In particular, significant emphasis was placed on the role of abortion in reducing maternal mortality and morbidity, supported by Medical Research Council data on unsafe abortions and deaths REES, REES, Helen et al. However, it would be wrong to characterise the narratives on legal reform as solely health-based. In: Everatt, D. Feminist StudiesVol. The political emphasis of women was often on the racial consequences of limited reproductive choice, rather than choice itself. Nevertheless, it was recognised as a central component of reproductive rights, and as described above, was included in the Constitution in express terms.
Although, this agreed with the liberal idea of women as autonomous rights-bearers able to make individual decisions about their bodies and lives, for many feminists, the idea of freedom was socially constituted. The right to control our bodies, the right to choose a safe legal termination of pregnancy, is in the context of political, social and economic choices for women, in the context of moving our society towards equality, respect and a healthy sharing of power and responsibility in the home and in society HANSARD, 29 October , col.
Heads of Argument, July South African Journal on Human Rights. In South Africa, during the s, equality arguments focussed particularly on the effects of race and class which placed black, rural and working-class women in the most vulnerable position in relation to reproductive health and choice in general, and access to abortion in particular. In this country, substantive equality required a complex and intersectional understanding of the subordination of women on the basis of gender, race and class.
Equality came to dominate as a political idea and as a strategic choice. Indeed, as discussed below, this opposition extended to those health-workers who were responsible for providing abortions services BATEMAN, Nevertheless, I want to suggest that the narratives of the early s also contained an incipient idea of reproductive justice. In South Africa, it suggests overcoming the particular exclusion of poor black women from access to abortion under the Apartheid era law, not only required a new law that guaranteed safe access and the provision of comprehensive services, but also attention to the social and economic conditions that impeded meaningful equality and choice.
Nowadays, this idea was not always fully articulated legally or politically. Once the law was passed, the focus shifted to widening access within a post-apartheid health-care system through the provision of comprehensive reproductive health-care services. Public and reproductive health narratives again took hold, and feminist ideas of freedom, equality and reproductive justice, while present, were less visible. Attention shifted to the public and reproductive health imperatives of providing comprehensive services.
Despite evidence of significant societal discomfort with abortion and divisions within the ANC over its status, the government and ANC retained a strong, if sometimes rhetorical, commitment to reproductive choice. Over time, however, early problems of implementation expand and become entrenched, affecting the quality and quantity of abortion services, increasing backstreet abortions, and revealing old and new patterns of exclusion.
This required a significant redistribution of available resources and structures from a past in which health service delivery was sparse and race-dependent, and where black women in rural, high density urban and peri-urban areas and informal settlements had been particularly disadvantaged.
Equity in access to services required the urgent restructuring of the health system as a primary health care system with MCW health care as a key component of the package. The development of policies focused on institutional transformation and reallocation of resources to deliver effective services, including reproductive health services.
The NGO sector weighed in to assist as major national and transnational reproductive health, providing assistance with policy development, training and values clarification. Access expanded rapidly, if unevenly. British Medical Journal. International Journal of Obstetrics and Gynaecology. The results of a study commissioned by the Department of Health found the number of patients with high morbidity had almost halved in 9.
The majority of cases had no signs of infection on admission This decrease in maternal mortality and morbidity also provided a rational basis for expanding access in the face of growing anti-choice opposition to the law.
Indeed, health and mortality reasons continued to be a major justification for the law and for expanding services. In South Africa, the right to abortion was established politically through the legislative process, and it was perhaps less vulnerable to attack than court established rights, such as those in Roe v Wade U. This was unsuccessful as the High Court relied on the common law to find that the fetus was not a rights-bearer under the Constitution and could not claim a rights violation B-C; C-D.
Constitutional Law of South Africa. Juta and Co: Cape Town, This argument denied moral autonomy to minors to make reproductive decisions. Minors were capable of this, they could consent; the test for informed consent was not about the age, but capacity to consent p. Again the attempt to undermine the moral autonomy of women in this case, minors was unsuccessful.
Finally, in , the Department of Health tabled legislation amending the CTOPA in Parliament to increase access to safe termination of pregnancy services and achieve better governance of those services. For the first time, the public face of the anti-abortion lobby was not that of white, professional men, but of large numbers of black, church-going township women and men RRA It was noted that most of the objections spoke to the main act, not the amending act.
It is worth pausing to comment on the shifts in public narratives on abortion rights that these events signify. Firstly, the pro-life narratives had shifted and diversified from the s.
