It is crucial that women, especially those living in less developed parts of the world such as Sub-Saharan Africa, have access to termination of pregnancy (TOP) services, according to Dr Helen Rees of the Reproductive Health Research Unit at Chris Hani Barangwanath Hospital.  

This makes an Act such as the Choice on Termination of Pregnancy (TOP) a crucial tool in offering women, young and old, the choice of aborting the fetus rather than pushing ahead with an unwanted pregnancy that could lead to much pain, trauma and as born out by statistics, death.

Addressing Parliament’s health committee at the national oversight hearings into the implementation of the Choice on Termination of Pregnancy Act, Rees said that contraception remained one of the best tools to contain maternal mortality, but that the fact remained that many women died from complications of unsafe abortions each year.

Rees said that the Act had already had a major effect on mortality with over 90% of incomplete abortion cases admitted to public hospitals in 2000 showing no signs of infection on admission, compared to 79% in 1994.  

“This fact will lead to an improvement in terms of mortality and morbidity,” Rees said.  

She said there was also a marked decrease in women presenting with genital injuries or foreign bodies.  

Rees said she believed the number of women accessing abortions was increasing, as women were now able to access the right to a safe abortion.  

Highlighting the link between violence against women, HIV/AIDS and the need for a TOP service, Rees said studies in Sub-Saharan Africa showed that for many girls their first sexual experience was often forced.

A study done in Cape Town revealed that of the girls interviewed, 30% reported that their first intercourse had been forced, 11% reported being raped and 75% thought their boyfriends would beat them should they refuse to have sex.

“Girls between the ages of 15 and 19 are also the peak group in terms of HIV/AIDS. This shows that the matter before us is not just a question of a right to have an abortion, but the right that protects you against violence and HIV.”

Other presenters pointed out that although there were major hurdles in terms of women accessing TOP services in the less resourced provinces, there had been a notable decrease in septic or unsafe abortions.  

“The health system is failing and harming women if they are denied access,” said Dr Ames Dhai of the Nelson R Mandela Medical School at Natal University.

She said a high number of health workers were blocking access to TOP because of conscientious objections and that their colleagues threatened those who were providing the service in some instances.  

“A small number of health workers are prepared to perform TOPs,” Dhai said.  

But Elizabeth Serobe, a midwife at Chris Hani Baragwanath Hospital who has been providing TOP since its implementation five years ago, told the committee that she was dedicated to save women from losing their lives and be able to exercise their reproductive right. “I want to emphasise that we are saving lives.”  

One case that has stuck in Serobe’s mind was a young girl who had shot herself in the abdomen to get rid of the unwanted pregnancy. “They came with coat hangers hanging from their cervixes and lost their uteruses from sepsis,” Serobe said.