International Safe Abortion Day - celebrated every year on September 28 - marks a woman's fundamental reproductive right to access safe, legal abortion. For many women all over the world, this right, along with the right to access modern contraception, is essential for their maternal health, sexual and reproductive health and rights (SRHR) and well-being. It allows women and couples the right to decide freely if and when to have children.
Especially for the many women who have unsupportable pregnancies, abortion is a vital yet normal medical procedure during their reproductive lives. When performed properly, abortion procedures are safe and can saves women's lives. However, unlike other reproductive health services, abortion is enveloped by stigma and silence, which leads to many women in South Africa lacking access to this crucial health service.
It is indeed a dichotomy that abortion remains such a highly stigmatized issue in a country that has one of the most progressive abortion laws around the world. Our much-celebrated Choice on Termination of Pregnancy Act (CTOPA) promotes the reproductive rights and freedom of choice of women by allowing them to have a safe and legal abortion. CTOPA has saved the lives of many women since its enactment. However, there seems to be a laxness on our society's part in ensuring that this right is available to many more women who really need it.
This laxness stems from and feeds on the silence and stigma associated with abortion in South Africa. This stigma due to religious, cultural or moral beliefs that "abortion is wrong" is one of the biggest barriers in the complete implementation of the CTOPA. It subjects women to judgmental attitudes, curtails their right to access safe services and drives them to illegal and unsafe abortion providers.
We already know that many healthcare providers - due to their own moral or religious beliefs - are reluctant to conduct abortions and provide pre- and post-abortion emergency care to women. The stigma related to abortion is so strong that some providers who may want to receive training on abortion or provide these services hesitate to do so as they fear being ostracised by their community. This has led to a shortage of health facilities offering safe abortion services in South Africa, and the impact of this on women's health and well-being cannot be overstated.
Stigma, in turn, perpetuates silence. Fear of harsh judgment and ostracism by the community can prevent women from sharing their abortion experiences with their friends and families. Oftentimes, women use silence as a coping mechanism as they believe that if no one knows about their experience, they cannot be stigmatised. Due to this severe stigma and silence, even today many women are unaware of their legally recognised rights under CTOPA and lack information about where, how and when to access safe and legal abortion services. In fact, many of them believe that informal/illegal and possibly unsafe abortion service providers are their only option in the event of an unwanted and/or an unsupportable pregnancy.
Unsafe abortion procedures can lead to serious health complications for women and, all too frequently, death and disability. As per many estimates, a significant number of maternal deaths occur in South Africa due to septic abortions, many of which can be attributed to unsafe abortion procedures. Therefore, addressing this stigma around abortion is the need of the hour if we are serious about reducing maternal mortality in South Africa. If done effectively, this step can go a long way in creating an enabling environment for the full and effective implementation of CTOPA and save the lives of many more women.
Towards this end, we need to empower women with easily accessible and accurate information to enable informed decision-making about their body, health and well-being. This includes providing information about legal provisions under the CTOPA, as well as information on how to access abortion services. The government must lead this endeavour by publishing and regularly updating information on where women can access safe abortion services both in the public and private sectors. Furthermore, engaging with women and young girls through community awareness activities and encouraging them to talk about their abortion experiences can help break the silence and increase the uptake of safe and legal abortion services.
There is also a need to normalize abortion within public discourse. The civil society and the media can play an important role in this by reminding people that abortion is a common and normal procedure. They must also impress upon the community the fact that access to safe abortion is intrinsically linked to values such as women's agency and self-determination.
To help tackle stigma among healthcare students and providers, various stakeholders must come together to conduct training, which could enable critical reflection on and challenge their deeply held beliefs and attitudes regarding abortion. These trainings, organised in collaboration with the government and development partners, could help bring about a much-needed attitudinal shift.
On this International Safe Abortion Day, we must resolve to address stigma, its root causes and its consequences to bring about real and deep change. Only then would we be able to fully implement our venerable CTOPA. The time to act is now!
Marion Stevens is the Chairperson, and a founding member, of the Sexual and Reproductive Justice Coalition. She is also currently a Research Associate with the African Gender Institute and the University of Cape Town, and the Coordinator for WISH Associates.