Research & Innovation 2015-16 - Page 80

Access to healthcare for women
The culture of illegal abortion in South Africa
In 1996, the South African Choice on Termination of Pregnancy (CTOP) Act was passed, promoting the right to
safe and legal abortion. Even though abortion is now freely accessible under South African law, many thousands
of women continue to terminate unwanted pregnancies illegally every year. 
Medical historian, Dr Rebecca
Hodes, at the AIDS and Society
Research Unit in the Centre
for Social Science Research,
investigated why the rates of
illegal abortion remain persistently
high, despite the mandates of
reproductive health legislation.
While the law reflects the state’s
commitment to reproductive
rights, the stigma and suffering
that often accompany abortion
reveal a chasm between policy
objectives and their real-world
enactment in South Africa’s public
health sector. Clinical observations
and expert interviews revealed
that pain and humiliation among
abortion patients may be accepted
as an inevitable part of its public
provision. The participants in
her research describe how pain
blockers are given infrequently to
abortion patients. 
One healthcare worker, with
decades of experience in treating
medical abortion patients,
explained: “The woman don’t
get pain medication. They abort
at home, they abort on the
way [to hospital], or they abort
while waiting there.” While some
healthcare workers sought to
adapt national health protocols to
Novel use of mobile technology helps women self-assess their
eligibility for early medical abortion
New research suggests that women could use their cell phones to
accurately assess their eligibility for medical abortion, via an online
gestational-age calculator called i-calculate.
Most pregnancy-calculator
applications or websites use
due-date calculators, and provide
other information that is not
suitable for a woman seeking to
terminate a pregnancy. This mobile
app represents an opportunity to
empower women, by providing
them with self-assessment
opportunities and accurate and
safe abortion information.
The director of the Women’s
Health Research Unit (WHRU),
Associate Professor Jane Harries,
led the IPAS-funded pilot study
to explore women’s experience
of using the i-calculate app. Once
they had accessed the site, women
were guided through a process
that included determining the first
day of their last menstrual period,
as well as five standardised medical
abortion-eligibility questions. After
completing the online process, they
received confirmation messages of
their self-calculated gestational age.
Most of the participants found the
online gestational calculator easy
to use.
“Seeking services earlier in
pregnancy is safer, less expensive,
and provides more options for
women,” says Harries. The ability
to self-assess gestational age
using an online calculator has the
potential to empower women,
providing them with some selfautonomy of health care.
improve the patient experience,
“shortages in equipment to ensure
the quality of care rendered the
experience of abortion more
painful and more difficult for many
women in this study,” says Hodes.
“The law mandates that abortion
should be a safe medical procedure
that forms an integral part of
healthcare in South Africa.
Nevertheless, through obstructing
its access and rendering its
legal procurement a conduit of
punishment and suffering, it remains
a source of pain, enacted against
the women whose health it is meant
to protect,” says Hodes.
As part of a multi-country Global
Turnaway Study, the Women’s
Health Research Unit (WHRU)
partnered with researchers
at the University of California,
San Francisco to find out what
happens when women are
denied access to legal abortion
services in South Africa. A high
proportion of women who were
initially denied an abortion
at legal facilities went on to
seek options for pregnancy
termination outside the legal
system, through internet
searches – some of which could
have led to unsafe abortion
practices. “Further efforts should
be directed towards informing
women about the availability of
free services in the public sector,
and educating them about the
dangers of unsafe methods
of pregnancy termination,”
says WHRU director Associate
Professor Jane Harries.

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