Women and girls risk unsafe abortions that can lead to serious health complications, and even death, due to persistent barriers to legal abortion services, according to research by Amnesty International and the Women’s Health Research Unit of the School of Public Health and Family Medicine at the University of Cape Town.
The briefing published today highlights how despite South Africa having one of the world’s most progressive legal frameworks for abortion, many women and girls - especially those in the poorest and most marginalized communities - struggle to access safe abortion services. A key barrier is the failure of the government to regulate the practice of ‘conscientious objection’ through which health professionals can refuse to provide abortion services.
“No one, regardless of their social status, should be denied their right to make a decision about their pregnancy. This briefing exposes the deep inequalities in the health system that continue to discriminate against impoverished women and girls,” said Muleya Mwananyanda, Amnesty International’s Deputy Director for Southern Africa.
“The National Department of Health must urgently intervene to ensure women and girls’ access to abortion is no longer at the mercy of health professionals’ personal attitudes.”
Today marks 20 years since the adoption of the Choice on Termination of Pregnancy Act (CTOPA) in the country.
In one case highlighted in the report, a 19-year-old student from Johannesburg died in 2016 following complications from an unsafe abortion. A United Nations representative blamed health system deficiencies, stigma and discrimination as contributing factors in the woman’s death.
Other deaths due to unsafe abortions are harder to document. The briefing highlights the need for disaggregated data on deaths resulting from abortion within the government’s monitoring of pregnancy-related deaths.
It also warns that the implementation of the CTOPA remains inadequate, and could result in violations of the government’s obligations under international human rights law. Under regional and international human rights standards, South Africa has a duty to ensure that conscientious objection does not impact on access to services and that a functioning referral process guarantees timely and appropriate quality care to every person seeking an abortion.
The briefing also highlights the confusion around the limits of conscientious objection and health care professionals’ duties in relation to providing abortion care.
Under the right to Freedom of Conscience in the South African Constitution, health care professionals are understood to have the right to refuse to perform an abortion in certain cases, but never in emergencies, or where the woman or girl’s life is at risk.
The CTOPA further stipulates that any person who prevents or obstructs access to legal abortion services is guilty of an offence, punishable by a fine or imprisonment.
“The lack of clear policy guidelines to service providers creates a vacuum and allows conscientious objection to be applied inconsistently,” said Muleya Mwananyanda.
“A woman’s right to life, health and dignity must always take precedence over the right of a health care professional to exercise conscientious objection to performing an abortion. This is not the reality in South Africa. Regulation and clear policy guidelines are urgently required to correct the current vacuum.”