The abortion option

Ending a pregnancy is not an easy choice, but it's there if you need it and meet the criteria.

27 November 2017
By Glynis Horning

It’s 20 years since abortion became a legal option in South Africa with the Choice on Termination of Pregnancy Act passed in February 1997 – and the Marie Stopes reproductive health group estimates that 260 000 abortions are performed here each year. But abortion is still contentious for many on moral and religious grounds, and is a choice that needs to be taken after consideration of all options – including having your baby and placing it for adoption.

The timeline

In the first trimester of pregnancy (until week 13), abortion is available on request, no reasons required, to any woman of any age. Parental consent is not required for under 18s, but they are advised to discuss it with a trusted adult, though they can decide not to, says Dr Deborah Constant, senior researcher at the Women’s Health Research Unit at the University of Cape Town.

In the second trimester (weeks 13 to 20), abortion is available only if your physical or mental health is at risk, the baby will have severe physical or mental abnormalities, the pregnancy is the result of incest or rape, or you are of the opinion that your social or economic position is enough reason to end the pregnancy. “There’s no means test and this is a common enough situation – not being able to manage a child now,” says Constant.

In the third trimester (after week 20), abortion is available if your life or the life of the foetus is in danger, or there are likely to be severe birth defects.

Where is it available?

Up to nine weeks of gestation, professional nurses, midwives and medical doctors can perform a medicine-induced abortion at their premises, if these have been designated to provide safe abortion services; and up to 12 weeks, nurses and midwives with special training can perform a surgical abortion at clinics or hospitals, says Whitney Chinogwenya, spokesperson for Marie Stopes SA.

In the second and third trimester, abortion must be carried out by a medical doctor, and after 20 weeks, this must be done in a designated government hospital.
 It’s crucial to choose a safe and legal provider, and to avoid a back street abortionist, who will usually be untrained and put your health, future fertility and even life at risk. Marie Stopes reports that up to 58% of abortions in South Africa each year are still illegal, because many women struggle to access legal services.

According to research by Amnesty International in collaboration with the University of Cape Town’s Women’s Health Research Unit, only half of the state facilities designed to provide abortions are delivering the service. Reasons range from nurses and doctors at state health facilities being unwilling to provide abortion care (it’s their choice), to women lacking information on their reproductive rights, or being afraid to be seen accessing it because of stigma around it.

“But there are increasing numbers of facilities coming online that were not designated before,” says Constant. “So in the Western Cape, for instance, the number of termination of pregnancies performed has risen significantly in the last few years – mainly an increase in early medical abortion.”

The process

At Marie Stopes clinics, after you’ve been examined to confirm your pregnancy, and offered counseling, there are three options, depending on your personal choice and medical history, says Chinogwenya:

  • A medical process (available from 4 to 9 weeks), where you are given a set of abortion tablets to take orally in the clinic, and a second set to take later at home. There is usually no need to return.
  • An early surgical method – a nurse uses a suction method to remove the pregnancy. The procedure takes five to 10 minutes and is available from 4 to 12 weeks. You go home the same day.
  • From 12 to 20 weeks, a surgical abortion is offered, where a doctor removes the pregnancy vaginally. The method used depends on how advanced your pregnancy is. Later abortions (after week 18) are done under general anaesthetic; for earlier ones you can request “conscious sedation” so you feel sleepy and relaxed. You go home the same day, but should be accompanied.

Useful contacts:

  • Marie Stopes South Africa: 0800 11 77 85.
  • Local government clinics: For a free abortion you need to make a request at a primary healthcare clinic. Pregnancy will be confirmed, counseling provided, an appointment made and a referral letter given to a facility where the procedure can be performed.
  • LifeLine offers counseling to women considering abortion: 0861 322 322.
  • The SA Depression and Anxiety Group offers counseling if you are considering or have had an abortion: 0800 20 50 26.

The morning-after pill

This is not the same as an abortion pill. Instead of terminating a pregnancy, it prevents it by interfering hormonally with ovulation or fertilisation of the egg or sometimes with implantation. It must be taken within 72 hours of unprotected sex, and is available over the counter at Clicks pharmacies. “It’s best to take it the next morning after unprotected sex – the sooner you take it, the more effective,” says Constant.

IMAGE CREDIT: Getty Images