Members of religious and church groups continued to censure women who procured abortions as murderers of unborn children. These included mandatory counselling, including photographic images; wider provision for conscientious objection; parental consent for minors; and limiting the numbers of service providers and facilities for terminations see for example, SMYTHE, undated. In addition, public health and equality arguments dominated as these groups drew on research that showed how the legalization of abortion had significantly reduced maternal morbidity and mortality, but that many poor, rural and unemployed women were still unable to access safe, legal abortions.
The amendments, it was argued, were critical to extending the right to all women by improving the reach and quality of termination of pregnancy services. This example brings into sharp focus the contesting ideas of women that characterise each side.
On one side, those opposing abortion speak of protecting women, suggesting women require more information and assistance in making choices about abortion and that the law should be amended to reflect this. The anti-abortion focus of these arguments means that there is a normative and practical bias against choice. Women are seen as mothers, victims or promiscuous agents — in all instances these views suppress the agency of women and show little understanding of their context. Thus, it is recognized that women live in a societal context in which their rights and freedoms are limited by gendered power and inequalities, reflected in discriminatory attitudes, beliefs and practices.
The right to choose an abortion and also the ideas of women that underpin this law remained sites of struggle as the state and civil society organisations have sought to defend the CTOPA in the past two decades.
This is discussed in the next section. Every year, further than 40 women or so obtain abortions from just one private clinic with outlets across the country HODES, For more programs, initiatives, and strategies that are delivering for girls and women please view The Improve Maternal and Newborn Health and Nutrition policy brief.
IMPACT Since , there has been a significant decrease in morbidity for women in South Africa who have undergone unsafe abortion, especially younger women. Featured Stories. Scaling-Up Breastfeeding in Bangladesh. Moreover, women need to be aware of the time constraints involved, as well as how and where to access abortion services.
This study investigated knowledge of the abortion legislation eight years after the introduction of legal abortion services in South Africa among women attending primary care public health clinics in the Western Cape Province, South Africa.
The Western Cape is among South Africa's better-resourced provinces, with the largest number of positive reproductive health indicators, and is considered to have the best-developed reproductive health infrastructure in the country. The study was requested by the Western Cape provincial health department. Here we report on women's knowledge about abortion legislation. In each region, we selected a random sample of primary health care clinics with the probability of selection weighted by patient load based on the clinics' usage statistics obtained from the provincial health department.
Over a two-day data collection period at each clinic, interviewers approached consecutive women as they signed into the clinic to participate, regardless of their reason for attending the clinic. Women were eligible if they had ever had sexual intercourse and were between the ages of 15 and The number of women interviewed at each facility was proportional to clinic size based on total patient load and varied from 11 to We interviewed consecutive women until the target sample size was reached.
Semi-structured interviews were conducted in participants' home languages and lasted approximately 15 minutes. To assess knowledge of the abortion law, we asked the following key questions: 1 "Does the present law on abortion in South Africa allow for a woman to have an abortion?
After responding to these questions, a description of legal abortion was then read to all participants and they were asked open ended questions about their attitudes towards legal abortion and their perceptions of its safety.
In the analysis, responses to open-ended questions were coded and collapsed into categories to facilitate quantitative assessment. A multiple logistic regression model was developed to examine how demographic and behavioral factors were associated with abortion knowledge.
Variables were retained in the final model if they demonstrated a significant independent association with the outcome of interest, or if their removal altered the association between other covariates and the outcome of interest [ 8 ]. All participants provided written informed consent and ethical approval to conduct the survey was granted by the Provincial Department of Health, the City of Cape Town Health Department, each participating clinic and the Research Ethics Committee of the University of Cape Town.
The median age was 28 years and the median level of education was grade 10 Table 1. Age, level of education and employment were not associated with knowledge of legal abortion in the bivariate analysis. In the multivariate analysis, characteristics independently associated with knowledge of legal abortion were: living in the urban vs. This is one of the few studies focusing on South African women's knowledge of the abortion law.
These findings show that one-third of women surveyed do not know that abortion is legal in South Africa. Although this study used the same questions as the DHS, the DHS figures are not directly comparable to these findings due to different sampling methodologies: the DHS was a community-based sample of women and this study sampled women attending health services.
A comparison of these two sets of data suggests that more women know about legal abortion now than did in However, another explanation for this apparent difference in levels of knowledge is that this survey was conducted among individuals attending public health clinics, with greater access to health education. In general, it is likely that awareness of abortion legislation in this clinic-based sample in the Western Cape Province, which has a better reproductive health infrastructure than most other areas of the country, is higher than in the general population of South Africa.
At least 1 of these doctors must have been practicing for 4 years and neither can participate in the procedure. The operation must take place in a state controlled institution or an institution specifically designed for abortion.
This law is currently not serving the needs of the women of South Africa, even among the women who are legally entitled to have an abortion.
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