The High Cost of Legal Abortion in South Africa

Riding around Johannesburg, Cape Town, and East London, I was struck by the ubiquitous roadside signs advertising “Safe Same-Day Abortion” and “Abortion—Quick and Safe, 100% Pain-Free in 30 Minutes.” They advertised low prices—100 Rand (about $6.50)—and included cell phone numbers. Shady.  I wondered why abortion services were advertised this way when it’s been legal for 20 years.

In 1996, South Africa legalized abortion up to 20 weeks with the Choice on Termination of Pregnancy Act, which also called for providing free services in certain public health facilities. Although the law is one of the most liberal and progressive in the world, the lived experience of many South Africans points to a different reality. Poverty, lack of access to information and services, and stigma remain significant barriers to safe abortion.

Marion Stevens, chair of the Sexual and Reproductive Justice Coalition (SRJC), a network of feminist advocates and service providers, noted that the law legalizing abortion was not well-communicated to the public, which “further impoverished women in terms of access to information.” In her research, Stevens found that urban, poor women mistakenly believed that the flyers posted by illegal providers offered accurate information . “These girls and young women said it was good to know the price, that it was safe and pain-free. This is so terribly wrong as the [illegal] services are not what we liberalized our abortion [law] for and what is just and right.”

But even when a woman knows her right to an abortion under the law, actually accessing safe and legal services can prove near impossible for many. One study found 45 percent of women did not receive abortions on the day they sought services due to lack of funds or inability to travel the distance to a legitimate abortion provider.

While middle class women have the option of private services, poor women can only procure safe and legal abortions through free public services, only available in major cities. Rural women are doubly impacted, as they can neither afford private services nor travel costs to urban centers for public services.

Faced with these barriers, illegal providers advertising their services on street signs seem to offer a much more accessible, convenient, and affordable alternative—but at significant risk. Some illegal providers offer medical abortions with black market pills, and others perform unsafe, dangerous surgical procedures. We heard horror stories of metal hangers in back alleys, leading to major trauma and even death.

As we’ve seen in many countries where IWHC’s partners work to increase access to legal abortion, stigma also burdens both patients seeking abortions and the providers who care for them. The cultural stigma is so great that abortion is not even included in the country’s standard nursing and medical curricula.  As Dr. Tlaleng Mofokeng, a sexual and reproductive health physician in Johannesburg and vice chair of SRJC told me, “The moralistic, faith-based views held by many who [provide services] hurt women and they too contribute to the stigma.”

For those who are trained, many end up working in abortion clinics marginalized within medical facilities; one provider was forced to work in a former hospital mortuary. Rather than facing the social challenges of being seen at a clinic, some women opt for the illegal street providers.

Although the situation is severe, several organizations are working to combat such stigma, including SRJC, the End Abortion Stigma Initiative, and Marie Stopes International. IWHC joins them and other advocates in urging the South African government to fulfill its own promises and uphold its own policies. Every woman, regardless of her socioeconomic status, has a right to a safe and legal abortion.

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