Although abortions are legal and free in South Africa, doctors and nurses are not required to provide this service (so to speak). Therefore, many doctors and nurses refuse to perform abortions on moral grounds, sometimes without knowing that they are breaking the law. By one estimate, only 7% of public facilities actually provide abortions.
This means that figuring out how to have an abortion in South Africa can be difficult. The lack of abortion clinics in certain areas and the stigmatization of the procedure are the reason why many South African women choose to have illegal abortions.
Illegal or “backstreet” abortions can be unsafe and can result in injury and death. This is why Marie Stopes, a registered reproductive healthcare provider, recommends using a legal abortion clinic. However, “there is a difference between an illegal abortion and an unsafe abortion,” clarifies Victoria Satchwell, the director of Abortion Support South Africa, a non-profit organization that provides teleabortion services. “If there is no access to a legal abortion, people may choose an illegal provider, but it is important to know that some illegal providers are safer than others.” Are you concerned about the safety of the abortion procedure? Here we explain exactly how safe an abortion is at different points in your pregnancy.
READ MORE: Where should you go for a safe abortion in South Africa?
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Your legal rights regarding abortion in South Africa
The National Clinical Guideline for the Implementation of the Choice on Termination of Pregnancy Act (2020) outlines the clear steps for abortion in South Africa. In South Africa, a woman can terminate her pregnancy for any reason up to 12 weeks. This abortion can be performed by a trained nurse, midwife or trained doctor. Between weeks 13 and 20, you are allowed to terminate the pregnancy if there is a reason to do so, such as if you cannot afford a child, if the pregnancy was due to rape or incest, if there are risks to your physical or mental health (e.g. if continuing the pregnancy could lead to depression), or if there is a fetal anomaly. After 20 weeks and 6 days, abortion is allowed only if your life is in danger or there is a serious abnormality in the fetus. For more information on the legal details, see this article.
Important: Only the pregnant person has to consent to the abortion. If you are under 18, you do not need parental permission. You never need the consent of a partner or spouse.
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You are pregnant and don’t want to be – what should you do?
Step 1: Take a pregnancy test
If you have pregnancy symptoms like nausea, more frequent peeing, or tender breasts, it’s a good idea to take a pregnancy test before seeking abortion care, says Satchwell. If you’d rather not buy one yourself, you can have it delivered through delivery services.
Women who wish to terminate their pregnancy are advised to have the abortion as early as possible. “Act quickly. Abortion is time sensitive,” Satchwell said. “Many clinics only offer treatment for up to 10 or 12 weeks, so delays can affect both your legal options and your ability to get an appointment.”
Step 2: Know your abortion options
What different types of abortions are there?
Abortion treatment can be performed with pills (medical abortion) or in a clinic with minor surgery (surgical abortion). Both medical and surgical abortion are safe and effective throughout the pregnancy, but not all clinics offer both options.
Abortion with pills (medical abortion)
There are two ways to have an abortion using pills. One option uses two drugs together, mifepristone and misoprostol, and is 98% effective (2 in 100 abortions will be unsuccessful). The other option uses misoprostol alone, which is about 90% effective (10 out of 100 abortions will not be successful). Some people choose to use misoprostol alone because it is cheaper and more widely available.
Self-directed abortion
When you go to a clinic for a medical abortion, in most cases you will take the pills that cause bleeding at home. According to Satchwell, “some women find that it is more affordable, more convenient, more private, or more empowering not to go to the clinic at all but to access medications through telemedicine.” This is also known as self-directed abortion and is recommended by the World Health Organization for up to 12 weeks.
Research shows that taking pills at home is safe and effective. According to the Department of Health’s Abortion Policy, an ultrasound scan is not routinely required before an abortion, and you only need to see a healthcare professional after the abortion if you are concerned that there have been complications or that the abortion did not work.
You can order abortion pills online, by phone, or online from a healthcare provider. Your abortion pills can be picked up at a pharmacy or delivered to your home. This service is available from Abortion Support or Marie Stopes. “Abortion Support does not charge for this service, but you pay R220 for abortion pills and collect your medication from a pharmacy,” says Satchwell.
Surgical abortion
A surgical abortion is performed by a nurse or doctor in a clinic or hospital and involves a minor procedure in which the pregnancy is removed using gentle suction.
In the first trimester, you can have a medical abortion, which requires taking two tablets, mifepristone and misoprostol (also known as Cytotec), to induce a miscarriage if the pregnancy is between the fourth and ninth weeks. Medical abortions after nine weeks are illegal in South Africa. Unlike surgical abortions, medical abortions become less effective over time.
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READ MORE: Finally there are contraceptive services in South Africa
Is abortion safe?
Decades of research show that abortion is safe and effective. “Perceptions of abortion safety are influenced by stigma and sometimes intentionally misleading information,” Satchwell says. “It’s important that people know the science – 56 million women have an abortion every year and the data shows this is safer than other common medications we use and much safer than childbirth.” According to research, abortion with pills is safer than Panado, it is safer than antibiotics and it is safer than Viagra. Only about 2% of women who undergo abortion experience complications. In the rare cases where a complication occurs, most complications are minor and easily treatable.
Where to have an abortion in South Africa
If your pregnancy is 10 weeks or less, you can opt for a home abortion with pills. You can order abortion pills from a healthcare provider over the phone or online. Your abortion pills can be picked up at a pharmacy or delivered to your home. You cannot buy abortion pills at the pharmacy without a prescription; You will receive your prescription from your abortion provider.
You can also go to a public or private clinic. Satchwell outlines these points:
- Public care is free. You can visit the nearest public clinic to find out if they perform abortions. Or ask them where the nearest referral opportunity is.
Keep in mind that only about 7% of public health facilities provide abortion care. And you may be far away from a clinic. There is currently no complete or accurate list of public clinics offering abortions.
- Private clinics and some gynecologists offer abortion care. The costs for these services vary depending on the provider.
You can check out the following resources to find clinics near you that offer abortions:
It is important to choose a secure provider. For more information on identifying an unsafe provider, click here.
After 10-12 weeks, it may be more difficult to find abortion care because there are fewer clinics offering this service. If you are having difficulty finding medical care at this gestational age, you can contact Section 27.
READ MORE: Why it’s important to talk about your period and how to do it
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Why access to legal abortion is important
It has been just over 30 years since South Africa passed the Choice on Termination of Pregnancy Act, legalizing abortion. Since then, abortion deaths have declined. According to the National Department of Health, 1.2% of all maternal deaths are due to unsafe abortions.
Doctors note that there is a close connection between the safety of the procedure and the legality of the clinic. And because of the barrier to accessing legal, safe abortions (nationwide, only about 7% of public hospitals actually offer this service), unsafe abortions are a common practice. According to a 2018 study, about 52 to 59 percent of the estimated 260,000 abortions in South Africa were illegal. WH couldn’t find any recent studies.
“The most effective way to curb unsafe abortion is to make safe abortion truly accessible,” Satchwell says. “When women, pregnant women and girls can receive safe, affordable and compassionate care, they are far less likely to turn to someone selling pills at the taxi rank. There are unsafe providers because there is a gap in the formal healthcare system, and where there is a gap there is a market.”
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