The young girl who shot herself in the stomach to get rid of her unwanted pregnancy has always stuck in Elizabeth Serobe’€™s mind.

This image and the girls who came into the hospital with coat hangers hanging from their cervixes has remained with her and it is one the main driving forces behind this Soweto midwife’s commitment to providing women in Soweto with a choice to terminate an unwanted pregnancy.

Despite endless protestations from African Christian Democratic Party MP Cherylyn Dudley, who accused speaker after speaker of murdering or drowning unborn fetuses, doctors, midwives, social workers and researchers shared their assessment of the Choice on Termination of Pregnancy (TOP) Act with Parliament this week.

The hearings, conducted by the health committee attempted to sketch a picture of where the Act had dramatically improved the lives of thousands of women and young girls and where it was failing.

Passed by an overwhelming majority in parliament five years ago, the Act has been challenged twice in the Constitutional Court by the Christian Lawyers Association, but both attempts have failed.

For the handful of midwives like Serobe the greatest challenge is to overcome the lack of support from management who are opposed to the service, lack of infrastructure, burn-out and name calling and resistance by their peers.

“Irrespective of the negativity from our colleagues we are dedicated to providing this service to save the lives and empower women to exercise their choice. I want to emphasise that we are saving lives,” a determined Serobe told the committee.

But midwives are not the only specialists in the firing line. Dr Martin Cuellar, a Cuban Obstetrician and Gynaecologist, has been doing second trimester abortions at a TOP Clinic in Bloemfontein’€™s state hospital. The National Hospital is one of only four TOP facilities in the Free State.

“TOP is part of our training as doctors in Cuba. During the last three years at the medical school the students are exposed to terminations, so it is simply viewed as part of the other health services we offer,” Cuellar said.

Cuellar confirmed that  TOP were often moved around on hospital premises and offered second rate facilities with not much support from management.

Dr Ames Dhai, of the Nelson R Mandela Medical School, warned that the health system would be harming and failing women if they were denied access.

“Many health workers are still blocking women’€™s access to this service because of conscientious objections. They threaten those who are providing the service and at the end of the day it is the poor who are deprived of the right to TOP,” Dhai told the committee.

She confirmed that a small number of health workers were prepared to perform a TOP.

“Unwanted pregnancies must be recognised as a health risk. It also leads to many neglected and abandoned babies being born,” Dhai said.

According to statistics supplied by the Reproductive Rights Alliance there has been a steady increase in women presenting for abortions.

Between August and October 1997, 2 945 pregnancies were terminated, the vast majority in Gauteng. During the same period last year, 4 973 women received abortions.

But the figure that gave the most encouragement was the significant decrease in women and young girls presenting with back street abortions that had become septic.

“We want to avoid as many terminations as we possibly can, but in the meantime women need to have access to TOP services,” said Dr Helen Rees of the Reproductive Health Research Unit at Chris Hani Baragwanath Hospital.

She said that although South Africa compared favourably with the developed world in terms of contraceptive use, the maternal mortality figures coming out of Sub-Saharan Africa were worrying.

“Things are improving in terms of maternal mortality and morbidity (in South Africa) with fewer women presenting with genital injuries and foreign bodies.”

Rees said the fact that the abortion figures were rising showed that women were 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.”

Khosi Xaba of Ipas, a global body dedicated to improving women’€™s access to TOP services, said it was crucial that TOP training be integrated for all health care providers.

This proposal was seconded by Democratic Nursing Organisation of SA manager Phumelele Zulu, who believes that the nurse has an ethical responsibility to care indiscriminately for anyone in her care before or after a TOP.

“Denosa commits itself to providing training and giving support to providers.”

Zulu said there was a need to ensure that women understood that the decision to terminate was theirs only and that if one gets subjected to interference, that perpetrator faces penalties.