“We were saddened to learn of the death of Ms Ayanda Masondo as a result of an illegal abortion on Sunday, 18 March 2012. We send our deepest sympathies to Ms Masondo's family and will continue to work with government, legal authorities and the media to ensure that illegal abortion providers are identified, and women everywhere understand their rights to access safe abortion services. We appeal to all women to contact our National Call Centre on 0800 11 77 85 if they have accessed an illegal abortion service, are concerned over their treatment, want to report an illegal provider anonymously or to receive information on how to access safe, legal abortion services,” says Denise Hunt, Country Director, Marie Stopes South Africa.
Since the legalisation of abortion in 1996 through the Choice on Termination of Pregnancy Act, the number of abortion-related mortalities has decreased dramatically. Abortion services are available to women of any age up to 20 weeks gestation through public health facilities as well as registered and designated private practitioners.
Evidently, a market for illegal and unsafe abortion providers has also been created, and flyers advertising “safe, pain free, quick and cheap abortions” litter the city streets. These illegal abortion providers target disadvantaged, vulnerable women and put their lives at risk by working outside all laws governing the provision of this specialised medical intervention. A study published by the South African Medical Research Council in 2010 reports that 48.5% of abortions undergone by young people between the ages of 13 and 19, took place outside a hospital or clinic, and were therefore likely to be unsafe 6. According to the DOH, 25.7% of avoidable maternal deaths were due to unsafe abortions between 2005 and 2007 2, and mortalities associated with unsafe or incomplete abortions have risen by 4.6% between 2004 and 2007.
At least one-third of sexually active women believe abortion is illegal 12 and are therefore unlikely to seek safe abortions through official or regulated channels and will instead opt for an unsafe service. Additional reasons cited for not using legal services include: not knowing where to access safe abortions; judgmental staff (particularly in public facilities); and concerns over the confidentiality.15 Marie Stopes South Africa (MSSA) is well-known organisation in South Africa that advocates for a women's right to have “Children by Choice and not by Chance”. MSSA sees the consequences of illegal abortions in its clinics everyday and runs educational programmes and outreach projects to educate women on their rights to access safe and legal termination of pregnancy and family planning services. Unsafe terminations are more likely to lead to complications, such as haemorrhage, septicaemia, internal organ damage, tetanus, sterility, and even death.
Varying methods are used by unsafe providers, which include ingesting mixtures or inserting objects or instruments into the womb that will cause rupture and septicaemia, or giving tablets which cause the cervix to dilate. Early warning signs of incomplete and unsafe terminations are fever, shivering, smelly discharge, haemorrhaging, lower extreme abdominal pain, high temperature, anaemia.
Women seeking termination of pregnancy services should: look for a name or brand (like Marie Stopes or Dept of Health) to ensure it is an approved clinic; look for a landline telephone number – not just a cellphone number and enquire as to the practitioners after-hours contact details in case of emergency; receive counselling which provides them with all the information they require to make an informed decision; do not pay until they are satisfied with the service and receive a receipt; and ensure the facility is at a fixed address in clinical surroundings, not a street corner. The gestation period needs to be ascertained before any options or methods are considered (Marie Stopes uses ultrasound). Do not accept medical pills claiming to terminate pregnancies if you are more than nine weeks pregnant, as a surgical procedure is required at this point. Terminations cannot be offered (except under stringent circumstances) after the 20th week of gestation.
Results of unsafe terminations – warning signs
* Unsafe termination are more likely to lead to complications, such as haemorrhage, septicaemia, internal organ damage, tetanus, sterility, and even death.
* Varying methods are used by unsafe providers which include ingesting mixtures, inserting objects or instruments into the womb that will cause rupture and septicaemia.
* Early warning signs of incomplete and unsafe terminations are fever, shivering, smelly discharge, haemorrhaging, lower extreme abdominal pain, high temperature, anaemia. If anyone suspects an incomplete or unsafe termination has been performed they should contact the MSSA call centre or go to their nearest hospital immediately.
How can unsafe terminations be prevented?
Our country enjoys some of the most liberal sexual and reproductive health laws in the world. The mechanisms are in place to empower women to have control over their fertility and have access to safe and legal sexual and reproductive health information and services.
Regardless of whether abortion is legal or illegal, safe or unsafe, some women will choose to have an abortion. The difference is that where abortion is illegal and unsafe, many of these women will be killed or left severely injured by the experience. The consequences of unsafe abortion - death, serious injury, infertility and increased health care cost are largely borne by poor women. Reducing the incidence of unsafe abortion would result in an immediate and substantial reduction of maternal mortality and improve maternal health. Lack of access to family planning services is a major contributory factor to unsafe abortion. The lowest abortion rate in the world is in for Western Europe (12 per 1 000 women aged 15-44), where contraceptive services and use are widespread and safe abortion is easily accessible and legal under broad grounds.
Please contact Marie Stopes SA National Toll Free Number on 0800 11 77 85 or the Dial SMS Info Line on *120*535# if you have concerns or queries. Marie Stopes is your provider of choice. We advise, you decide.