17 January 2008
Reproductive Rights Alliance welcomes adoption of the Choice on Termination of Pregnancy Amendment Act
Today parliament passed the Choice on Termination of Pregnancy Amendment Act. This comes after a process of public hearings undertaken by both houses of parliament. The extended consultation processes came as a result of a Constitutional Court ruling. However, the substance of the law was not in question. In brief, the law is aimed at expediting the designation of facilities; extending the pool of service providers; and clamping down on unscrupulous practitioners.
It builds on the principal Act, the Choice on Termination of Pregnancy Act no 92 of 1996, which has resulted in a positive impact on women's health. In particular it:
. Raised awareness of choices available to pregnant women, enabling
them to discuss options available to them and to access services.
. Significantly reduced the number of women dying by 91% as a result
of backstreet abortions. Also reduced health complications by 50%.
. Reduced public health care costs of treating complications resulting
from backstreet abortion; and
. Provided greater access to services, especially to poor, young and
Parliamentary hearings in 2002 identified barriers that prevented optimal access. This resulted in the 2004 Amendment Act that increases and expands access to safe and legal pregnancy terminations, especially for poor and rural women. It does so in the following ways:
. Decentralisation to provinces helps the government improve the
quality of reproductive health services to women, especially at local level.
. It increases the pool of health care providers and the quality of
. It improves provincial administration of reproductive health
services, by enabling better internal accountability (eg. planning, record-keeping, monitoring services etc).
. It prevents the proliferation of illegal abortion clinics and
providers and strengthens the arm of the state in prosecuting these.
Little or no opposition to these provisions was expressed in the public consultation process. The opposition that was voiced was directed at provisions of the principal act (such as conscientious objection) and was aimed at limiting access to services and eroding women's constitutional right to reproductive choices and health-care. Such opposition is well-resourced and is part of a wider, global campaign to attack and erode these rights. It is characterised by strategies that include:
. Repeated and unsuccessful legal challenges to the principal Act;
. Appealing to emotion and the use of graphic materials to stigmatise
termination providers and services, as well as the women who use them;
. The spread of misinformation, including the use of pseudo-science
that draws spurious links between terminations and women's ill health
. Creating a climate of confusion and guilt that intimidates health
workers and clients
For example, the right of health workers to conscientious objection is often raised as a problem. There is no evidence that this requires a legislative response. Despite claims to the contrary, no one has laid a complaint with either Democratic Nursing Organisation of South Africa (DENOSA) or South African Medical Association (SAMA) about being forced to perform TOPs.
The Constitution makes provision for conscientious objection, but also mandates access to reproductive health care and requires non-discrimination.
This provides a framework for genuine issues of conscientious objection to be addressed at management level. However, competency in pregnancy termination care is necessary for all health workers. The Health Professions Council of South Africa (HPCSA) requires doctors to be generalists, able to provide termination of pregnancy for women in various states of life.
Calls for conscientious objection do the following:
. Promote discrimination against patients based on the kind of service
. Disrupt the patient - health worker relationship by prioritising the
rights of the provider over those of the patient
. Marginalise termination services, placing them outside of the core
reproductive health services
. Promote a climate of fear, victimisation and stigmatisation
The amendment Act is necessary to improve women's rights to reproductive health care and choices. Distribution of services remains uneven across provinces, with women, particularly in rural areas, having little or no access. The amendment Act will ensure that access is improved in order for women to exercise their right to choose whether to have an abortion or not.
Issued by the Reproductive Rights Alliance:
Ipas South Africa
Centre for Applied Legal Studies, University of the Witwatersrand Health Systems Trust Women's Health Research Unit, University of Cape Town Women's Legal Centre Mosaic Training, Service & Healing Centre for Women OUT LGBT Well-being Tshwaranang Legal Advocacy Centre to End Violence Against Women Reproductive Health Research Unit, University of Witwatersrand Women's Net
Health Systems Trust