Limpopo: An 18-year-old from rural Limpopo says she was denied a legal abortion at a public clinic last month, after a nurse refused to help her on religious grounds, leaving her to seek an illegal abortion from a traditional healer.
In May, the matriculant from Makotopong village, says she missed her period and suspected she was pregnant.
“The moment I missed my menstruation, I just suspected that there was something wrong. I confided in my cousin, and she suggested that we buy a pregnancy test kit from a pharmacy. The kit confirmed the pregnancy.”
Liza* says another urine test was done at her local community clinic, which also showed a positive pregnancy result.
“Since I didn’t want the pregnancy, I opted for abortion,” she says.
Liza* says she didn’t want to go back to her local clinic where she is known, and decided to travel 29 kilometres to the Rethabile Community Health Centre in Polokwane, accompanied by her cousin.
Abortion care refused based on religious beliefs
Instead of receiving care, Liza* says she was judged.
“I was shocked by the reaction of the nurse after I informed her that I was there for an abortion. She stared into my eyes, shook her head and called her colleague, who she spoke to silently. I was confused when the nurse said she couldn’t help me.”
Liza* says she asked the nurse why she was unable to help her, and was shocked by her response.
“She said ‘my religion is against abortion.”
Liza* says she then approached another nurse. “She shrugged and left me stranded. None of them bothered to give me another option.”
In South Africa, the Choice on Termination of Pregnancy (TOP) Act allows abortion on request during the first 12 weeks of pregnancy, with no reasons required. Between 13 and 20 weeks, abortion is legal only under specified circumstances.
Turning to a traditional healer
Liza* says after being turned away from the Rethabile clinic, she felt desperate and approached a traditional healer who is not authorised to provide abortion services under South African law.
“My cousin suggested that we go to a traditional healer at Ntsima village who is known to perform abortions from her home. I was reluctant but ended up boarding a taxi to the place on 16 May, with my cousin as my only support structure. No one at home knew that I was pregnant,” she says.
They agreed on a fee of R500.
“Unlike the nurses at Rethabile, the traditional healer was polite,” Liza* says.
“She brought a powdered muti and a brownish concoction in a two-litre bottle. She told me to drink the concoction every morning on an empty stomach over three days.”
Liza* says the healer told her to return after five days, after she had finished the concoction.
“I followed her instructions, but I suddenly experienced nausea, a running stomach and severe abdominal cramps a day later. I bled profusely, and the pain was unbearable. The only person who knew about my situation was my cousin. I only told my mom that I was having a headache,” she says.
“After five days, I returned to the healer who assured me that the procedure was successful and gave me another concoction, which she said was to cleanse my womb.”
The teen says the experience left her shaken, and she has not returned to any medical facility to confirm whether the pregnancy was terminated.
“I believe the pregnancy is gone, but I’m not sure whether the procedure could have dire consequences in the future. I’m scared that I might struggle to conceive.
Source: National Department of Health. Clinical Guideline for Implementation of the Choice on Termination of Pregnancy Act.
“In SA the right to a safe, legal abortion remains unrealised”
Liza’s* experience echoes findings in a recent report by the public interest law centre, Section27, which found that some healthcare workers in Limpopo and the Eastern Cape refused to provide abortion care on the grounds of conscientious objection – declining to actively participate in abortions because of religious or ethical beliefs.
SECTION27 paralegal, Kholofelo Mphahlele says they have been inundated with calls from distraught women who complain that they were unable to undergo Termination of Pregnancy (TOP) care due to various challenges.
“There is a worrying shortage of trained nurses in rural healthcare facilities, and this often forces patients to travel long distances to get services,” she says.
“Patients say they are insulted by rude nurses who tell them that they won’t go to heaven for terminating their pregnancies and end up being turned away by nurses who cite religious beliefs.”
The report identifies a chronic shortage of abortion providers and says conscientious objection, together with staff shortages, delayed transfers and the failure to replace providers, contribute to barriers to care.
“In South Africa, the right to a safe, legal abortion, especially for poor, black, rural and township women, remains unrealised,” says Mphahlele.
Illegal abortion services are widely advertised through pamphlets displayed in public spaces. Photo: Moyahabo Mabeba
According to Mphahlele, so-called backyard abortion services are widely advertised through pamphlets displayed in public areas in towns, townships, and rural villages.
“Illegal abortion services persist because of delays in care, insufficient number of abortion providers to meet demand, the arbitrary practice of conscientious objection and a shortage of abortion medicine,” says Mphahlele.
Religious objections and patient rights
The Democratic Nurses Organisation of South Africa (Denosa) in Limpopo says nurses are allowed to practice their ethical beliefs, as provided by the Bill of Rights.
The union’s provincial secretary, Jacob Mamabolo says: ”Nurses face a profound legal-ethical dilemma when placed in sections performing TOP that conflicts with their religious or moral beliefs.”
According to Mamabolo, the Constitution guarantees freedom of conscience and religion, affording nurses the right to refuse to actively perform or directly assist in abortion procedures.
“However, nurses cannot refuse to treat a patient facing a life-threatening medical emergency or severe obstetric complications. If a nurse could not provide TOP services due to religious or ethical beliefs, she or he is legally and ethically obliged to provide the patient with accurate information and refer them to another provider or facility where they can receive safe, legal care,” says Mamabolo.
Limpopo Health Department responds
According to the National Department of Health’s Clinical Guideline for Implementation of the Choice on Termination of Pregnancy Act, healthcare workers who object to providing abortion services on religious or moral grounds must ensure that patients are referred to another provider without delaying access to care.
The Limpopo Department of Health was asked specific questions about Liza’s* allegations, but spokesperson Neil Shikwambana did not address those questions directly. However, Shikwambana says it is ethically not allowed for nurses to refuse Termination of Pregnancy (TOP) care based on religious beliefs.
“While we respect the right of religion as a fundamental right enshrined in the constitution, the work of nurses and public servants, by and large, is governed by the public service regulations and policies,” says Shikwambana.
“TOP is allowed by the laws of this country and forms part of the duties that certain healthcare professionals need to undertake depending on their area of deployment.”
