Abortion is legal in South Africa, but over half of abortions remain unsafe there. Evidence suggests women who are (Black) African, of lower socioeconomic status, living with HIV, or residents of Gauteng, KwaZulu-Natal, or Limpopo provinces are disproportionately vulnerable to morbidity or mortality from unsafe abortion. Negative attitudes toward abortion have been documented in purposively sampled studies, yet it remains unclear what attitudes exist nationally or whether they differ across sociodemographic groups, with implications for inequities in service accessibility and health. In the current study, we analysed nationally representative data from 2013 to estimate the prevalence of negative abortion attitudes in South Africa and to identify racial, socioeconomic and geographic differences. More respondents felt abortion was ‘always wrong’ in the case of family poverty (75.4%) as compared to foetal anomaly (55%), and over half of respondents felt abortion was ‘always wrong’ in both cases (52.5%). Using binary logistic regression models, we found significantly higher odds of negative abortion attitudes among non-Xhosa African and Coloured respondents (compared to Xhosa respondents), those with primary education or less, and residents of Gauteng and Limpopo (compared to Western Cape). We contextualise and discuss these findings using a human rights-based approach to health.
After its formation in 1910 as a self-governing dominion within the British empire, the Union of South Africa followed a combination of English and Roman-Dutch common laws on abortion that decreed the procedure permissible only when necessary to save a woman's life. The government continued doing so after South Africa withdrew from the Commonwealth and became a republic in 1961. In 1972 a sensational trial took place in the South African Supreme Court that for weeks placed clandestine abortion on the front pages of the country's newspapers. Two men, one an eminent doctor and the other a self-taught abortionist, were charged with conspiring to perform illegal abortions on twenty-six white teenagers and young unmarried women. The prosecution of Dr Derk Crichton and James Watts occurred while the National Party government was in the process of drafting abortion legislation and was perceived by legal experts as another test of the judiciary's stance on the common law on abortion. The trial was mainly intended to regulate the medical profession and ensure doctors ceased helping young white women evade their 'duty' to procreate within marriage. Ultimately, the event encapsulated a great deal about elites' attempt to buttress apartheid culture and is significant for, among other reasons, contributing to the production of South Africa's extremely restrictive Abortion and Sterilisation Act (1975).
"BACKGROUND: The Choice on Termination of Pregnancy Act of 1996 (Act 92 of 1996) allows abortions to be legally carried out in South Africa. It is not clear how many people are utilising this service. Mthatha is a poverty-stricken area with a high rate of illiteracy. The available infrastructure, such as roads, health facilities and communication, is poor. METHODS: This was a retrospective, descriptive study carried out at the Nelson Mandela Academic Hospital in Mthatha. The registered criminal abortion cases recorded between 1993 and 2006 were analysed. RESULTS: There were 51 cases of criminal abortions recorded from 1993 to 2006. Of these, 32 were aborted in the first trimester of pregnancy and the rest were in the second trimester. No significant gender differences were observed among aborted babies. 10 of the foetuses were male and nine were female. The highest number (nine) of abortions was recorded in 1993 and in 2005. The highest number of criminal abortions (11) took place in May. Most cases (35) were concealed births and were discovered accidentally either by the public or the police. CONCLUSION: The Choice on Termination of Pregnancy Act of 1996 (Act 92 of 1996) had no impact on criminal abortions in the Mthatha area of South Africa."
A rich literature exists on local democracy and participation in South Africa. While the importance of participation is routinely built into the rhetoric of government, debate has increasingly focused on the dysfunctionality of participatory mechanisms and institutions in post-apartheid South Africa. Processes aimed ostensibly at empowering citizens, act in practice as instruments of social control, disempowerment and cooptation. The present article contributes to these debates by way of a critique of the approach used by the South African state, in partnership with the Non-governmental sector, in what are called abortion "values clarification" (VC) workshops. This article examines the workshop materials, methodology and pedagogical tools employed in South African abortion VC workshops which emanate from the organization Ipas — a global body working to enhance women's sexual and reproductive rights and to reduce abortion-related deaths and injuries. VC workshops represent an instance of a more general trend in which participation is seen as a tool for generating legitimacy and "buy-in" for central state directives rather than as a means for genuinely deepening democratic communication. The manipulation of participation by elites may serve as a means to achieve socially desirable goals in the short term but the long-term outlook for a vibrant democracy invigorated by a knowledgeable, active and engaged citizenry that is accustomed to being required to exercise careful reflection and to its views being respected, is undermined. Alternative models of democratic communication, because they are based on the important democratic principles of inclusivity and equality, have the potential both to be more legitimate and more effective in overcoming difficult social challenges in ways that promote justice.
