Despite abortions being legal – and free – in South Africa, doctors and nurses are not obligated to offer this service (kind of). As a result, many doctors and nurses refuse to conduct abortions for moral reasons, sometimes not knowing they are breaking the law. According to one estimate, only 7% of government facilities actually offer abortions.
This means trying to figure out how to get an abortion in South Africa can be tricky. The lack of abortion clinics in certain areas, coupled with the stigma surrounding the procedure, is why many South African women opt to have illegal abortions.
Illegal abortions, or ‘backstreet’ abortions, can be unsafe and can lead to injury and death. This is why registered reproductive health service provider, Marie Stopes, recommends making use of a legal abortion clinic. However, “there is a difference between an illegal abortion and an unsafe abortion,” clarifies Victoria Satchwell, who heads up Abortion Support South Africa, a non-profit organisation that provides tele-abortion services. “If it is not possible to access a legal abortion, people may choose an illegal provider, but it is important to know that some illegal providers are safer than others.” Worried about the safety of the abortion procedure? Here we break down exactly how safe it is to get an abortion at different periods during gestation.
READ MORE: Where Should You Go For A Safe Abortion In South Africa?
Your Legal Rights Regarding Abortions In South Africa
The National Clinical Guideline for the Implementation of the Choice on Termination of Pregnancy Act (2020) outlines the clear steps for abortion in South Africa. In South Africa, a woman may terminate her pregnancy for any reason until the 12th week. This abortion may be performed by a registered nurse, midwife or registered medical practitioner. Between 13 and 20 weeks, you’re allowed to terminate the pregnancy if there is a reason, such as not being able to afford a child, a pregnancy from rape or incest, risks to your physical or mental health (for example, if continuing the pregnancy could cause depression), or a fetal abnormality. After 20 weeks and 6 days, abortion is only allowed if your life is at risk or there is a severe abnormality with the fetus. For more about the legal details, read this article.
Important: Only the pregnant person needs to consent to the abortion. If you are under 18, you do not need permission from a parent. You never need consent from a partner or spouse.
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You’re Pregnant And Don’t Want To Be – What To Do Now?
Step 1: Take A Pregnancy Test
If you are having pregnancy symptoms like nausea, needing to pee more often, or tender breasts, it’s a good idea to take a pregnancy test before seeking abortion care, says Satchwell. If you’d rather not buy one yourself, you can have it delivered using delivery services.
Women wanting to terminate their pregnancy are encouraged to have the abortion as early as possible. “Act quickly. Abortion is time-sensitive,” says Satchwell. “Many clinics only provide care up to 10 or 12 weeks, so delays can affect both your legal options and your ability to get an appointment.”
Step 2: Know Your Abortion Options
What are the different types of abortion?
An abortion treatment can be done with pills (medical abortion) or in a clinic with a minor operation (surgical abortion). Both medical and surgical abortion are safe and effective across pregnancy durations but not all clinics offer both options.
Abortion with pills (medical abortion)
There are two ways to have an abortion using pills. One option uses two medicines together, mifepristone and misoprostol, and is 98% effective (2 in 100 abortions will not be successful). The other option uses misoprostol on its own, which is around 90% effective (10 in 100 abortions will not be successful). Some people choose to use misoprostol alone because it is more affordable and more widely available.
Self-managed abortion
In most cases, when you visit a clinic for a medical abortion, you will use the pills that cause bleeding at home. According to Satchwell, “Some women find that it’s more affordable, convenient, private or empowering not to visit the clinic at all but to access medication through telehealth.” This is also called self-managed abortion and is endorsed by the World Health Organisation up to 12 weeks.
Research shows that using pills at home is safe and effective. According to the Department of Health’s Abortion Guideline, ultrasound is not routinely needed prior to an abortion, and you only need to visit a healthcare worker after the abortion if you are concerned you had a complication or that the abortion didn’t work.
You can order abortion pills online, by telephone call or online consultation with a healthcare provider. Your abortion pills can be collected at a pharmacy or delivered to your home. This service is available at Abortion Support or Marie Stopes. “Abortion Support does not charge for this service, but you will pay R220 for abortion pills and will collect your medication at a pharmacy,” says Satchwell.
Surgical abortion
Surgical abortion is performed by a nurse or a doctor at a clinic or hospital and involves a minor operation that uses gentle suction to remove the pregnancy.
In the first trimester, you can have a medical abortion, which requires taking two pills, Mifepristone and Misoprostol (also known as Cytotec) to induce a miscarriage if gestation is between four and nine weeks. Medical abortions after nine weeks are illegal in South Africa. Unlike with surgical abortions, medical abortions become less effective as time goes on.
READ MORE: Finally, Contraception Delivery Services Are In South Africa
Is Abortion Safe?
Decades of research show that abortion is safe and effective. “Perceptions around the safety of abortion are influenced by stigma and sometimes deliberately misleading information,” says Satchwell. “It’s important that people know the science – 56 million women have an abortion every year, and the data shows it’s safer than other common medications we use and much safer than giving birth.” According to research, Satchwell says that abortion with pills is safer than Panado, it’s safer than antibiotics, and it’s safer than Viagra. Only about 2% of women who undergo an abortion experience a complication. On the rare occasion that a complication does occur, most complications are minor and easily treatable.
Where To Go For An Abortion In South Africa
If your pregnancy is 10 weeks or less, you may choose to do an abortion with pills at home. You can order abortion pills by telephone or online consultation with a healthcare provider. Your abortion pills can be collected at a pharmacy or delivered to your home. You can’t buy abortion pills at a pharmacy without a prescription; you’ll get your prescription from your abortion provider.
You can also choose to visit a public or private clinic. Satchwell outlines these points:
- Public care is free of charge. You can visit your closest public clinic to find out if they provide abortion. Or, ask them where the nearest referral option is.
Keep in mind that only around 7% of public health facilities provide abortion care. And, you may find yourself far away from a clinic. At this time, there is no complete or accurate list of public clinics that offer abortion.
- Private clinics and some gynaecologists offer abortion care. The cost of these services varies by provider.
You can look at the following resources to find clinics near you that provide abortion:
- WhereToCare: please turn on your mobile data service, enable location services and select ‘Comprehensive Family Planning Services.
- Mmhoho Hotline: 080-001-4597.
- List of clinics per province
It’s important to choose a safe provider. Find more information about how to identify an unsafe provider here.
After 10-12 weeks, it can be more difficult to find abortion care as there are fewer clinics that offer this service. If you are struggling to find care at this gestational age, you can get in touch with Section 27.
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Why Access To Legal Abortions Is Important
It’s been a little over 30 years since the Choice on Termination of Pregnancy Act was passed in South Africa, legalising abortion. Since then, deaths resulting from abortions have decreased. According to the National Department of Health, 1.2% of all maternal deaths are due to unsafe abortions.
Health practitioners note that there is a strong correlation between the safety of the procedure and the legality of the clinic. And, because of the barrier to access legal, safe abortions (only about 7% of public hospitals actually offer this service countrywide), unsafe abortions are a common practice. Approximately 52% to 59% of the estimated 260 000 abortions that occurred in South Africa were illegal, according to a 2018 study. WH has been unable to find newer studies.
“The most effective way to curb unsafe abortion is to make safe abortion genuinely accessible,” says Satchwell. “When women, pregnant people and girls can get safe, affordable and compassionate care, they are far less likely to turn to someone selling pills at a taxi rank. Unsafe providers exist because there is a gap in the formal health system, and where there is a gap, a market emerges.”
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