By Youlendree Appasamy
“Well, I had an inkling I might have been pregnant for about two weeks. But only found out about it, after taking a hasty pregnancy test in the mall…”
Sam* explains her story. She did not tell her family about it. No support was offered from anyone other than herself and closest friends, who knew about the incident. The test was taken 5-6 weeks into the unplanned pregnancy. On arriving at Dora Nzinga Hospital in Port Elizabeth, one of the public healthcare facilities in the area where abortion is offered as a free service, more complications arose.
Three appointments later, Sam* managed to have an ultrasound taken and get the abortion medication. She managed all of this in the last possible week of what is termed an ‘early abortion’ – the eighth week of pregnancy. The ninth week of pregnancy is the last time-frame within which to take this particular abortion medication, which induces a miscarriage in the early stages of pregnancy.
“Thank God I trusted my instinct, went to get a test, and then followed up with a consultation very soon after. I was able to take the abortion medication in my supposed ninth week,” Sam* continued. The abortion medication worked and within a period of a week, the miscarriage had taken place. She suffered no side effects from the abortion process and continues to live a normal life.
Abortion is an ethically contested topic globally, yet in South Africa the law is clear. The South African Choice on Termination of Pregnancy (CTOP) Act No. 92 of 1996 protects and promotes a woman’s right to have an early, safe and legal abortion. According to research undertaken by the Pew Research Centre on global views of morally contentious subjects, 61% of South Africans are opposed to abortion. In Grahamstown, doctors invoke the right to conscientiously object to terminating pregnancy. This practically means abortion on demand is not available to women seeking an abortion within the first trimester. A clause on conscientious objection does not exist explicitly in South Africa’s legal framework, but the principle is invoked by doctors, to protect their rights.
Two classifications are used when speaking of abortion – medical abortions and abortion on demand. The CTOP Act allows for abortion at the woman’s request up to 12 weeks. From 12 – 20 weeks, the pregnancy may be terminated on medical grounds. Often, an abortion may be performed in cases of emergency from complications arising from gestation or as a result of a botched illegal abortion. Doctors and medical practitioners are within their right to freedom of conscience, belief, thought and religion and this right is clearly exercised in Grahamstown. According to Masters research conducted by Desire Chiwandire, abortion on demand is not provided in Grahamstown. As a result, women seeking a legal abortion within the first 12 weeks and by her own volition must go further afield to Marie Stopes Clinic or Dora Nzinge Hospital in Port Elizabeth.
The contesting rights involved with the abortion provision service, is a topic not many are aware of. “Doctors in South Africa have their own beliefs and there is no standardised method of conscientious objection in South Africa,” Chiwandire states. This confusion around the CTOP Act happens in both public and private healthcare spheres. “There is a dual problem of the CTOP Act and the Constitution not being understood fully and medical practitioners not knowing what to do in certain situations,” continued Chiwandire. Dr Juggedesen Santhia, a GP practising in Grahamstown does not provide abortion on demand. “This follows my strong feelings about the wonder of life, and to terminate a life so prematurely, with the foetus an unfortunate victim, goes against my conscience”, said Santhia.
Doctors may be personally against abortion due to their moral framework, but doctors must fulfil their duty to refer to facilities and other medical professionals who will help them in procuring an abortion.
“I do not believe that I am denying the patient her rights by refusing to provide this service. I provide counselling, look at the reasons for the termination, always being non-judgmental, and assist the patient by referring to appropriate service providers,” said Santhia.
However, this solution may not be suitable for all parties involved. Open access to abortion services is a constitutionally enshrined right which can be rendered ineffective by medical practitioner’s refusal to perform abortion on demand. In the conflict between rights, women seeking an early and legal abortion may be marginalised. The proliferation of pamphlets offering “free abortion services” on High Street attests to the fact that abortion centres (legal or illegal) exist and are operational in the area. The closest place one can access a legal and free abortion on demand is Dora Nzinge Hospital in Port Elizabeth.
Sam* was somewhat lucky in her situation – she resides in Port Elizabeth and could access Dora Nzinge Hospital services without the obstacles that a woman living in Grahamstown would have to face. Transportation costs and even accommodation are necessary to consider if one goes to Port Elizabeth or East London to get an abortion done. This is besides the negative stigma and perhaps, silence around reasons for leaving.
“Your choice is not a mistake, regardless of what the world might make you feel. Find out what you can. And be sure, you are ready for the kind of questions you will be asked. Go for counselling after, if you think you may be deeply affected by the choice.”
Sam* lives without regrets about her decision. “I had been pro-choice before the abortion and had no doubt in my mind that I wanted to abort,” she said. The choice to abort, or not abort is personal. “I suggest that more females be willing to make a choice – the right one for them,” she concluded.
*Names changed to protect the anonymity of the students.
Read an update on abortion provision in SA here.