“When my sister phoned to break her news, I couldn’t speak. She called to tell me she was pregnant – and the day before, while she was having her first scan and seeing for the first time her baby’s heartbeat, I was curled up on the bathroom floor, terminating my pregnancy.

 

“I haven’t told her. We haven’t told anyone, actually, because it’s so hard to explain,” Steph Green*, a graphic designer from Johannesburg, chooses her words carefully as she twists her wedding band. “In my heart, I have no doubt that what I did was right for me. For us. But I can’t find the words that will make people understand why I chose to have an abortion.”

 

Steph pauses, searching for a way to explain the biggest decision she’s ever made. This is the first time she’s spoken about her abortion and while she struggles to find the words, Steph speaks with conviction.

 

“Many people will say what I did was wrong – but I’m in no position to be a good mother. I have suffered from depression for a few years; our marriage is on rocky ground; my job is unstable and I am in huge debt. In my mind, bringing a child into this sort of environment is irresponsible,” Steph insists. “Plus, I’ve never wanted to have a baby.”

 

And so one summer afternoon just before Christmas, Steph took a series of pills she’d bought from a pharmacy and ended what for so many women would have been a dream: the journey through motherhood.

 

 

The right to a healthy life

 

According to figures released by the Department of Health, there were 77,771 legal abortions in South Africa in 2011 – a 31 percent increase on the previous year. While the latest statistics aren’t yet available, it’s safe to say that Steph is one of at least 80,000 South African women who chose to terminate their pregnancies in 2012; however, Steph won’t be included in the official count when the figures are released. Her abortion was not legal.

 

Steph’s pregnancy was six weeks along when, after lengthy discussions with her husband, they decided to terminate. “Neither of us believed that at that stage there was anything more than a growing collection of cells in my uterus, which is why we were able to consider termination,” she says. “Still, I was ashamed of myself and didn’t want anyone – not even my doctor – to know, so I did the abortion myself.”

 

Instead of seeking medical advice Steph, who describes herself as smart, practical and health-conscious, Googled “safe abortion methods” and read about a drug called Misoprostal, widely recognised as the safest method for terminating first-trimester pregnancies. “The pills are also used to treat gastric ulcers so my husband went into a chemist and pretended he was on holiday and hadn’t brought his repeat prescription along. The pharmacist gave him the pills; I took them that afternoon and started to bleed within a few hours.”

 

While the method she used to terminate her pregnancy is the one advised by most healthcare practitioners, the way in which Steph went about her abortion – without consulting a health worker, and lying to the pharmacist – makes it illegal. Steph is one of the lucky ones: she suffered no complications. But for thousands of women, the illegal termination of a pregnancy often results in the loss of their life.

 

Ironically in South Africa, where abortion has been legal for more than 17 years and where abortion laws are among the most progressive in the world, experts say that access to safe services is becoming more difficult. In an article published earlier this year in American Journal of Public Health, Karen Trueman and Makgoale Magwentshu from the South African office of Ipas, a global nongovernmental organisation that’s dedicated to ending preventable deaths and disabilities from unsafe abortion, say that “in the same way opponents of abortion in the United States have whittled away at access with increased bureaucracy, South Africa faces similar assaults that leave women without safe care.” A major stumbling block is that people who don’t support abortion are hindering service delivery and, says Ipas policy director Charlotte Hord Smith, “politicians are prioritizing ideology that harms women over good public policy”.

 

What contributes to the problem is that there aren’t the resources and financial support in many areas for hospitals and clinics to perform abortions. Added to that, many women in rural areas struggle to find enough money to pay for a taxi ride to a hospital – and so they turn to people who offer (illegal) “quick and easy” methods.

 

Elizabeth Serobe, a Gauteng-based midwife who renders abortion services, stresses that through all of the emotion and the ethical debate of what is right and what is wrong, it is the health of the woman that should be considered first. “I’ve seen women dying from back-street abortions,” she says on the Ipas website. “Women have come in with coat hangers hanging from their cervixes and lost their uteruses from sepsis. One case that will always be in my mind is a young girl who had shot herself in the abdomen to get rid of the unwanted pregnancy. I want to emphasize that [by offering safe abortions] we are saving lives.”

 

 

The right to choose?

 

While those who are vehemently pro-life or pro-choice will make their voices heard, it’s very difficult to gauge the general attitude towards abortion in South Africa, says Professor Catriona Macleod, leader of the Critical Studies in Sexualities and Reproduction Research Programme at Rhodes University. “Research has shown that people hold contradictory and complex views on abortion, and that their attitudes vary according the circumstances under which abortion is being considered,” she says.

 

Recent research Macleod conducted among university students shows that there is a relatively strong pro-life sentiment. Women have more liberal attitudes than men; they also show stronger approval for women having autonomy in abortion decision-making. Men, on the other hand, tend to feel that the male partner should be informed of the pregnancy, should have a say in the abortion decision, and should have the right to prevent the woman from terminating her pregnancy. Men are also more likely to view abortion as a sin, and to regard the foetus as a human being.

