South Africa has some of the most liberal sexual and reproductive health laws in the world. This means that as women we have control over our bodies. In South Africa, women have a legal right to a safe abortion up to the 20th week of pregnancy. This has been the case since November 1996 under the Choice on Termination of Pregnancy Act 92 of 1996. An abortion can be performed after 20 weeks, but only if your life is in danger or your baby cannot be delivered to term.
Still, it can be difficult to actually have a safe abortion in South Africa. Stigma and negative attitudes from health care providers affect women’s ability to have safe abortions. What’s more, despite the law, “only about 7% of public health facilities provide abortion care,” explains Victoria Satchwell, executive director and co-founder of Abortion Support. Every second flyer offers safe and painless abortions. But who can you trust? Here’s everything you need to know about your options.
What abortion rights exist in South Africa?
All women have the right to legal and safe abortions. This means it doesn’t matter how old you are or what your family, husband or partner think. Essentially, it’s up to you. There is also no limit to the number of times you can perform the procedure. You have the right to decide what is best for you and your body. Further rights:
Women of all ages do not need a permit to have an abortion.
“Only the person performing the abortion has to consent,” Satchwell says. “If you are under 18, you do not need to inform your parents or get their permission.”
READ MORE: Everything you need to know about pregnancy and abortion now
Abortions in state clinics and hospitals are free.
And according to the mandatory minimum benefits, abortions in private facilities must be covered by your medical assistance. “This applies whether the abortion is for medical reasons or because you decide not to continue the pregnancy,” explains Satchwell, “although the level of coverage may depend on your plan and provider network.” If your medical certificate indicates that abortion is not covered, you should contact the Council for Medical Schemes to lodge a complaint.
Any facility that offers legal abortion in South Africa must be registered.
This is one way to ensure the safety of your treatment. Satchwell recommends asking the provider for their registration number, either HPCSA for doctors (Health Professions Council of South Africa) or SANC for nurses (South African Nursing Council), and checking this online.
Alternative practitioners have the right to refuse termination…
However, this only applies to the person who actually carries out the termination. According to the National Clinical Guideline for the Implementation of the Choice on Termination of Pregnancy Act, Ed 1, “Only the direct TOP (termination of pregnancy) provider may refuse treatment (no other health care provider or support staff member may refuse treatment).”
This means that only a doctor who would directly terminate the abortion can refuse to perform the abortion, but the care staff cannot refuse to do so either. But any provider who refuses “shall refer the individual to a colleague or facility capable of providing such services,” the policy continues.
A pharmacist may not refuse treatment.
By law, pharmacists must provide the necessary care. Anyone who obstructs access to an abortion may be fined under Section 10 of the CTOP Act.
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What options are there for abortions?
There are options when it comes to abortion methods. It’s important to talk to your doctor about which option is safest for you.
Medical abortions
A medical abortion is carried out exclusively with medication (pills or tablets). This option is available to women between the fourth and ninth weeks of pregnancy. The length of the procedure varies for each woman, but usually lasts a few days.
A medical abortion requires the use of two medications. One of them stops the growth of the embryo and the second (taken two days later) triggers contractions that expel the embryo. There will be heavy bleeding within the first six hours, and you should expect bleeding or spotting for about two weeks. A follow-up visit after 10 to 14 days is important to ensure the abortion was successful.
Surgical abortions
Surgical abortions involve a nurse or doctor and are a same-day procedure in the clinic or hospital. You may be given the same medications used in a medical abortion to get the process started. Typically, once the surgical abortion is complete, you will not bleed as much as you would with a medical abortion.
READ MORE: “We need to have more open conversations about miscarriage, abortion and pregnancy”
Where can you get an abortion in South Africa?
Abortion Support offers a free digital consultation to get a prescription for abortion pills. You must purchase the medication from your local pharmacy. Misoprostol alone costs around R220. The slightly more effective combined method using mifepristone and misoprostol costs around R1100. The cost of medication is the only cost incurred.
Marie Stopes offers a telemedicine option, including delivery and medication administration. For inpatient care, prices differ between medical abortion (abortion with pills) and surgical/procedural abortion. More advanced pregnancies incur higher costs. Prices depend on gestational age and method used.
How do you know if an abortion is unsafe in South Africa?
“Legal abortions are almost always safe in South Africa,” says Satchwell. “There is a difference between an illegal abortion and an unsafe abortion.” While legal abortions are not always accessible for many reasons, illegal providers become lifelines, although some are safer than others, Satchwell says. Here Satchwell outlines guidelines for the margin for safety.
A provider is not safe if it:
- Don’t estimate how far along you are in your pregnancy (you should ask for an ultrasound or the date of your last period).
- Do not provide clear instructions about how to use medications, what to expect during the abortion in terms of bleeding and pain, what warning signs to look for, and what to do if complications arise
- They tell you to insert any foreign objects such as herbs, roots, newspaper, steel wool, etc. into the vagina. (This is very dangerous and should never be done.)
- Perform surgical/procedural abortions outside of a sterile (clean) environment. (This is very dangerous and should never be done.)
When purchasing abortion medication, make sure the pills are misoprostol or mifepristone. Avoid using other medications for abortion purposes. Pills not in the original blister pack (silver packaging) may be counterfeit or unsafe. For guidance on how to safely use medication at home, you can contact Women on Web at info@womenonweb.org who will provide you with guidance and support throughout the process.