Monday July 22, 2019

Widespread Stigma in South Africa, Despite Liberal Abortion Laws

At the clinic in Rustenburg, nurse Christa Tsomele has been performing abortions for a decade, and says she is proud of her work. She says she thinks some of her colleagues are contributing to the stigma of abortion -- and worse.

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Nurse Margorie Sithole, left, explains to Martina Mabe, center, and Flora Tshabalala, right, that abortion proceedures will only be performed during the week at Baragwanath Hospital in Johannesburg, Feb. 1, 1997. VOA

Twenty-six-year-old Precious, as she has asked us to call her to protect her identity, is 16 weeks pregnant. And so is her best friend, also by Precious’ boyfriend. That event turned her life upside down and brought her to the difficult decision to seek an abortion.

She lives in South Africa, where abortion is legal without justification and available through a nurse through 12 weeks of pregnancy, and legal up to 20 weeks, when done by a doctor and with justification.

But when she tried to get an abortion in her home city of Johannesburg, she ran into problems.

“When I went to register my name, I simply said, ‘I want to do abortion,’ and then they said, ‘No,’” she told VOA.

“And there were two nurses there, and the older one said, ‘Oh, thank God, I’m not trained for this,’ whilst the other one said, ‘no, you have to do back to your place and do it there.’ Then we had a disagreement there, as, like, I’m being against God and more stuff like that.”

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The company recently launched a campaign to try to reduce the stigma around abortion care. Pixabay

Hers is a common experience, and it’s what reproductive health advocates say drives 10,000 South African women to seek illegal, backstreet abortions every year.

The nation’s health department estimated that as many as 25 percent of maternal deaths from septic miscarriages were the result of such illegal abortions. More than half of all abortions in South Africa are unlicensed, despite the fact that half of all government hospitals offer the service for free.

Precious, who says she fears being judged by her neighbors, chose instead to travel to the dusty mining town of Rustenburg, where aid agency Doctors Without Borders has set up a free abortion clinic.

She said she was sure of her decision.

“I want this thing to be done as quickly as — because I can’t, I can’t take it anymore,” she said, her voice soft and wavering. “Because what I’m thinking is what happened. I can’t think of, like, of positive things. I think, if this thing failed, then what will I do? Should I end my life?”

‘We give women a choice’

Whitney Chinogwenya, head of marketing at South Africa’s best-known private abortion provider, Marie Stopes, says their clinics address a real need. The company recently launched a campaign to try to reduce the stigma around abortion care.

“When a woman wants to terminate a pregnancy, they’re going to terminate the pregnancy,” Chinogwenya told VOA from the organization’s office in downtown Johannesburg. “It doesn’t matter what methods they use, it doesn’t matter whether it’s legal, it’s illegal or it’s safe — they’re going to find a way to terminate the pregnancy.

“So what’s so great about South Africa and it being legal here is that there’s a safe place where you can get the procedure, where it’s not going to harm your body, where it’s not going to cause serious complications. And the most important thing is that we give women a choice.”

Another problem, she said, is that few women know that abortion is legal, and think backstreet providers — who advertise openly, but who are not licensed — are their only option.

Medical experts told VOA harrowing tales of the practices performed by such providers. Many don’t perform ultrasounds, don’t attempt to determine how far along the pregnancy is, don’t follow up after the procedure, give the wrong medication, give incorrect medical advice, or administer dangerous chemicals such as bleach and drain cleaner to desperate patients.

One particularly egregious provider, Chinogwenya told VOA, even tried to sexually assault a woman in his care.

‘Somebody has to do it’

Nurse Kgaladi Mphahlele, who heads the Doctors Without Borders project in Rustenburg, says demand for the clinic’s services is high. He estimates he performs as many as 100 first-trimester abortions each month, and says he sees women from as far away as Botswana, where abortion is illegal.

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South Africa, where abortion is legal without justification and available through a nurse through 12 weeks of pregnancy, and legal up to 20 weeks, when done by a doctor and with justification. VOA

His patients, he said, range in age from teenagers to 50-year-olds. He began his career delivering babies, but switched course, and says he’s proud of his decision.

“I look back, ‘why did I get myself into this profession?’” he said, adding that his friends and family were initially worried, but have since become supportive of his choice.

“I said, ‘I want to be a health care provider because I want to help the people.’ And then, you see a gap, and this is part of health care service, and if no one is doing it, somebody has to do it. And I enjoy doing it, and I enjoy working with people.”

At the clinic in Rustenburg, nurse Christa Tsomele has been performing abortions for a decade, and says she is proud of her work. She says she thinks some of her colleagues are contributing to the stigma of abortion — and worse.

