Lack of support for termination of pregnancy (TOP) service providers in the public health sector has led to an exodus of qualified people who can perform abortion services. Stigma and judgement from their colleagues make their working conditions so difficult that many opt to leave the service rather than continue to work in hostile environments.

According to Kgaladi Mphahlele, the Doctors Without Borders’ Choice of Termination of Pregnancy Manager in Rustenburg, North West, part of their work has been to train nurses and doctors who perform abortions, especially for women wanting them late in their pregnancy. 

‘Baby killers’

Mphahlele said doctors and nurses who provide these services are often abused and called “baby killers” by their colleagues.

“When a woman or girl is determined to end her pregnancy she will do so, regardless of the safety and legality of the procedure,” said Mphahlele. “ Where safe abortion care is not available, she will risk her life with unsafe abortion, often because the prospect of continuing the pregnancy is unbearable.”

Speaking at the Sexual and Reproductive Health workshop by Health-e News and Global Health Strategies, Maphahlele added that once a woman goes to a clinic with the intention to have an abortion, it doesn’t matter how far she is, if she is denied this service, she will go somewhere else. 

Mphahlele noted that the lack of referral services for women who are far into their pregnancies has been a stumbling block to women’s rights to access legal and safe abortion. 

Legislation

Under South Africa’s legislation, women have a right to an abortion up to 12 weeks of pregnancy. The law also makes it legal for women to have abortions until 20 weeks under certain circumstances such as rape, incest and economic hardship. 

Thembi Zulu, Sexual and Reproduction Health programme manager at the Department of Health, said TOP service providers were not adequately supported because the service they offered was not a priority programme. 

According to Zulu, for so long there have been no guidelines of how abortion services are provided and abortions have been administered according to the Choice of Termination of Pregnancy Act of 1996 – which is open to interpretation. 

“We have just finished developing guidelines that will bring a standard of how TOP is performed. There is a final draft of the TOP guideline that will be presented to the Health Council and Parliament,” she said. 

Zulu said the document will be presented to Parliament in August and will then go to the provinces.

“When we go to the provinces with this document, we are going to ask them to give us an implementation plan. Whatever they do and how they intend to implement the TOP guidelines they must align with what we present to them. We will support the provinces on their implementation plan,” she said.

Part of the department’s plan is to strengthen family planning services. 

“We will look at the issues of why women do not have access to family planning. We realised that for a woman to want an abortion means she didn’t want to fall pregnant in the first place.” – Health-e News

A version of this story was published in the Sunday Independent.