WHAT YOU NEED TO KNOW ABOUT ACCESSING SAFE AND LEGAL IN SOUTH AFRICA IN SOUTH AFRICA KNOW YOUR RIGHTS ABOUT ABORTIONS SOUTH AFRICAN LAW SAYS

Abortion in South Africa is legal South are Human Rights. All women have the right to access safe Africa. Yet most women do not know and legal abortions (termination of where to access safe abortion services, We firmly believe and agree with the pregnancy), for free at a government how to obtain information about abortion Choice of Termination of Pregnancy Act hospital or clinic during the first 3 months facilities in South Africa or that they are that: of pregnancy. Before the end of the first legally entitled to a free abortion in the 3 months of pregnancy, an abortion can public health care facilities. The decision to have children is part be carried out by a doctor OR a trained of to women’s access to registered nurse or midwife – therefore The SRJC, together with partners and allies, reproductive health care services. making an abortion more accessible has put together this pamphlet to ensure This also includes contraception, earlier in the pregnancy. that you have basic information on your termination of pregnancy, as well right to access safe and legal abortion, as sexuality education and Health workers CANNOT refuse to as well as helping you assess whether counselling programmes and perform an abortion because of: abortion providers you see advertised are services. legal and safe or not. 1. Your age Women and girls have the right If you are under 18, you can ask a to be informed of and to have trusted adult – for example, a parent, access to safe, effective, affordable aunt or teacher, for support and and acceptable methods of fertility to accompany you while you have the regulation of their choice, abortion, if you want to. No one, including your parents, has the right Women have the right to access to to say you cannot have the abortion if appropriate health care services you want it. and the government has the responsibility to provide 2. It is your decision not your family or reproductive health to all, and also husband or boyfriend or partner’s to provide safe conditions under which the right of choice can be 3. Any other reason not related to your exercised without fear or harm or physical health -- such as being a sex stigma; worker, being married, or being a migrant, refugee or asylum seeker. - There is no limit on the amount of abortions that you allowed to have under South African law. Remember, you always have the right to choose what is best for you and your body. SOUTH AFRICAN LAW SAYS HOW TO ACCESS SAFE AND LEGAL ABORTION SERVICES WHEN CAN YOU GET AN ABORTION?

To have a free abortion at a public health Administrative staff, pharmacists, security, Timeline Conditions: Abortion clinic or hospital: or other clinic staff have no right to refuse for performed First, you need to go to a local primary to assist you. When you arrive for services pregnancy: by: healthcare clinic. The primary health care they are obliged to assist you. clinic must: First 12 No conditions A doctor, a Second, you will have an appointment to weeks of – available on nurse or a pregnancy request registered • Examine you to confirm that you are have the abortion at a clinic or hospital midwife pregnant by doing a urine test that has trained staff and equipment to do • Provide counselling services, if you this safely. 13-20 Abortion available A doctor choose to have counselling Where else can you go to have a safe weeks of under the following • Make an appointment for the abortion; abortion? pregnancy conditions: or give you a referral letter to a public - Rape or incest health clinic or hospital where the Private doctors and non-profit - Danger to your mental or physical abortion can be performed. organisations who are trained and health qualified to do abortions also provide - The fetus is not If you are HIV positive, it is important to safe and legal abortions. Private health viable ensure your health care provider knows facilities and organisations do charge fees - If the pregnancy about your status as they may need to for this (sometimes thousands of rands). would significantly give you antibiotics when you have the affect your procedure. This is for your own personal economic or social health and safety during the procedure. circumstances

NOTE: The law says health workers MUST After 20 Abortion is only A doctor inform you of your rights and MUST refer weeks of available in limited you to a public health clinic or hospital pregnancy circumstances, where you can get these services. Health namely: workers CANNOT refuse to help you - If the pregnancy have an abortion for any reason. Health is a danger to your workers who are unwilling to give the life or the health of service for any reason must refer you to a the fetus colleague who is willing to do so; or to the appropriate health care facility near you with a referral letter and a booking. INFORMAL/ILLEGAL ABORTIONS BEWARE HAVING AN ABORTION

Even though the law says you have a right An abortion done by a person who is not Abortion methods: to an abortion at a public clinic, for free, trained and unqualified and has not been many women in South Africa still have designated as an abortion service provider If you are considering going for an informal/illegal abortions. This happens by your provincial Department of Health abortion, speak to a medical practitioner because: can be a danger to your health and your about the best methods available to you. life. With a legal provider, abortion is a very • The health workers at the public clinic safe procedure. refuse to give abortions, or to send you Some ways to tell if the provider is “illegal” to another health provider or “informal”: Each woman should choose the method (this is illegal) that is best for her own circumstances. • Private legal abortion providers may • They only provide a cell phone number is more common now; charge more money, and they may be • They do not provide a landline number but if you do not live where there is water far away or hard to reach • They do not advertise their physical and sanitation (a flushing toilet) you • You have been pregnant for more than address should tell your provider to make a plan 3 months; after this time only a medical • They do not tell you about the for you. Similarly, if you have experienced doctor can perform this procedure and methods they use sexual assault or are very young, a surgical there are not many doctors providing • They want you to pay cash up front method may be easier for you to cope this service. and do not offer other payment with. • Many of the illegal providers offer this methods service as it the Department of Health • They use medical abortion tablets, but Whatever method is offered to you or you does not have enough doctors only give one kind of tablet. For a choose, it is really important to get to the providing services for women who are medical abortion you need two clinic or provider early in your pregnancy. over three months pregnant. different types of tablets taken at different times. On your first visit to the clinic, you should • They tell you to not come back but expect to be told what methods are going rather to go to a government hospital to be used and what may happen to you. if you have a problem. If you are late and you need to have the • They tell you that they can do the procedure before the cut off of 12 weeks abortion up to 20 weeks - 10 weeks or 20 weeks, you may be required to have after your last period or more. the procedure on the day that you arrive at the clinic. WHAT HAPPENS DURING HAVING AN ABORTION MEDICAL ABORTIONS A MEDICAL ABORTION?

