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Women in rural areas still struggling to access abortion services, MPs told

The availability of abortion services are still out of reach for women who are mostly poor and in rural areas, the Commission for Gender Equality (CGE) said on Wednesday.

Pregnant women facing such a predicament have no choice but to turn to the lethal illegal termination of pregnancy, despite the Choice of Termination of Pregnancy Act having been around since 1996 to prevent illegal and dangerous back street abortions.

The CGE presented its investigation into the nature and the availability of abortion services across the country to members of the portfolio committee on health.

The probe was conducted during hard lockdown in 2020, and done through questionnaires disseminated through the national and the provincial health departments.

“As much as we’ve seen improvements, we find there still significant number of women still dying in informal terminations. Also, since the introduction of the Act throughout our democracy, we’ve seen a reduction in illegal terminations, but deaths from such procedures still remain and is unacceptable, hence we push for access in the public service,” said CGE CEO Jamela Roberston.

‘Only four facilities in Northern Cape’

Women in the Northern Cape were the most affected with only four pregnancy termination facilities available for the vast and mostly rural province.

The Western Cape has the most facilities at 109, with adequate patient care and counselling in place.

The Free State has 12 abortion facilities and the North West has 26. Mpumalanga has 30, including two that are privately owned, Eastern Cape has 45 while KwaZulu-Natal has 50 facilities.

Robertson said the adequate budgets, training and public awareness campaigns on abortion should be channeled to health services by the Department of Health.

In areas such as Gauteng, with at least 60 facilities, women face reluctant staffers who wont perform abortions.

“Unwillingness of health practitioners to perform abortions is a barrier to service delivery, it’s a very old issue that still persists. We found in early 2000s when we were training workers in the early 2000s on the Act, there was a lot around this matter… it still exists, but we have to keep educating,” said Robertson.

She added that departments are subpoenaed through the CGE legal department if recommendations are not implemented,

Robertson told MPs about an incident at Soweto’s Chiawelo clinic, where a pregnant woman was turned away by nurses last year.

“The reason given to her was that the clinic was only attending to emergency services. The woman approached the CGE for help, and we intervened and got assisted with termination.. That is what what many come across at facilities.”

‘Other maternal health matters also need investment’

ANC MP Annah Gela said although improvement of services was needed in many provinces, there were other health problems women faced that needed more resources.

“In their findings they mentioned provinces that are still struggling, has the CGE met with the authorities in these provinces to attend to issues faced by pregnant women?”

“Also, South Africa battles with many health conditions such as non-communicable diseases, maternal and child mortality, so why should more investment be made for termination of pregnancy services?,” she asked.

African Christian Democratic Party (ACDP) MP Marie Sukers , whose party opposes termination of pregnancy, said a cost analysis on what abortion services costs across the country should be made available.

While other women can opt for abortion, there were other solutions available too, she added.

“We cannot overlook the fact that abortion is an emotive matter. It is not clear how conscious objections by nurses and physicians are accommodated. it seems when it comes to term of pregnancy, religion and people’s convictions are not considered.

“We live in a country where African people have serious views on this. We cannot have a situation where abortion is the only alternative for the woman in such a crisis. What we are seeing here is the aggressive narrative that abortion is a right and should be available, but you cannot look at it only in that context, there are other elements to this.”

Robertson replied that her organisation is a Chapter 9 institution that has a watchdog role on gender issues, and can only make recommendations and follow ups.

“Our act specifies how far we can go in terms of follow up. This report was produced in March 2021, but there hasn’t been a follow-up report. CGE has a mandate to start from here and end there…other authorities take over. The work involves multiple stakeholders.”

In the case of the woman was turned away at Chiawelo clinic, said Robertson, consequences for the health workers who turned her away did not fall under CGE

“Hence we present these reports to enable additional action and other work. We periodically look at reports and recommendations and go monitor. Different authorities need to work together in this, and as we have said, this does not only fall under the Department of Health.

Economic Freedom Fighters (EFF) MP Naledi Chirwa suggested innovative ways to reach rural women, especially in referrals.

“The CGE could do much more, you gave us reports but there is nothing tangible on what you plan to do. The presentation is too broad and does not have insights on individual cases for such an important issue,” she said.

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