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Barriers to Safe and Legal Abortion in South Africa

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Barriers to Safe and Legal Abortion in South Africa BRIEFINGBRIEFING Barriers to Safe and Legal Abortion in South Africa © Amnesty International Amnesty International is a global movement of We are independent of any government, political more than 7 million people who campaign for a ideology, economic interest or religion and are funded world where human rights are enjoyed by all. mainly by our membership and public donations. Our vision is for every person to enjoy all the rights enshrined in the Universal Declaration of Human Rights and other international human rights standards. 2 AMNESTY INTERNATIONAL BRIEFING: BARRIERS TO SAFE AND LEGAL ABORTION IN SOUTH AFRICA 3 CONTENTS The South African Government’s The South African government’s human rights obligation to ensure access to safe and legal abortion services in South Africa …..........................................................…. 3 Human Rights Obligation Human Rights Framework ………………........….....……………. 7 The Failure to regulate Conscientious Objection …….......…..… 8 to Ensure Access to Safe and Inequality of Access to Services …………..…...............………..12 The Right to Access Information ……...……….........…………. 14 Conclusion and Recommendations ………......….........………..17 Legal Abortion Services Annex 1: South Africa's Human Rights Obligations in Relation to Access to Abortion ..................................... 20 Amnesty International Publications First published in 2017 by ACCESS TO SAFE AND LEGAL ABORTION SAVES LIVES Amnesty International Publications International Secretariat Peter Benenson House The World Health Organisation (WHO) is clear that access to safe abortion is a key step for avoiding maternal 1 Easton Street deaths and injuries.1 In contrast, restrictive access to abortion services violates numerous human rights, London WC1X 0DW including the right to life, health, privacy, and to be free from discrimination, torture and ill-treatment. United Kingdom www.amnesty.org Abortion has been legal in South Africa for almost twenty years. The Choice on Termination of Pregnancy © Amnesty International Publications 2017 Act (CTOPA) (1996), gives women and girls the right to have an abortion on request up until the 12th week Index: AFR53/5423/2017 of pregnancy and with certain conditions before the 20th week. This legislation has been credited for Original Language: English advancing women's health and rights.2 Abortion related deaths and injuries are estimated to have reduced Printed by Amnesty International, International Secretariat, United Kingdom by over 90% since the CTOPA came into force.3 All rights reserved. This publication is copyright, but may be reproduced by any Despite the progressive legal framework, many women and girls - especially those in the poorest and most method without fee for advocacy, campaigning and teaching purposes, but not for marginalised communities - are still struggling to access safe abortion services. A recent expert review resale. The copyright holders request that all such use be registered with them for of maternal deaths has indicated growing concern that the lives of pregnant women and girls are put at impact assessment purposes. For copying in any other circumstances, or for reuse unnecessary risk due to barriers to abortion services, which are legal and available.4 in other publications, or for translation or adaptation, prior written permission must be obtained from the publishers, and a fee may be payable. To request permission, or for any other inquiries, please contact 1. World Health Organization (WHO), Safe Abortion: Technical and Policy Guidance for Health Systems, [email protected] 2012, pp. 23, 47-49. The WHO defines unsafe abortion as a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both (Hereafter WHO 2012). Cover photos: Thom Pierce / Amnesty International 2. R Jewkes, H Rees SAMJ Vol 95, No 4 (2005) Dramatic decline in abortion mortality due to the Choice on Termination of Pregnancy Act. 3. Ibid. The CTOPA 92 of 1996 was amended by Choice on Termination of Pregnancy Amendment Act 1 of 2008 from 18 Feb 2008: Section 1, 3, 7-10; the Criminal Law (Sexual Offences and Related Matters) Amendment Act 32 of 2007 from 16 Dec 2007: Section 1; the Choice on Termination of Pregnancy Amendment Act 38 of 2004 from 11 Feb 2005: Section 1, 3, 7-10 see further http://www.gov.za/documents/choice-termination-pregnancy-act accessed 1 December 2016. 