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“If you can’t help a patient as a nurse, just refer the client to the relevant place so that the patient must get help,” she said. “Don’t just tell her, ‘no, I can’t do that, or ‘I can’t help you,’ and leave the patient stranded. That is why they end up going to the bogus [provider]. Because when you leave her stranded, now she decides to go out to the street, that is where she is going to die.”

It’s that, she says, that keeps her going, through the judgment, through the tears, through the difficult stories she hears day in and day out. Because, she says, whether people agree with her work or not, she’s saving women’s lives, and following the law. (VOA)

Next Story

Trump: Taxpayer-Funded Family Planning Clinics Must Stop Referring Women for Abortions Immediately

Ahead of a planned conference Tuesday with the clinics, the Health and Human Services Department formally notified them

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FILE - A Planned Parenthood clinic is seen June 4, 2019, in St. Louis. A Missouri commissioner on June 28, 2019, ruled that the state's only abortion clinic can continue providing the service at least until August as a fight over its license plays out. VOA

Taxpayer-funded family planning clinics must stop referring women for abortions immediately, the Trump administration said Monday, declaring it will begin enforcing a new regulation hailed by religious conservatives and denounced by medical organizations and women’s rights groups.

The head of a national umbrella group representing the clinics said the administration is following “an ideological agenda” that could disrupt basic health care for many low-income women.

Ahead of a planned conference Tuesday with the clinics, the Health and Human Services Department formally notified them that it will begin enforcing the ban on abortion referrals, along with a requirement that clinics maintain separate finances from facilities that provide abortions. Another requirement that both kinds of facilities cannot be under the same roof would take effect next year.

The rule is widely seen as a blow against Planned Parenthood, which provides taxpayer-funded family planning and basic health care to low-income women, as well as abortions that must be paid for separately. The organization is a mainstay of the federally funded family planning program and it has threatened to quit over the issue.

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Taxpayer-funded family planning clinics must stop referring women for abortions immediately. Pixabay

Planned Parenthood President Leana Wen said in a statement that “our doors are still open” as her organization and other groups seek to overturn the regulations in federal court. “We will not stop fighting for all those across the country in need of essential care,” Wen said.

HHS said no judicial orders currently prevent it from enforcing the rule while the litigation proceeds.

Clare Coleman, president of the umbrella group National Family Planning & Reproductive Health Association, said “the administration’s actions show its intent is to further an ideological agenda.”

Abortion opponents welcomed the administration’s move. “Ending the connection between abortion and family planning is a victory for common-sense health care,” Kristan Hawkins, president of Students for Life, said in a statement.

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Known as Title X, the family-planning program serves about 4 million women annually through independent clinics, many operated by Planned Parenthood affiliates, which serve about 40 percent of all clients. The program provides about $260 million a year in grants to clinics.

The family planning rule is part of a series of Trump administration efforts to remake government policy on reproductive health.

Other regulations tangled up in court would allow employers to opt out of offering free birth control to women workers on the basis of religious or moral objections, and grant health care professionals wider leeway to opt out of procedures that offend their religious or moral scruples.

Abortion is a legal medical procedure, but federal laws prohibit the use of taxpayer funds to pay for abortions except in cases of rape, incest, or to save the life of the woman.

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The head of a national umbrella group representing the clinics said the administration is following “an ideological agenda” that could disrupt basic health care. Pixabay

Under the administration’s rule, clinic staff would still be permitted to discuss abortion with clients, along with other options. However, that would no longer be required.

The American Medical Association is among the professional groups opposed to the administration’s policy, saying it could affect low-income women’s access to basic medical care, including birth control, cancer screenings and testing and treatment for sexually transmitted diseases. By law, the family planning program does not pay for abortions.

Religious conservatives see the regulation as a means to end what they call an indirect taxpayer subsidy of abortion providers.

Although abortion remains politically divisive, the U.S. abortion rate has dropped significantly, from about 29 per 1,000 women of reproductive age in 1980 to about 15 in 2014. Better contraception, fewer unintended pregnancies and state restrictions may have played a role, according to a recent scientific report. Polls show most Americans do not want the Supreme Court to overturn Roe v. Wade, the 1973 ruling that legalized abortion.

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The Trump administration’s policy echoes a Reagan-era regulation that barred clinics from even discussing abortion with women. It never went into effect as written, although the Supreme Court ruled it was appropriate.

The policy was rescinded under President Bill Clinton, and a new rule took effect requiring “nondirective” counseling to include a full range of options for women. The Trump administration is now rolling back the Clinton requirement. (VOA)