The State of Women’s Health in South Africa
Government aid is not an appropriate method of family planning
As long as you live you’ll never see a photograph of 7 women signing legislation about what men can do with their reproductive organs pic.twitter.com/dXjfVjnRiX
— Martin Belam (@MartinBelam) January 23, 2017
Not a photo from a Saturday Night Live skit nor a prophetic image of a dystopian future to come, on 23 January this year, US President Donald Trump, surrounded solely by men, signed an executive order described as the “global gag rule on steroids”.
But what exactly is the global gag rule?
If women’s fundamental rights are subject to change dependent on which man holds the Oval Office, can women truly consider themselves free?
First imposed on women by Ronald Reagan in 1984, the global gag rule, also known as the Mexico City Policy, was rescinded in 1993 by Bill Clinton, who referred to the policy as “excessively broad”. However, in 2001, George Bush reintroduced the policy only for it to be rescinded once again by Barack Obama in 2009.
Under Trump’s administration, the global gag rule has been reinstated and significantly expanded to the extent that US foreign aid is barred from going to any non-governmental organisation (NGO) that either provides abortions or even discusses abortions with its patients, even if such programmes are self-funded. In other words, while the original policy focused on family-planning organisations, the current policy extends to organisations focused on Aids, malaria and paediatrics. To ensure continued funding, these organisations must not allow any of their programmes to even suggest an abortion, even if it’s legal, even if a woman asks.
While this obviously affects local NGOs funded by the US and government programmes, because of bilateral relations with the United States Agency of International Development (USAID), it brings the wider issue of women’s access to abortion into focus, especially given its contingent nature subject to change per the whims of the government of the day.
What’s the state of women’s health in South Africa with regard to abortion?
“No one, regardless of their social status, should be denied their right to make a decision about their pregnancy.” — Muleya Mwananyanda, Amnesty International’s deputy director for Southern Africa
In February 1996, one of the most progressive abortion laws in the world came to pass in South Africa. The Choice on Termination of Pregnancy Act entitled South African women of whatever age to free abortions at a public facility.
Fast-forward 20 years and only 40% of public, surgical abortion facilities are operational, medical abortion drugs are not listed as essential drugs, and healthcare providers opt out of providing women with abortion services without following the proper procedures for referral. It is estimated that 50% of abortions in South Africa are provided by illegal or untrained providers and almost 10% of maternal deaths in South Africa are due to unsafe abortions with 30% being from Aids-related conditions. This is according to Marion Stevens, chairperson of the Sexual and Reproductive Justice Coalition and Research Associate at the African Gender Institute (University of Cape Town).
This indicates a disjuncture between the constitutional promise and the lived experience of many women in South Africa. In fact, so overwhelmed by the prevalence of posters advertising ‘safe and pain-free abortion’ by backstreet clinics, many women in South Africa do not even know that they are constitutionally entitled to a free and legal abortion. With endemic sexual violence, this is a disturbing reality made worse by the top-down stigma surrounding abortion. Health minister Aaron Motsoaledi has repeatedly asserted disapprovingly that young women use abortion as contraception, despite activists responding that this assertion is not only sexist, it’s also not backed by data.
While the health minister’s views are disappointing and disturbing, they are sadly a reflection of the view of many healthcare professionals. Amnesty International suggests that the refusal of doctors or nurses to perform abortions under the cloak of conscientious objection is the major issue, as there is a lack of clear guidelines and protocols. Healthcare providers who exercise their constitutional right to conscientious objection are still required to refer women to alternative abortion providers, and they cannot refuse to perform pre- or post-abortion care. Doctors and nurses are also not allowed to refuse to perform an abortion when there is an immediate risk to the woman’s health.
As Mwananyanda has stated: “A woman’s right to life, health and dignity must always take precedence over the right of a healthcare professional to exercise conscientious objection to performing an abortion.”
If you need more information about abortion facilities and your rights to an abortion, visit the Marie Stopes website: www.mariestopes.org.za
Or call: 0800 11 77 85