Photo: Tiggy Ridley/IRIN

A pregnant woman is given a routine check-up at a clinic in Monrovia.

Cape Town — There are many abortion advertisements posted around Cape Town, at bus stops, taxi ranks and even churches. They usually have the name of someone claiming to be a doctor along with a contact number.

I phoned a "Dr Abba" advertised on a pamphlet at a bus stop in Luzuko, a township near Khayelitsha, and posed as a person needing an abortion.

There were a total of 15 abortion pamphlets posted at the bus stop, each with detachable strips of papers with the contact number printed on.

Dr Abba explained that he is a registered doctor and runs a clinic in Delft where he attends to 20 or more people a month. For a first trimester abortion (one to three months) he charges R400 and also provides abortion services to women who are in their third trimester (from six months onwards).

Abortion is available free in the public sector. It was legalised in South Africa in 1997. However many people still choose what are called "backstreet abortions" such as those offered by Dr Abba. According to the Choice on Termination of Pregnancy Act (Act) the law permits women an abortion on demand for the first 12 weeks of pregnancy. The Act says abortions are only supposed to be provided by nurses, doctors and trained midwives in a facility designated by the Minister of Health and approved by the MEC where there is access to surgical equipment and medical staff.

According to Sara Osman, head of new business at Marie Stopes, a reproductive health service that provides legal abortions, the problem is that public facilities are not easily accessible. She explained that many public facilities do not advertise that they provide abortion and that facilities are unfriendly about the service.

"The level of aggressive marketing done by these people with the pamphlets is very much in your face, with flyers and posters everywhere. It is simply easier for patients to access them and there is a high risk that they are illegal," Osman stated. She further explained that many doctors and nurses do not want to perform the procedures due to conscientious objections.

When asked whether his procedure was safe, Dr Abba claimed, "It is a very quick and safe process that takes anything from 30 to 45 minutes. We give the patients tablets and then we clean them up afterwards. There are no side effects or complications."

But Osman warns that the most dangerous problem arising from illegal abortions is septicemia. This can be fatal and is caused by unsterile equipment. Another problem is haemorrhage which can lead to hysterectomy, infertility or death.

Marie Stopes has launched a street marketing pamphlet to alert the public to illegal abortion providers. Osman explained that removing the pamphlets is something that law enforcement and the Advertising Standards Authority have to deal with.

Lieutenant Colonel Andre Traut of the SAPS said that the governing of health care is the responsibility of the Department of Health, however if a criminal case is reported to SAPS, an investigation will be conducted. "The fixture of posters to public places is an issue which is addressed by the City's Law Enforcement" explained Traut.

According to Rebecca Hodes, a medical historian at the Institute for Humanities in Africa at the University of Cape Town, many of the backstreet abortion advertisers are not medical doctors, although some claim the title. Some say they are traditional healers.

Hodes explained, "Many health facilities do not offer abortion, so women need to be transported to clinics or hospitals in other areas. If the ambulance is full, the first patients who are told to get out are the abortion patients. This is just one of the many ways in which abortion is not prioritised by healthcare workers."

She continued, "The punitive treatment of abortion patients in the public health sector is an incentive to seek an abortion elsewhere, from a provider who will help you quickly and who will treat you with kindness and respect. Women are willing to put up with the risks of getting an illegal abortion rather than put up with the constraints and humiliations that often attend to procuring an abortion in the public sector."