There exists an enormous gulf between the aspirations of South Africa's abortion legislation – among the most liberal in the world – and its implementation. One weakness in the provision of abortion services in South Africa is the absence of comprehensive abortion counselling services. On the face of it, the idea that counselling ought, as a matter of course, to be a significant component of a country's termination of pregnancy service provision, seems both straightforwardly sensible and politically innocent. This paper describes how abortion counselling has historically, in many different contexts, been saturated with questionable assumptions about women and their bodies. Counselling has more often than not been deployed, either as the formal policy of states or through informal mechanisms, as a means of curbing the right to abortion rather than deepening the meaning of that right. Differing approaches to counselling emerge as a reflection of contestations over reproductive and gender politics. Specifying an appropriate model for the provision of state-sponsored abortion counselling in the public health sector of a secular constitutional state provokes more of a hornet's nest of dilemmas than is sometimes supposed.
"BACKGROUND: Although abortion is legally available in South Africa, barriers to access exist. Early medical abortion is available to women with a gestational age up to 63 days and timely access is essential. This study aimed to determine women’s acceptability and ability to self-assess eligibility for early medical abortion using an online gestational age calculator. Women’s acceptability, views and preferences of using mobile technology for gestational age (GA) determination were explored. No previous studies to ascertain the accuracy of online self-administered calculators in a non-clinical setting have been conducted. METHODS:A convenience sample of abortion seekers were recruited from two health care clinics in Cape Town, South Africa in 2014. Seventy-eight women were enrolled and tasked with completing an online self-assessment by entering the first day of their last menstrual period (LMP) onto a website which calculated their GA. A short survey explored the feasibility and acceptability of employing m-Health technology in abortion services. Self-calculated GA was compared with ultrasound gestational age obtained from clinical records. RESULTS: Participant mean age was 28 (SD 6.8), 41 % (32/78) had completed high school and 73 % (57/78) reported owning a smart/feature phone. Internet searches for abortion information prior to clinic visit were undertaken by 19/78 (24 %) women. Most participants found the online GA calculator easy to use (91 %; 71/78); thought the calculation was accurate (86 %; 67/78) and that it would be helpful when considering an abortion (94 %; 73/78). Eighty-three percent (65/78) reported regular periods and recalled their LMP (71 %; 55/78). On average women overestimated GA by 0.5 days (SD 14.5) and first sought an abortion 10 days (SD 14.3) after pregnancy confirmation. CONCLUSIONS: Timely access to information is an essential component of effective abortion services. Advances in the availability of mobile technology represent an opportunity to provide accurate and safe abortion information and services. Our findings indicate that an online GA calculator would be accurate and helpful. GA could be calculated based on LMP recall within an error of 0.5 days, which is not considered clinically significant. An online GA calculator could potentially act as an enabler for women to access safe abortion services sooner. "
A key element in cultural and gender power relations surrounding abortion is how women who undergo an abortion are represented in public talk. We analyse how women were named and positioned, and the attendant constructions of abortion, in South African newspaper articles on abortion from 1978 to 2005, a period during which there were radical political and legislative shifts. The name 'woman' was the most frequently used (70% of articles) followed by 'girl/teenager/child' (25%), 'mother' (25%), 'patient' (11%) and 'minor' (6%). The subject positionings enabled by these names were dynamic and complex and were interwoven with the localised, historical politics of abortion. The 'innocent mother' and the bifurcated 'patient' (woman/foetus) positionings were invoked in earlier epochs to promote abortion under medical conditions. The 'dangerous mother' and woman as 'patient' positionings were used more frequently under liberal abortion legislation to oppose and to advocate for abortion, respectively. The positioning of the 'girl/teenager/child' as dependent and vulnerable was used in contradictory ways, both to oppose abortion and to argue for a liberalisation of restrictive legislation, depending on the attendant construction of abortion. The neutral naming of 'woman' was, at times, linked to the liberal imaginary of 'choice'.