Medical abortions use medication (pills Step 1: At the clinic The woman should expect to bleed or spot for or tablets) only. In South Africa, medical about 2 weeks after taking the tablets and she abortion is generally available up until When a woman comes to the clinic, the may see blood clots and tissue coming from 10 weeks after your last period. In some doctor or nurse will explain the process the uterus. provinces and hospitals, doctors do it till and answer any questions that they 13 weeks after your period and in certain have. After the woman’s medical history This is an expected part of ending the circumstances possibly up until 18 weeks. has been reviewed and she has been pregnancy. The heaviest bleeding will happen The length of the process - from when you examined, a pregnancy test will be done. while the abortion occurs, usually within the take the pill - is different for each woman If indicated, an ultrasound may be done, first 6 hours after taking the second tablets. but it usually takes a few days, during but not in all instances. After this, the first which some woman experience symptoms medicine will be given and swallowed at Step 3: 10 - 14 days later, follow-up visit to similar to a miscarriage. the clinic. The woman may experience the clinic some cramps and bleeding in the days Medical abortion requires the use of two after taking the first medicine, but very The medicine causes bleeding and cramping drugs: and . One few women will have a complete abortion - these symptoms mean that the treatment is tablet of mifepristone is swallowed first, before taking the second medicine. working. Sometimes women can get cramping causing the embryo to stop growing. Two and bleeding and still be pregnant. This is days later, the woman takes misoprostol, Step 2: As instructed, a day later why it is very important to return to the clinic causing contractions of the uterus and - at home 10 – 14 days after taking the first medicine to expelling the embryo. The timing, dose ensure that the pregnancy has ended. If you and way of administering misoprostol The woman will swallow or place the are still pregnant after taking the medicine, may vary slightly. Studies have shown that tablets under her tongue or to the side you must have a surgical procedure to these drugs effectively terminate more of her cheek in her mouth - 2 to 4 tablets complete the abortion. than 9 out of 10 pregnancies early in the of the second medicine at home usually first trimester. Medical abortion is not a in the morning before having anything to good option if you previously have had a eat or drink. Within 2 hours she can have caesarean section. breakfast and something to drink. Taking pain medication is advisable as she will You should have some follow-up exam start to have strong cramps and bleeding, one or two weeks after you have taken which can be heavier than an ordinary the drugs to ensure that the abortion period. has happened. If you take these drugs you must be prepared to have a surgical abortion if the pills did not work fully. The drugs that induce medical abortions cause birth defects if the embryo is not aborted. WHAT ARE THE POSSIBLE SIDE EFFECTS COULD I GO BACK TO WORK AFTER SURGICAL ABORTIONS OF A MEDICAL ABORTION? TAKING THE MEDICINE?

Surgical abortions involve a nurse Bleeding and cramping are a normal On the day you take the second set of (up to 12 weeks of pregnancy) or a doctor part of the process and show that the tablets it would be best for you to take the (from 12 to 20 weeks). A surgical abortion medicines are working. Cramps generally day off if you can, snuggle in bed with a is a same-day procedure that is done in a last a few days. Bleeding is heavier at hot water bottle, take your pain meds, and clinic or a hospital. You may be given some first but some bleeding or spotting may change your pad regularly. You should of the medical abortion drugs to start the continue for as long as 12 days. A woman expel the fetal sac that day and it would process of opening your womb so it is may also have some nausea, vomiting and be good to be in a safe place, close to your easier to perform the procedure diarrhoea on the days that she takes the toilet and comforts. - this may cause cramping. medicines. The following day you can go back to There are two methods: Occasionally some women will also have work but do continue to care for yourself, headaches, dizziness, chills or fever. These changing your pads and taking pain meds 1) uses a machine symptoms usually last a short time; you if needed. to suck out the contents of the uterus can take medicine for pain and nausea. through a thin tube. This can be either an electric or hand-held machine.

2) (D&E) is used after 15 weeks. These are mostly done if there has been an incomplete abortion, or in a very late pregnancy. A womb scrap or is an old-fashioned method and should not be used these days.

You do not bleed as much with a surgical abortion compared to a medical abortion. You should discuss pain options and relief with your health provider before the procedure. COULD I GO BACK TO WORK AFTER TAKING THE MEDICINE? SRJC Members involved in this pamphlet:

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