Remaining Challenges to Providing Safe Abortion in South Africa: Q&A with Pathfinder's Zandile Bakaco
“At Pathfinder, we have always stood steadfast in our conviction that women should have the right to safe abortion. Today, we are proud to stand strong with our sister agencies in affirming our conviction and support to the International Campaign for Women’s Right to Safe Abortion."
- Pathfinder President Purnima ManeIn 1996, South Africa passed the Choice on Termination of Pregnancy Act, one of the most liberal abortion policies in the world. By law, South Africa allows "termination of pregnancy," or abortion up to the twelfth week of pregnancy. It also allows abortion from the thirteenth to the twentieth week under most circumstances, including rape, incest, or endangerment of the mother or child's physical, psychological, mental, or socioeconomic conditions. For serious medical reasons, including endangerment of the life of the mother, terminations after twenty weeks are allowed.
Despite the country's liberal abortion laws, challenges still persist in ensuring women's rights to safe abortion are actualized. Common barriers include limited access to abortion services due to stigma in the community and the public health system, limited knowledge about South Africa's abortion laws, and the absence of youth-friendly services.
Want to learn more about Pathfinder's work on safe abortion? Check out this new blog including voices from our colleagues and friends in Mozambique who are busy preparing for September 28th, the Global Day of Action for Safe, Legal Abortion.
In honor of the Global Day of Action for Safe, Legal Abortion, we asked Pathfinder's Project Coordinator and Nurse Mentor Zandile Bakaco a few questions about ongoing challenges to Pathfinder's work to provide safe and legal abortion in South Africa.
How you first became involved in reproductive health and the abortion movement in South Africa?
Soon after graduating, I went to work in Cape Town for a reproductive health clinic as a professional nurse. I was sent to training for a certificate in sexual and reproductive health by the Western Cape Department of Health. It was in this training that I first became aware that abortion is actually part of the sexual and reproductive health package and that it is legal and is the right of a woman to decide to terminate her pregnancy.
Before my training I met with a number of women who requested information and referrals for abortion and most of the time we would refer them verbally to two hospitals within the province or to nearby clinics. Most women did not have the means to afford private abortion rates. I think some used illegal, unsafe methods as they were desperate and others were left with no choice but to continue with their pregnancies.
Shortly after the training, I left the clinic to work for an NGO that was providing free abortion services. That was the first time I worked directly on abortion-related issues. Today, I am a Project Coordinator and Nurse Mentor for Pathfinder International. My job involves site assessments, setting up abortion units, continuous mentoring and coaching of nurses, and facilitating workshops.
What is the most rewarding part of your job?
The most rewarding part of my job is when I see attitudes change from the staff in the sites that we support after the workshops and seeing that change maintained. This change is evident during our visits to the sites. Also rewarding is when we hear positive reports from the Department of Health about the services provided by Pathfinder-trained nurses. My job is also rewarded by the excellent feedback that we get from the clients themselves.
There are also clients who recognize us when we meet and still appreciate the excellent service we provided to them. Attitudes of abortion providers that Pathfinder has worked with have also changed for the better and are able to positively influence other abortion providers at sites in which Pathfinder is not working.
The Choice on Termination of Pregnancy Act, or CTOP Act, is the South African abortion law that allows abortion on demand up to the twelfth week of pregnancy, under certain circumstances from the thirteenth to the twentieth week, and only due to serious medical reasons after the twentieth week. In South Africa, abortion is often referred to as "termination of pregnancy
South Africa’s abortion environment is pretty unique, with liberal abortion laws, but limited access to abortion and knowledge about abortion. Can you tell us a little bit about that?
There is limited knowledge about abortion in the sense that most clients and even nurses still do not fully understand the content of the Choice on Termination of Pregnancy Act, the national abortion law.
Some professional nurses still impose their beliefs on clients and even try to persuade or counsel clients against the client’s own decision. Pathfinder’s Value Clarifications Workshop touches on personal beliefs vs. professional responsibilities to try to change these norms.
What are some ways in which abortion rights are still impeded in South Africa?
There is very limited access to abortion services after the second trimester because few nurses and doctors are willing to provide those services. Many trained abortion providers are unwilling to provide services for personal reasons or for fear of being persecuted within the community due to resistant stigma around the procedure.
Limited information about abortion services sometimes leads people to believe that those seeking abortion services have committed a crime, so there is lingering stigma around women who have received abortions.
In South Africa, Pathfinder works to ensure young people can access safe abortion services. What are some of major barriers youth face?
South Africa’s Eastern Cape Department of Health has seen a need for adolescent and youth friendly services to be offered in clinics and has a strategy in place for all the provinces that includes targets for to have a certain number of clinics assessed and recognized as adolescent and youth friendly each year.
Although nurses and health care providers at Pathfinder sites have been trained on provision of youth friendly services, this component has not been fully incorporated into services offered at public facilities. Young people not catered for and are treated the same as adults. There are a very limited number of abortion providers trained on how to provide adolescent and youth friendly services.
At times, when young people’s needs go unattended, they do not access health care services as early as they are required/ expected to do. That means we see a very high number of young women requesting abortion services when they are already on second and, sometimes, third trimester of their pregnancy. In addition, abortion services are often offered at public facilities between 7am and 4pm on weekdays. That makes it incredibly difficult for young people to access these services without interrupting their school program.
Youth friendly services means a young person can walk in and walk out feeling good about themselves, provided with knowledge and information, treated with respect, dignity and provided with the service they were seeking.What should youth friendly services look like?
A lot still needs to be done to address young people’s needs including training of health care providers, ensuring youth friendly services are available and convenient at public health facilities, and informing youth about the services available to them to encourage making informed decisions about their health.
Providing youth friendly services is about the attitude of the provider and understanding the challenges and needs of a young person. It is about creating an enabling environment for young people to freely express themselves without fear of being judged, fear of being chased away, and fear of being rejected.
Youth friendly services means a young person can walk in and walk out feeling good about themselves, provided with knowledge and information, treated with respect, dignity and provided with the service they were seeking.
What’s one thing you think people would be surprised to know about your work in South Africa?
That it is not smooth sailing. It involves a lot of negotiations. We meet a number of barriers, that we are also judged as we advocate and support the needs of women and youth of our country.
For more information about Pathfinder's work on safe abortion in South Africa, please visit the Expanding and Sustaining Safe Abortion Services project page.