 

The point at which a foetus should be considered a human being with the right to life is hotly contested. Dr Evelyn Bester, a GP who belongs to a pro-life organization called Doctors For Life (DFL), says that when asked “when is life a life?” their response is standard: “Scientific research clearly defines that the beginning of life is at conception,” she says. “Immediately after conception each cell has sufficient information in its DNA structure to produce a complete human being. Destruction at any stage of the development of a person, from the single cell stage up to several million cells, is the taking of a life.”

 

Legally, it’s a different matter. According to South African law, says Dr Roland Eddie Mhlanga, chief specialist of obstetrics and gynaecology at the Department of Health and Social Development, Mpumalanga, the baby is considered to be a legal person only once it has taken its first breath.

 

 

Safety first

​

The 1996 Choice on Termination of Pregnancy Act states that it “promotes reproductive rights and extends freedom of choice by affording every woman the right to choose whether to have an early, safe and legal termination of pregnancy according to her individual beliefs” – but this doesn’t mean that you can simply make an appointment with your GP and assume she will abort your pregnancy. “Private GPs are not under any obligation to provide termination services,” says Mhlanga. “There is nothing the client can do if a GP refuses to provide the service or refer her to someone else.”

If you find yourself in this position, what are your options? There are several trusted websites that will direct you to clinics and hospitals where abortions can legally be performed (see box); you should also call other doctors in your area. “If you decide to go through with having an abortion, ensure that the facility you use is registered to do abortions from beginning to end,” advises Bester. “If the facility tells you to go to a provincial hospital or to another practitioner to finish the abortion, then please go to another facility. If a doctor tells you to tell no one, or that they are not registered as an abortion facility, then the procedure is illegal.”

There are two types of termination procedures – medical, where pills induce abortion, and surgical, where instruments are used to remove the foetus – and the method will be determined by the duration of the pregnancy (see box). Two pills called Mifepristone and Misoprostal are acknowledged worldwide as being a safe method to terminate a pregnancy that is less than 12 weeks along. The pills work together: Mifepristone blocks the effects of progesterone, a hormone required to sustain a pregnancy, and Misoprostal induces labour by causing the uterus to contract. Once a woman has taken these pills, she will experience severe cramping and bleeding as her body expels the foetus.

 

This is the method Steph used to terminate her pregnancy. “I felt awful for about three days. The cramps would suddenly hit, and the pain was bad just before a lot of ‘matter’ came out. It was five or six days before the termination was complete,” she says. “Towards the end I was worried that something was wrong; for peace of mind, I should just have been honest and gone to a doctor.”

 

The surgical procedures are either vacuum aspiration, or dilation and evacuation (D&E), and both are performed through the cervix. Vacuum aspiration is often done during the first trimester, and a machine is used to suction all the tissue out of the uterus; a D&E is performed in the second trimester, and combines vacuum aspiration and the use of instruments to clear the uterus of foetal and placental tissue.

 

“Most people think a safe abortion ensures no complications and no risks, but some women do need surgical intervention after an abortion, especially if done illegally,” says Bester. “Some women lose too much blood and need transfusions; others need to have the last of the pregnancy products removed, get infections or have their uterus perforated during surgical procedures. A woman might even lose her uterus. This is very, very rare but the risk still remains.”

 

 

Mind over matter

 

While the physical effects of an abortion can be tracked and treated, the psychological impact is harder to monitor. The pro-life camp says that women who terminate a pregnancy are more likely to suffer from post-traumatic stress, depression, anxiety and sexual dysfunction; those who are pro-choice say this isn’t always the case.

 

Debates concerning the psychological consequences of abortion have raged for decades, and many studies have been conducted. Some have found that women suffer negative mental health effects but many of these studies, says Macleod, are marked by methodological problems. “Major reviews of the credible studies conducted on abortion find that majority of adult women who terminate a pregnancy do not experience mental health problems.”

 

Some women will, however, experience depression, anxiety, grief, guilt or feelings of loss. “It is important that the range of possible emotions following abortion are acknowledged, so that women who do experience difficulties may, without fear or stigma, be able to find and make use of non-discriminatory counselling and assistance,” says Macleod.

 

Something that may help is to keep a journal of the processes a woman goes through when deciding to terminate her pregnancy. “She may need it when her life is different and she possibly doubts the decision,” advises Macleod. “Reading about and remembering what deep processes she went through to reach the decision may help in putting these doubts to rest.”

 

 

A constant reminder

 

By the time you read this story, Steph will have sat through her sister’s baby shower and shopped for cuddly toys. The Beatrix Potter books she’s bought will be on the shelf in the nursery, and the artwork she designed will be on the walls. She will also have held her sister’s baby in her arms for the first time.

 

“Over the past few months I’ve been watching my sister’s tummy grow, and asking what she’s feeling and what the baby’s progress is,” says Steph. “All along I’ve known that it could have been me; that I should have been at the same place in that journey – and I am so relieved and grateful that I’m not.

 

“The process was horrible, and the decision to have an abortion is not one I ever want to make again.” Steph’s eyes fall to her stomach and then she says, quietly: “For the rest of my life, I will have a very special nephew or niece who will always be a reminder of the child I chose not to have – and I’m okay with that. Really, I am.”