At least six out of 10 unintended pregnancies end in induced abortion, the World Health Organisation (WHO) says, in a world where birth control measures have become more and easily accessible.
Saying abortion remained a common health intervention, one that was safe, as long as it was carried out using recommended methods, appropriate to the pregnancy duration, and by someone with the necessary skills, they said around 45% of abortions were still unsafe.
In South Africa abortion is legal, but there remains too many pregnant women who still do not know that they are legally entitled to terminate their pregnancies.
Abortions are free in public health care facilities, and, the law of the country says, all pregnant women have the right to a safe, legal abortion at a public health facility, just as long as it is before the three month cut-off time.
“There is no limit to the number of abortions one is allowed to have under the South African law,” the government has said. And as the country marked safe abortion day last week, organisations emphasised that access to safe abortion remained a fundamental human right, one that was essential for women's empowerment, equality and dignity.
Gender links went on to say: “In every country in the world, women of all ages and socio-economic means will at some point decide that they are not able to carry a pregnancy to term for many different reasons. Once a woman decides to have an abortion, she will find a way to do it.”
Many in the country still undergo informal or ‘backstreet’ abortions, gynaecologist and obstetrician Dr Remi Mofokeng said.
“Cultural implications, desperation, and running out of time when the pregnancy has developed beyond the legal termination stage are just some of the reasons,” she said.
The lack of easy access to facilities, the fear of being judged by health workers was another, she added. “The fear of facing social stigma by health workers has led many a woman to opt for backstreet abortions, advertised all over on posters crudely plastered on every available public space.”
And this, said one 36 year-old woman, was precisely why she had had six of her pregnancies terminated.
Asking not to be named in order to protect her identity, she said initially she fell pregnant too soon after giving birth to her first child. “I knew I could not handle two babies and feared my then boyfriend would abandon me,” she said. She was 26 and lived at home, in a community she said judged falling pregnant outside marriage harshly.
She could also not put her mother through the embarrassment of attending church and society meetings with the added shame.
“She was already being frowned at for allowing me to have the one baby by the women she depended on as her own social support structure. If I had had another so soon she would have been ostracised.”
Some of the ladies in her mothers circle were nurses, working in clinics and hospitals where termination was available, but no matter what the codes of confidentiality were, she knew the whole community in her township would have known of her ‘dirty secret’, she said.
She took tablets recommended by someone she had confided in, and while it took three months to recover, she continued with her life, cared for her baby and swore to be always be careful.
It was hardly two years later when she fell pregnant again. “My first baby daddy had gone off and was married, something everyone knew, so the added embarrassment would have been how I had not only failed to keep him, but that I was a baby making machine.”
The only option she saw fit was to terminate the pregnancy, and a quick call to a number on a poster, talking to what she picked up were foreigners at the other end, and two taxi rides to a backroom in another section of her township, she had her second abortion.
“It was unpleasant, but I was not alone. There were other frightened women there, with whom I bonded over the shared secret.”
She spent 4 hours in the room between arriving and post a procedure she still shudders to recall, but two days later she had recovered well enough to return to work.
In quick succession she had fallen pregnant two more times by a married man and he took her to and paid for safe abortions at a reputable facility. “The fifth one was during Covid….I did not trust the father to help raise the baby and did not want to rock my child’s world by bringing another child into a world I had made comfortable for him, so back to a dingy room I went, but not after waiting too long to reach the decision.”
And this time it was so horrific she knew she was living the life of nightmares.
“They gave me tablets and sent me home with instructions not to go anywhere until ‘it’ had come out. I bled so badly and got so weak that an ambulance was called and it took me to hospital.”
It was all a blur, she said, but she was aware of being rushed to theatre, only to come to on a bed in a ward, with a cold baby lying next to her.
The nurses had established that she had been terminating what was an already developed foetus and were punishing her, she said. “I lay there as they went about their business, with a baby wrapped in a small thin blanket next to my head. It was only when the doctor came that they removed it.”
But after a day and a night of sleeping with what the staff told her was an almost seven month old foetus before they took it away, she knew she would never recover from that incident.
She would eventually go to a private facility for therapy and to check for the damages she was told she had probably suffered, and after counselling she turned her back on ever making the mistake of falling pregnant again.
“The emotional scars run deep, I have nightmares. If it was not for the hope of marriage and perhaps having another child to love and care for, even just to erase what I went through I would have, by now, asked to have my womb removed so I never fall pregnant again.”
In Dr Mofokeng’s rooms she has come to slowly regain her trust and confidence in therapy sessions.
Said the doctor: “There are too many women who use abortion as birth control in high rotation. The numbers cannot be collated because of the easy availability of illegally performed procedures.”
She added that cultural and religious, societal and other factors prevented both clear and concise information that was crucial to sustain the health of generations. And all this in addition to laws which did not touch the industry which offered the illusion of ‘easy, safe abortions’ at the hands of untrained people.
Sex and reproductive health education in the home and school was lacking, and young girls and boys fell into a trap, Mofokeng said, one they either used as a safe option not to alarm their parents, or that they never recovered from.
Sunday Independent