South Africa has some of the most liberal sexual and reproductive health laws in the world. This means that, as women, we are in control of our own bodies. Women are legally entitled to a safe abortion in South Africa up to the 20th week of pregnancy. It’s been this way since November 1996, under the Choice on Termination of Pregnancy Act 92 of 1996. A termination can be performed after the 20th week, but only if your life is at risk or your baby can’t be carried to term.
Even so, actually obtaining a safe abortion in South Africa can become difficult. Stigma and negative attitudes from healthcare providers impact women’s ability to have safe abortions. Added to that, despite the law, “only around 7% of public health facilities provide abortion care”, explains Victoria Satchwell, executive director and co-founder of Abortion Support. Every second flyer is offering safe and painless abortions. But who can be trusted? Here’s everything you need to know about your options.
What are the abortion rights in South Africa?
All women, girls and pregnant people have the right to legal, safe abortions. This means that it doesn’t matter what age you are or what your family, husband or partner thinks. Essentially, it’s up to you. There is also no limit to the number of times you can have the procedure. You have the right to choose what is best for you and your body. More rights:
Women of any age do not need permission to get an abortion.
“Only the person having the abortion needs to consent,” says Satchwell. “If you are under 18, you do not need to inform your parent or get their permission”
READ MORE: Everything You Need To Know About Pregnancy And Abortion Right Now
Abortions at government clinics and hospitals are free.
Prescribed Minimum Benefits (PMBs) are a set of legal requirements outlining treatments that medical aids must cover by law. This includes abortion. “This applies whether the abortion is for medical reasons or because you choose not to continue the pregnancy,” explains Satchwell. If your medical aid indicates they do not cover abortion, you should contact the Council for Medical Schemes to lay a complaint. Satchwell notes that not all clinics work with medical aids – due to cost – so do research before booking your appointment.
Any facility offering a legal abortion in South Africa must be registered.
This is one way of ensuring your treatment is safe. Satchwell recommends asking the provider for their registration number, either HPCSA for doctors (Health Professions Council of South Africa) and SANC for nurses (South African Nursing Council), and verifying it online.
Healthcare practitioners have the right to refuse to terminate…
But this only applies to the person actually carrying out the termination. According to the National Clinical Guideline for the Implementation of the Choice on Termination of Pregnancy Act, Ed 1, “Only the direct TOP (termination of pregnancy) provider can refuse care (no other health care or support staff member can refuse care).”
What this means: only a practitioner who would directly terminate may refuse to carry out the abortion, but support staff cannot also refuse. But, any provider who refuses “must refer the individual to a colleague or facility that is able to offer such services,” the Guideline continues.
A pharmacist is not allowed to refuse care.
According to the law, pharmacists must provide the necessary care. Anyone who obstructs access to an abortion could be found liable to a fine, per the CTOP Act, Section 10.
READ MORE: 11 Important Things You Need To Know About The Morning-After Pill
What are the options for abortions?
There are options when it comes to abortion methods. It’s important to speak to your medical practitioner about which will be the safest option for you.
Medical abortions
A medical abortion is performed using medication (pills or tablets) only. The process is different for each woman, but it will usually take a few days. The pills will cause bleeding and cramping that will push out the pregnancy.
The heaviest bleeding typically occurs 2-5 hours after using the pills and usually slows down within 24 hours. Bleeding is often heavier than normal menstruation, and there can be clots for days or even weeks. In most cases, you will use the pills and expel the pregnancy at home. You can watch a video of an abortion at home to see what this process can be like.
Surgical abortions
Surgical abortion is performed by a nurse or a doctor at a clinic or hospital and involves a minor operation. You might be given the same drugs used in a medical abortion to soften and dilate (open) your cervix and pain medication, sedation, or anaesthetic. This method uses instruments and gentle suction to remove the pregnancy. While your appointment might take a few hours, the procedure itself usually takes less than 15 minutes, and you leave on the same day.
READ MORE: “We Need To Have More Open Conversations About Miscarriages, Abortions And Pregnancy”
Where to go for an abortion in South Africa
Abortion Support offers a digital consultation to get a prescription for abortion pills. You will need to buy the medication at your local pharmacy. Misoprostol alone costs about R220. The combined method using mifepristone and misoprostol, which is slightly more effective, costs about R1100. The medication cost is the only cost involved.
Marie Stopes offers a telehealth option, including delivery and medication. For in-clinic care, prices differ between medical abortion (abortion with pills) and surgical/procedural abortion. Costs are higher for pregnancies that are further along. Prices depend on gestational age and the method used.
Government clinics offer free services. You can visit your nearest clinic for more information.
How to know if an abortion in South Africa is unsafe
“Legal abortions in South Africa are provided by licensed clinics that work with trained healthcare providers – these are safe services,” says Satchwell. When legal abortion is not accessible, care seekers may end up choosing illegal care. Research shows that illegal services can differ in safety. “It’s important that people seeking abortion care know the signs that indicate a provider is unsafe.” Here, Satchwell outlines guidelines to scope for safety.
A provider is not safe if they:
- Do not assess how far along your pregnancy is (they should ask for an ultrasound or the date of your last period)
- Do not give clear instructions on how to use medication, what to expect during the abortion in terms of bleeding and pain, what warning signs to look out for, and what to do if complications arise
- They tell you to insert any foreign object into the vagina, such as herbs, roots, newspaper, steel wool, etc. (This is very dangerous and should never be done.)
- Perform surgical/procedural abortions outside a sterile (clean) environment. (This is very dangerous and should never be done.)
When obtaining abortion medication, it is important to ensure that the pills are misoprostol or mifepristone. Pills that are not in their original blister (silver packaging) may be counterfeit or unsafe. For guidance on using medication safely at home, you can contact Women on Web at info@womenonweb.org, who provide instructions and support throughout the process.
