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A 14-year old girl lived in a township outside Johannesburg. She was raped by a church elder and though she reported the abuse to her mother (who died soon afterward), other family members compelled her to continue helping the 66-year-old man. During six months of repeated sexual assault, she became pregnant and went to a local hospital to seek an abortion. Staff told her — incorrectly — that her 16-week pregnancy was too advanced to terminate and that she needed a parent or guardian’s permission; under the South African constitution, pregnancies resulting from rape can be terminated during the second trimester and her age should not have been an obstacle to care. Her abuser was arrested, but the girl carried the pregnancy to term. |
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In 1990, after four decades under apartheid rule, South Africa began a period of democratic transition. As the country had its first democratic elections in 1994 and approved a new constitution two years later, South Africa also ushered in an era of increased attention to reproductive health.
During apartheid, South Africa employed coercive sterilization policies and severely limited abortion. As a result of its abortion restrictions, hundreds of South African women died, and thousands more had to be treated for complications from unsafe abortion. According to the country’s first assessment of reproductive health programs, 425 women died annually as a result of unsafe abortion during the apartheid years.
But today, the country’s constitution says that the state “may not unfairly discriminate on one or more grounds, including: sex, gender, pregnancy, marital status, age, and religion.” Furthermore, it posits that “the right for sexual and reproductive health and rights is grounded in a woman’s right to life.”
Ipas South Africa is currently the nation’s only nongovernmental organization (NGO) that focuses exclusively on abortion care. In keeping with that unique role, Ipas South Africa will continue to support the government’s efforts to provide legal, safe, affordable and accessible woman-centered sexual and reproductive health care.
Much of Ipas South Africa’s work concerns the full implementation of the 1996 Choice of Termination of Pregnancy (CTOP) Act. It established a woman’s right to safe and legal termination of pregnancy (TOP) up to and including the 12th week of pregnancy upon request. It also allows termination under certain circumstances from the 13th up to the 20th week of pregnancy.
With the passage of the legislation, South Africa experienced an increasing demand for TOP services and recorded an impressive decline (91 percent) in abortion-related deaths. The act was amended in 2004 to affirm that the South African government is committed to the expansion of access to TOP services.
Ten years after the CTOP Act was passed, South Africa still grapples with the legacies of its “separate but unequal” system — racial and regional disparities in health care, poverty, poor housing, and high degrees of sexual and societal violence. In the realm of reproductive health, it also struggles with service-delivery issues, including high staff attrition rates in abortion-providing facilities and some managers acting as “gatekeepers” who illegally obstruct women’s access to abortion services.
Since 1995, when Ipas began providing technical support for the national and provincial departments of health, Ipas South Africa has trained providers; conducted research on abortion care; organized and facilitated values clarification workshops for health-care workers, facility managers and policymakers; and distributed reproductive health technologies and information in all nine South African provinces.
In addition to providing technical support, Ipas South Africa strives to create an environment in which all men and women can enjoy the highest possible standard of sexual and reproductive health. Ipas South Africa played a leading role in the designation of February as National Reproductive Health Month, a vehicle for raising awareness throughout the entire country.
- Engage more actively with private-sector policymakers in order to ensure the availability of the manual vacuum aspiration technology;
- Focus on removing barriers to minors’ access to abortion;
- Work to improve access to second-trimester services;
- Advocate for a national medication abortion policy;
- Partner with NGOs and community-based organizations to reach target populations, including youth, rural women, abused women, women in informal settlements, as well as people living with HIV and AIDS.
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