"Safe abortion is a necessary prerequisite of the human rights to health and gender nondiscrimination, yet half of abortions globally are still unsafe—contributing to 13% of maternal mortality. In South Africa, abortion was legalized after Apartheid in 1996, but today an estimated 58% of abortions remain unsafe there and researchers have observed resurgence in abortion-related deaths since 2002. Preliminary evidence suggests Black African women of lower socioeconomic position, particularly those living with HIV, are at disproportionate risk of unsafe abortion-related complications and death. Poor access to safe services is often cited as the major barrier to safe abortion. While most researchers have attributed such limited access to abortion stigma, it remains unclear how prevalent negative abortion attitudes are in South Africa today, how those might have changed over time, or whether differences exist by race or socioeconomic position. The current study analyzes abortion attitudes collected in a nationally representative sample from the South African Social Attitudes Survey in 2013. First, the study investigates how prevalent negative abortion attitudes are in South Africa today. Then binary logistic regression models of negative abortion attitudes are used to calculate odds ratios for race, educational attainment, and household income. Binary logistic regression models are also estimated stratified by race and education level. Results suggest an important role of secondary and post-secondary education in addressing abortion stigma. Significant differences in abortion attitudes are noted by province but not by race. "
OBJECTIVES: Home use of misoprostol for medical abortion is more convenient for many women than in-clinic use but requires management of abortion symptoms at home without provider backup. This study evaluated whether automated text messages to women undergoing medical abortion can reduce anxiety and emotional discomfort, and whether the messages can better prepare women for symptoms they experience. STUDY DESIGN: A multisite randomized controlled trial was conducted in which women undergoing early medical abortion were allocated to receive standard of care (SOC) only (n=235) or SOC+a messaging intervention (n=234). Consenting women were interviewed at the clinic after taking mifepristone and again at their follow-up clinic visit 2-3 weeks later; the intervention group received text messages over the duration of this period. Emotional outcomes were evaluated using the Hospital Anxiety and Depression Scale, Adler's 12-item emotional scale and the Impact of Event Scale-Revised. Preparedness for the abortion symptoms and overall satisfaction with the procedure were assessed using 4-point Likert-type scales. RESULTS: Between baseline and follow-up, anxiety decreased more (p=0.013), and less emotional stress was experienced (adjusted for baseline anxiety, p=0.015), in the intervention compared to the SOC group. Participants in the intervention group were also more likely to report that they felt very well prepared for the bleeding (p<0.001), pain (p=0.042) and side effects (p=0.027) they experienced. Acceptability and other negative emotions relating to the abortion did Not differ between study groups. Ninety-nine percent of the intervention group stated that they would recommend the messages to a friend having the same procedure. CONCLUSIONS: Text messages to women following mifepristone administration for early medical abortion may assist them in managing symptoms and appear highly acceptable to recipients. IMPLICATION STATEMENT: This randomized controlled trial provides evidence for the effectiveness of text messages following mifepristone administration in strengthening medical abortion care. The messages were associated with significant reductions in women's anxiety and stress during the abortion process; they improved preparedness for the abortion symptoms experienced and appeared highly acceptable.
Discursive constructions of abortion are embedded in the social and gendered power relations of a particular socio-historical space. As part of research on public discourses concerning abortion in South Africa where there has been a radical liberalisation of abortion legislation, we collected data from male group discussions about a vignette concerning abortion, and newspaper articles written by men about abortion. Our analysis revealed how discourses of equality, support and rights may be used by men to subtly undermine women's reproductive right to 'choose' an abortion. Within an Equal Partnership discourse, abortion, paired with the assumption of foetal personhood, was equated with violating an equal heterosexual partnership and a man's patriarchal duty to protect a child. A New Man discourse, which positions men as supportive of women, was paired with the assumption of men as rational and women as irrational in decision-making, to allow for the possibility of men dissuading women from terminating a pregnancy. A Rights discourse was invoked to suggest that abortion violates men's paternal rights