Here’s why South Africa’s women are still forced into unsafe ways to terminate pregnancy

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This is one of the findings presented in Amnesty International’s Barriers to Safe and Legal Abortions in South Africa research briefing released on Wednesday. The research was done in collaboration with the University of Cape Town’s Women’s Health Research Unit.

Wednesday marks 20 years since the adoption of the Choice on Termination of Pregnancy Act (CTOPA).

The briefing highlights three primary barriers to safe and legal abortions in the country – the failure to regulate conscientious objection‚ inequalities in access to services for poor and marginalised communities and a lack of information on sexual and reproductive rights.

The results of these barriers have been devastating in some cases‚ with a 19-year-old student dying in Johannesburg last year‚ following complications from an unsafe abortion. A special advisor to the Minister of Social Development Bathabile Dlamini told the United Nations that system deficiencies‚ stigma and discrimination contributed to her death.

The report found that the government’s failure to regularise conscientious objection‚ which is a health care professional’s right to refuse to perform an abortion‚ contributed to the shortage of facilities offering the service.

Of the 505 state facilities designed to provide abortions‚ only 264 are performing first and second trimester abortions.

Amnesty International researcher Louise Carmody said there is poor understanding of conscientious objection and its limits among health practitioners. “It does not apply to those administering medicine or in emergencies [for example].”

Legislation dictates that anyone who prevents a legal abortion in South Africa is committing an offence‚ but there are few accountability mechanisms in this regard‚ she said.

Some health workers opt out due to peer pressure.

“You’d often find midwives who would often not be practicing doing abortions because they fear the victimisation‚ being stigmatised and being isolated from their peers‚” a hospital manager noted in the report.

The lack of clear guidelines means conscientious objection is applied on an “ad-hoc basis with lots discrepancies”‚ Carmody said.

Another barrier to legal abortions – access to information – was found to be driven by negative attitudes of health workers‚ who are often the main source of health-related information in communities.

“Lack of information can lead to unnecessary delays in women and girls accessing abortion services. Delays can result in women and girls being denied abortion services due to gestational limits under the CTOPA‚” the report said.

Spokesperson for independent abortion service provider Marie Stopes‚ Whitney Chinogwenya‚ said some of its clients seeking abortions in the second trimester of their pregnancies were turned away at state facilities.

Under the law abortions in the 13 to 20 week gestation period is only available in the event of rape or incest‚ danger to the woman’s physical or mental health‚ an unviable foetus and proof of negative impact on a woman’s socio-economic status. These abortions may only be performed by a registered doctor.

A lack of information also leads women and girls seeking abortions to illegal clinics‚ which are rife‚ the report found.

Chinogwenya said some of these clinics pose as Marie Stopes clinics. “They use our brand to lure women to their unscrupulous practices and often women leave those practices either still pregnant or having suffered complications.”

Among Amnesty International’s recommendations are the regulation of conscientious objection with clear protocols‚ training of health workers around conscientious objection‚ the improved provision of information of where to access abortion on Department of Health mobile apps.

It also calls on the government to record maternal deaths specifically relating to abortion in order to better identify system gaps.

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