitutional, the Parliament removed first-term abortion from the criminal code. Once strict, over time laws have been relaxed to take into account high rates of teen pregnancy, women who lack the means or will to raise children, and the consequences of illegal abortion.

<span class="mw-page-title-main">Termination of Pregnancy Act (Zimbabwe)</span>

The Termination of Pregnancy Act is a law in Zimbabwe governing abortion. Enacted in 1977 by the Parliament of Rhodesia and effective starting 1 January 1978, it was retained after Zimbabwe's independence in 1980. The law expanded abortion access, permitting it under three circumstances: if the pregnancy endangers the life of the woman or threatens to permanently impair her physical health, if the child may be born with serious physical or mental defects, or if the fetus was conceived as a result of rape or incest.

In the Gambia, abortion is illegal except to save the life of the mother or to prevent birth defects. Abortions in the Gambia have high rates of mortality and complications. Abortions are common among adolescents. There is a stigma surrounding extramarital pregnancy and abortion.

References

  1. ↑ "Terminate pregnancy | South African Government". www.gov.za. Retrieved 2023-08-17.
  2. 1 2 3 4 "Termination of Pregnancy (TOP)". Western Cape Government. Retrieved 2023-08-17.
  3. ↑ Junod, Henri A (1912). The Life of a South African Tribe. Alpha Editions (published 2019). p. 166. ISBN   978-93-5386-843-7.
  4. ↑ "No beating about the bush". The Economist. ISSN   0013-0613 . Retrieved 2024-03-08.
  5. ↑ Harris, J. Rendel (1992). A Recent Twin-Murder in S. Africa. Taylor & Francis, Ltd. pp. 214–223.
  6. ↑ Stayt, Hugh A (1931). The Bavenda. Routledge (published 2018). p. 90. ISBN   978-0-429-94277-8.
  7. ↑ Ellenberger, David Frédéric (1912). History of the Basuto, Ancient and Modern. Caxton publishing Company (published 2023).
  8. 1 2 3 Guttmacher, Sally, et al. “Abortion Reform in South Africa: A Case Study of the 1996 Choice on Termination of Pregnancy Act.” International Family Planning Perspectives, vol. 24, no. 4, Guttmacher Institute, 1998, pp. 191–94, https://doi.org/10.2307/2991980.
  9. ↑ Republic of Namibia, Annotated Statues 'Abortion and Sterilization Act 2 of 1975 (RSA)'https://www.lac.org.na/laws/annoSA/MEDICINE%20(1975)%20-%20Abortion%20and%20Sterilization%20Act%202%20of%201975%20(annotated).pdf
  10. ↑ Klausen, Susanne M. (2015). Abortion under Apartheid: Nationalism, Sexuality, and Women's Reproductive Rights in South Africa. New York, United States: Oxford University Press. ISBN   978-0-19-984449-4.
  11. 1 2 Mhlanga, RE (December 2003). "Abortion: developments and impact in South Africa". British Medical Bulletin. 67 (1): 115–126. doi:10.1093/bmb/ldg006. PMID   14711758.
  12. ↑ Republic of South Africa, Government Gazette 'Choice on Termination of Pregnancy Act,1996' https://www.gov.za/sites/default/files/gcis_document/201409/act92of1996.pdf
  13. ↑ Christian Lawyers Association of SA and Others v Minister of Health and Others 1998 (4) SA 1113 (T) (10 July 1998), Transvaal Provincial Division
  14. ↑ "This Day in History: 10 July 1998". South African History Online. Archived from the original on 28 October 2018. Retrieved 27 August 2011.
  15. 1 2 3 4 5 6 7 8 Favier, Mary; Greenberg, Jamie M.S.; Stevens, Marion (October 2018). "Safe abortion in South Africa: "We have wonderful laws but we don't have people to implement those laws"". International Journal of Gynecology & Obstetrics. 143 (S4): 38–44. doi: 10.1002/ijgo.12676 . ISSN   0020-7292. PMID   30374986.
  16. 1 2 3 "Understanding South Africa's Healthcare System". International Citizens Insurance. Retrieved 2023-08-18.
  17. ↑ Harries, Jane; Daskilewicz, Kristen; Bessenaar, Tshegofatso; Gerdts, Caitlin (2021-09-23). "Understanding abortion seeking care outside of formal health care settings in Cape Town, South Africa: a qualitative study". Reproductive Health. 18 (1): 190. doi: 10.1186/s12978-021-01243-3 . ISSN   1742-4755. PMC   8460179 . PMID   34556120.
  18. ↑ Mosley, Elizabeth A.; Schulz, Amy J.; Harris, Lisa H.; Anderson, Barbara A. (2020-08-08). "South African abortion attitudes from 2007-2016: the roles of religiosity and attitudes toward sexuality and gender equality". Women & Health. 60 (7): 806–820. doi:10.1080/03630242.2020.1746951. ISSN   0363-0242. PMC   8988310 . PMID   32252606.
  19. 1 2 Steenkamp, V. (May 2003). "Traditional herbal remedies used by South African women for gynaecological complaints". Journal of Ethnopharmacology. 86 (1): 97–108. doi:10.1016/S0378-8741(03)00053-9. PMID   12686447.
  20. 1 2 Mchunu, G; Peltzer, K; Tutshana, B; Seutlwadi, L (2013-02-01). "Adolescent pregnancy and associated factors in South African youth". African Health Sciences. 12 (4): 426–434. doi:10.4314/ahs.v12i4.5. ISSN   1680-6905. PMC   3598281 . PMID   23515418.
  21. 1 2 Dawes, A. (Ed.) (2003). The state of children in Gauteng. A report for the office of the Premier, Gauteng Provincial Government. Archived July 26, 2011, at the Wayback Machine Pretoria: Child Youth and Family Development, Human Sciences Research Council. Page 82, 157, 161

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