Abortion: Government to get tougher on doctors with moral objections

South Africa is one of a handful of African countries with liberal abortion laws. The country passed its landmark Choice of Termination of Pregnancy Act in 1996. Following the Act’s introduction, the number of abortions performed in South Africa substantially increased.

Today, tens of thousands of safe, legal abortions are performed each year at a rate comparable to that of most nations that have legalised abortions, shows 2016 research by the US Centres for Disease Control. But the Act didn’t just pave the way for easier access to terminations; it also saved lives.

The legislation is credited with bringing about a 91% reduction in maternal deaths related to unsafe abortions in the country between 1994 and 2001, according to a 2005 scientific letter published in the South African Medical Journal. Shortly after, an amendment to the Act placed the responsibility of ensuring abortion services are available — and tracking which facilities provide them — in the hands of provincial departments of health.

Following the passing of the Act, the national health department designated facilities to provide the service and conducted workshops with healthcare professionals to ensure that they understood their roles and responsibilities regarding the law.


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But more than two decades after the legislation was passed, there have been, and will continue to be, many different voices both for and against the legalisation for termination of pregnancy services. Some see abortion as a woman’s right; others view it as an unconscionable act in terms of their faith.

These voices are heard in communities throughout the country as well as among health professions, and they help to shape how termination of pregnancy services are provided on the ground.

One senior hospital manager once recounted his staff’s fear of being labelled “baby killers” by the very community they served should they provide abortions. He said he felt powerless to protect his staff from these insults — or worse.

Meanwhile, many healthcare workers remain morally opposed to providing the service “It’s not everybody who actually agrees to termination of pregnancy, and it’s their right to do that,” said the head of a hospital obstetrics and gynaecology department in a 2014 study published in the journal Reproductive Health.


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As part of the study, researchers interviewed almost 50 healthcare workers, managers and policymakers in the Western Cape and found that resistance to providing abortions was not only confined to the doctors and nurses actually charged with terminating pregnancies but also among support staff.

“Some of the pharmacists refuse to dispense misoprostol for the patients, and even some of the ward staff don’t like to serve the women tea,” reported one nurse in the study, describing the reluctance of some pharmacists to fill prescriptions for misoprostol, a drug used in medical abortions.

The study also suggested that some healthcare workers do not know what to do when confronted by conscientious objectors, or people who remain morally opposed to performing abortions.

“I need a doctor who can prescribe misoprostol … but then they say: ‘No, it’s against my religion, and I’m not doing it.’ It’s not my position to say to them: ‘Where is your written excuse?’” said another nurse.


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