Credit: Jake Naughton. Support provided by the Pulitzer Center on Crisis Reporting.
This story is part of a Pulitzer Center on Crisis Reporting collaboration between African and American journalists on reproductive health issues.
Seventeen years ago, as apartheid came to an end and a democratically elected government took power, South Africa seemed ready to become an abortion rights pioneer. In 1996, the post-apartheid legislature passed the first law in sub-Saharan Africa legalizing abortion without restriction in the first trimester, and with a doctor’s approval thereafter. The new rules allowed women to walk into a public hospital or clinic, confirm their pregnancy and gestation period, and receive a free abortion if they were fewer than thirteen weeks along in their pregnancy. Simple and straightforward, the law is “probably the most progressive [abortion] law in the world,” says Jane Harries, director of the Women’s Health Research Unit at the University of Cape Town. But sixteen years on, the promise of access, no matter how liberal, “doesn’t necessarily translate into services that are available.” In today’s South Africa, it is often faster and easier to get an illegal abortion than a legal one.
Seventeen-year-old Marie (not her real name) has a story that is all too typical. When she found out she was pregnant, ”I wanted to kill my boyfriend,” she told us. Equally furious and fearful, she hid the news for months from her aunt and cousins, with whom she lived just outside Port Elizabeth, a waning shipping town on South Africa’s eastern coast. “I wanted an abortion,” Marie says. “It took me a long time to get the R140 [roughly $16] to get to the clinic.” When her belly was finally too big to hide, her aunt banished her, and Marie went to stay with her boyfriend. Once she got to a clinic, Marie says, ”I waited for a long time. When they finally did the scan, they said it was too late to abort. They could not help me.”
Marie’s story is repeated across the country. Free abortion is guaranteed at public hospitals and clinics designated by the government to offer the service. Yet less than half the facilities so designated actually offer the procedure. And even that’s an improvement over four years ago, when only 25 percent were providing services—more than a decade after legalization.
As a result, women like Marie have to run a gantlet when they need abortion services. Clinics are an expensive taxi ride away—for some South Africans, those taxi fares add up to a week’s wages—and even women with access to a household vehicle often don’t want their families or neighbors to know they need it for an abortion appointment. Plus the intake practices at these clinics, meant to streamline the high demand, mean that women have to schedule a procedure and then return later.
Last year, nearly 80,000 abortions were performed across South Africa, but women’s health experts are quick to point out that these numbers reflect the state’s current capacity, not the real demand.
Mfundo Mabenge, head of obstetrics and gynecology at Port Elizabeth’s Dora Nginza Hospital, blames the government for creating this crisis. “Government has failed us,” she says. “They compel us to offer a service for termination of pregnancy, but they give us no support.” Mabenge, like other Ob/Gyn chiefs we spoke with, was simply told to make space to provide abortions and then to offer them. The government covers the cost of the procedure, but Mabenge says there’s no money to add beds, mop the floors, or otherwise create and maintain a clinic space.
Meanwhile, Mabenge says, “demand is greater than we can handle.” Nationally, the number of abortions performed jumped nearly a third between 2010 and ’11. Joe Maila, spokesman for the national Department of Health, says the South African government doesn’t measure “demand” for abortion. But Mabenge’s hospital sees as many as twenty patients a day requesting one; the number of abortions there doubled between January and June 2012, even as the staff dropped from four to two midwives.