4. National Committee for Confidential Enquiry into Maternal Deaths, Saving Mothers 2011-2013: Sixth report on confidential enquiries into maternal deaths in South Africa Short report (2014) 4 AMNESTY INTERNATIONAL BRIEFING: BARRIERS TO SAFE AND LEGAL ABORTION IN SOUTH AFRICA 5 This briefing focuses on South Africa’s human rights commitments, which place clear obligations on the THE NEED FOR SAFE AND LEGAL ABORTION SERVICES government to safeguard women and girls’ access to safe abortion care.5 It discusses three key barriers, in policies and practice, to safe abortion services: The untimely death of a 19 year old student in Johannesburg in 2016, following complications due to an unsafe abortion, highlights the urgent need for action to address barriers to abortion services. Speaking at • The failure to regulate conscientious objection; the United Nations in April 2016, the Representative for South Africa cited health systems deficiencies, • Inequalities in access to services for women and girls from poor and marginalised stigma and discrimination as impacting the student’s access to safe abortion services. communities; • Lack of access to information on sexual and reproductive rights, including how and where to access legal abortion services. “[She] was a poor student, who could not access private health care. There was insufficient information available of the [abortion] services that she could Women and girls who are unable to access safe and legal abortion care, because or in part of these barriers, may be compelled to seek unsafe alternatives. access at public health care facilities and there is also some speculation that she may have been afraid of METHODOLOGY the attitudes of the public health care workers based on the experiences of some of her friends.”7 This briefing is based on desktop and qualitative research from Amnesty International and The Women’s Health Research Unit, School of Public Health and Family Medicine at the University of Cape Town.6 On 29 September 2016 Amnesty International wrote to the South African Minister of Health and the Choosing to have an abortion is a personal decision based on women and girls’ individual social or economic National Department of Health requesting further information in relation to the barriers to safe abortion life circumstances. High rates of sexual violence in South Africa, as well as unpredictable health and life and the related government programmes and policies in place to implement the CTOPA. Information received risks in pregnancy and the possibility of severe foetal abnormalities, mean that no matter how well fertility in reply on 3 November is reflected in this briefing. The National Department of Health emphasized that management services and information are implemented, there will always be a need to ensure access to the provision of termination of pregnancy services in South Africa is part of the provision of comprehensive abortion services. sexual and reproductive health and rights. This briefing draws on guidance from human rights bodies, including the Technical Guidance on Reducing Preventable Maternal Mortality and Morbidity developed by the Office of the United Nations High Commis- sioner for Human Rights (OHCHR), which has urged States parties (where abortion is legal) to include authoritative public health guidelines on access to safe abortion to which universal access should be effec- tively ensured in the national plan – as essential for improving maternal health. This briefing makes a number of recommendations in relation to addressing the identified barriers to safe abortion, to support South Africa’s full compliance with its human rights obligations. 5. The World Health Organisation advises governments that they have an obligation to ‘ensure that every woman who is legally eligible has ready access to safe abortion care.’ WHO 2012, pages 9, 87 and 98. 6. The Women’s Health Research Unit would like to acknowledge the funding they received from the South African Medical Research Council for some of the research on which their input to this Briefing 7. Special Advisor to the Minister of Social Development of South Africa, Speech to United Nations, April is based. 2016. 6 AMNESTY INTERNATIONAL BRIEFING: BARRIERS TO SAFE AND LEGAL ABORTION IN SOUTH AFRICA 7 The CTOPA gives women and girls the right to an abortion in the following circumstances: HUMAN RIGHTS FRAMEWORK TERMINATION OF PREGNANCY (TOP) AND GESTATIONAL LIMITS ON Access to sexual and reproductive health care is a constitutional right in South Africa9 and part of the universal right to health. South Africa has ratified international human rights treaties and agreements which ABORTION UNDER THE SOUTH AFRICAN CTOPA place South Africa under a duty to ensure that abortion services and information are available, accessible, and acceptable and of good quality.10 TIMELINE FOR CONDITIONS ABORTION South Africa has ratified the International Covenant on Civil and Political Rights, the International Covenant PREGNANCY PERFORMED BY: on Economic, Social and Cultural Rights, the Convention
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