Marion Stevens, Naomi Lince, Elna McIntosh and Judi Merkel on behalf of the Reproductive Rights Alliance
The WHO study, cited by the author, shows that whether legal or not, women continue to seek TOP services. In South Africa,
abortion is available upon request for women up to 12 weeks of gestation, and from 13 to 20 weeks it is legal in cases of
socio-economic hardship, rape, incest and for reasons related to the health of the pregnant woman or fetus. However, as the
author of Lifting the Lid rightly points out, significant barriers to accessing safe TOP still lead women to back street
providers. In South Africa currently only 60% of designated TOP facilities are functional. This inability to meet demand is
not peculiar to abortion services. In 2006, only 55% of pregnant women had access to Prevention of Mother to Child
Transmission (PMTCT) services. Other barriers to accessing safe TOP include provider opposition, stigma associated with
abortion, a lack of providers trained to perform abortions, and fear of poor treatment in public health care facilities.
The author describes a scenario where medical abortion is used to terminate pregnancy. This method is not currently
provided for in the public sector however, the Department of Health is currently refining guidelines for its inclusion.
This is to be commended as it may increase access to safe TOP and reduce some of the burden on our health system.
The article refers to 'new legislation' on minors' access to TOP. In fact, the CTOPA resolved the issue of minor consent in
1996. A recent amendment to the Act enabled the health system to improve access, through task shifting and
decentralization. Again the inclusion of this amendment is to be commended.
Finally, the article contains inaccuracies regarding the long-term consequences of TOP. It is certainly true that unsafe
abortions may lead to infertility or even death. Approximately 68 000 women die each year globally as a result of unsafe
abortions. However, when performed by trained providers in designated facilities, TOP is a safe procedure. The risk of
major complications is less than 1%. Furthermore, studies have shown that abortion does not increase one's risk of cervical
or breast cancer. Several sound empirical studies have published results to this effect. We feel that it is important to
correct the misinformation supplied by the Doctors for Life spokesperson quoted in the article as it may deter women from
seeking safe, legal TOP services.
Although our constitution upholds the right of women to access reproductive health services, many women are still not able
to exercise these rights. In South Africa, where it is estimated that 53% of births are mis-timed or unwanted, there is
clearly much need for education on this issue.