When challenged about the lack of campaigns that provide information on the legal status of abortion, Yogan Pillay of the department of health is quoted as saying: “What we don’t want to do is encourage unnecessary abortions. It’s a balance between making these services available, destigmatising them and creating awareness, and at the same time not encouraging people to use it as an alternative to contraception.” (“Moral crusade condemns SA women to die” Mail & Guardian, January 30)
Unnecessary abortions? What can this mean? By whose standards? But, perhaps more importantly, what are we saying when we equate abortion with contraception?
The idea that women may weigh up the use of contraception and decide against it because abortion is available is based on a number of problematic assumptions.
The first is that women are able to decide freely when, where and with whom to have sex. Given the well-documented levels of sexual violence, sexual coercion (even in stable relationships), transactional sex and multiple sexual partners in South Africa, this assumption is unfounded for a large number of women.
Men are the decision-makersThe second assumption is that women live in gendered relations in which decisions about contraception are entirely their own. Once again research shows us that men often have very different ideas about whether their partners should use contraception and what kind they should use. Men, other than using condoms, seldom take responsibility for contraception and rarely use condoms in long-term relationships.
The third assumption is that, in the rare cases where none of the gendered power relations are in operation, women will flippantly compare contraception with abortion, as if it is a choice between imbibing coffee or tea in the morning. Ah, who cares about taking the pill when I can take time off school or work and subject myself to pretermination of pregnancy counselling and a medical procedure that, even in good circumstances, will lead to at least some physical discomfort?
Finally, the assumption is that contraception is available and works. But the reality is that not all women have access to contraception or the support and information that they need to use the contraception effectively. And all contraceptives have some probability of failure.
Limited awarenessThe departments of health and education, whether at national or provincial level, have been lacklustre in their efforts to ensure that women are aware of their reproductive rights as enshrined in the Choice of Termination of Pregnancy Act.
Research shows that women presenting to hospitals with incomplete abortions after undergoing unsafe abortions cite lack of information on abortion rights under the Act and lack of knowledge about an existing designated facility for legal termination of pregnancy as some of the barriers to abortion service access. Women who seek late termination of pregnancies also cite insufficient information on abortion and abortion services (with four times the proportion of rural women compared with urban women giving this as a reason).
Among the general population, this limited availability of information is also clear. Surveys conducted among the users of public health clinics, university students and school pupils show that a large proportion of these men and women are wholly ignorant of their rights as laid out in the Act.
Education is powerWhat is to be done? Other than ensuring that there are sufficient functioning clinics for the termination of pregnancy (a difficult process, requiring, inter alia, buy-in from facility managers), there are a number of relatively simple steps the departments of health and education can take, if they have the will to do so. For example, include comprehensive information on the Choice of Termination of Pregnancy Act in life orientation programmes at schools and at all public health clinics, as well as disseminating the information using the radio, TV commercials, billboards and the internet.
The information can simply be factual and does not need to involve the moral arguments that swirl around abortion – and I would prefer the facts to include that there are fewer physical risks to safe abortion than carrying a pregnancy to term and that the psychological risks of safe abortion are no worse than carrying an unwanted pregnancy to term, as found by a recent review of research carried out by the American Psychological Association, but this may be a bridge too far.
Catriona Macleod holds the chair for the critical studies in sexualities and reproduction at the South African Research Chairs Initiative and is a professor of psychology at Rhodes University
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Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.