Fewer than half the state hospitals and clinics chosen to provide termination of pregnancy procedures are offering the service to pregnant women. This is according to the South African Health Review 1999 released yesterday (wed feb.9) by the Health Systems Trust.

Some 246 public health facilities are responsible for offering abortions to South African women but only 73 are delivering the service. Of these, almost half (49%) of all termination of pregnancies (TOPs) were done in Gauteng where a larger proportion of health services provide TOP services.

Despite having by far the largest female population in the country, Kwazulu-Natal, a largely rural province, only registered 10% of the total TOPs.

At first glance, the overall national figure of 70 000 TOPs already conducted since the passing of the Choice on Termination of Pregnancy Act two years ago seems encouraging, given that TOP is a new service.

But the review conducted by the Women’€™s Health Project shows that these national figures hide the way in which certain groups of women have greater access to TOP services than others.

In particular, access to TOP services for women from peripheral areas, and for teenagers throughout the country, remains limited.

The review shows that it is mostly older women who have already had children who use TOP services. The average age of women using TOP services is 28, whereas the latest findings in the Department of Health’€™s Demographic and Health Survey, show that one in three (35%) of South African women have been pregnant by the age of 19.

One of the reasons why the access of teenagers to abortion services is limited is that young women are still unaware of their right to request a safe and legal abortion. And many health care workers still have negative attitudes towards TOPs.

Although dedicated abortion staff are sympathetic, health care staff at referring centres, who act as gatekeepers to abortion services, often try to prevent women, especially young women, from having abortions.

Most nurses are still unaware that by law, young women, even if they are still minors, have the right to an abortion on request, and do not require parental consent.

In the general population, many people do not know that women are now legally entitled to an abortion without their partner or parent’€™s consent. In a study conducted in urbanised areas of the Northern Cape, only 55% of respondents had heard that abortion is available on request and just 24% knew that parental or partner consent was not required.

Although the number of maternal deaths resulting from incomplete or backstreet abortions has dropped substantially, it is still unacceptably high. In the Department of Health’€™s 1998 Inquiry into Maternal Deaths, lack of available TOP services was given as the cause of death in 44% of cases where abortion resulted in death.

According to a doctor at Umtata General hospital in the Eastern Cape, one of the reasons for the high number of deaths which still occur due to incomplete or septic “backstreet” abortions is that women requesting abortions are turned away because there are insufficient beds.

The doctor, who did not wish to be named, said that none of the beds at Umtata Hospital, the only facility providing TOP in the former Transkei, are reserved exclusively for abortions and the hospital admits a maximum of three patients for abortions per day.

A lot more needs to be done before TOP becomes available to all women in South Africa. Until then, women who are turned away from public health facilities will continue to die in South Africa from unsafe backstreet abortions.

“While on the one hand South Africa has a legal framework for abortion next to none in the world, implementation of the very same progressive legal victories have been slow and short-term in nature,” says Sanjani Varkey from the Women’€™s Health Project and author of the review. – Health-e news service