It is therefore important to classify and prioritize this phenomenon as a global pandemic,  and develop ways to prevent unsafe abortions by investigating the factors surrounding their ability to access illegal abortion systems and methods.³

One of the reasons why illegal (backdoor) abortions continue to be a popular choice in South Africa is due to heavy disapproval of the public, political figures and health care workers. The latter which are meant to carry out safe and legal abortions. ^4,5 Another reason for the abundance of illegal abortions is owed to public stigma around abortion. This has led to a lot of women opting to get abortions away from public scrutiny and judgement ⁴. Yet, another reason lies in the fact that most women are not knowledgeable on where and how to access safe and legal abortion clinics; in addition to concerns over the cost of the procedure and the often callous treatment by the staff and medical practitioners ⁴. Limited access to safe and legal abortions also possess a geographical and financial barrier because not all public hospitals provide abortions and of those that do, most are usually isolated and far apart.

Furthermore, there is a wide gap between the rich and the poor as women who are well off financially can afford abortion clinics such as Marie Stopes⁸and those who cannot afford rely on the state, and to a point illegal provider.

This delay in health services and queues at state facilities have led to an increase in the number of unsafe abortions performed and a high number of septic abortions in public hospitals.⁹

Research has proven that by implementing policies that will not only broaden the legal grounds for safe abortions but also provide universal access and knowledge for safe abortions, nearly 70 000 deaths and 5 million disabilities can be prevented.³ Reduced maternal mortality and morbidity through the use of safe abortions is best achieved through liberalized abortion policies being accompanied by improved availability of quality abortion services and distribution.¹⁰ For example, in Romania, the Romanian policy reform on abortion (1989) had a great impact on the decline of abortion related mortality moving from a high of 148 per 100 000 live births to a low of 58 per 100 000 maternal mortality.¹¹ Also, mortality due abortion complications dropped from 87% in 1989 to 67% in 1990 and this has been gradually decreasing over the years.¹¹ 

Medical abortion drugs, and related services should also be made available to public hospitals with trained medical professionals and midwives. Moreover, implement counselling and therapy by professionals should the need arise in order to prevent victims from being subjected to interrogations and discrimination based on their choice to abort.

The reason to the increased number of unsafe abortions could be as a result of the lack of education about legal and safer methods of abortion. According to the National Centre for biotechnological Information, there has been an increase in the number of unsafe abortions and a dramatic increase in the lamppost advertisements for “safe, pain free” abortions.⁹

As future doctors we can also support and strengthen policies that do not only allow for women to have safe abortions, but provide adequate facilities and excellent care for these women. It should be a priority to ensure that such policies are bound to be followed by all countries.

1. Choice on Termination of Pregnancy amendment Act 2008,

(RSA). Available from: https://www.parliament.gov.za/search?q=Termination+of+pregnancy+

 

2. National Committee on Confidential Enquiries into Maternal Deaths. Saving Mothers Report, 2008-2010. NCCEMD. 2012.

 

3. World Health Organization [Internet]. Worldwide, an estimated 25 million unsafe abortions occur each year. WHO; [2018]. Available from: http://www.who.int/mediacentre/news/releases/2017/unsafe-abortions-worldwide/en/

 

4.Sangonet [Internet]. Unsafe Abortion in South Africa: A Preventable Pandemic. Sangonet; [updated 2012 July 2; citied 2018 April 22]. Available from: http://www.ngopulse.org/blogs/unsafe-abortion-south-africa-preventable-pandemic.

 

5. Hodes R. The Culture of Illegal Abortion in South Africa. J South Afr Stud. 2016 Feb 29; 42(1):79-93.

 

6. Visser M, Moleko A, editors. Community psychology in South Africa. 2^nd ed. Van Schaik Publishers; 2012.

7. World Health Organization [Internet]. Preventing Unsafe abortions. [Updated 2018 January; cited 2018 April 22]. Available from: http://www.who.int/mediacentre/factsheets/fs388/en/

8. Benson J, Andersen K, Samandari G. Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh. Re[1]productive Health. 2011 Dec 22; 8(11).

 

9. National Centre for Biotechnological Information [Internet]. Abortion in a progressive legal environment: The need for vigilance in protecting and promoting access to safe abortion services in South Africa. Am J Public Health; [updated March 2013]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673529/ 

10. World Health Organisation [Internet]. Packages of interventions for family planning, safe abortion care, maternal, newborn and child health. WHO; [Updated 2018 January; cited 2018 April 22]. Available from: http://apps.who.int/iris/bitstream/handle/10665/70428/WHO_FCH_10.06_eng.pdf?sequence=1

 

11. Benson J, Andersen K, Samandari G. Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh. RH. 2011 December 22; 8(9). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287245/