Our reference: Nelouise Geyer

23 June 2003

The Chief Director Maternal, Child and Women's Health

Department of Health

Private Bag X828

PRETORIA

0001

Dear Dr. Mhlanga,

Thank you for the opportunity to comment on this Bill. As you may be aware, DENOSA represents nurses that are both willing to assist with termination of pregnancies as well as those that are not willing to assist with the termination of pregnancies. Both groups have submitted input on the Bill and it is summarized for your information.

It has been noted that the proposed legislation recommends that the terminology "registered midwife" be replaced by "registered nurse". This would not be correct and it is recommended by DENOSA that the terminology be "registered nurse and midwife" Substitution of registered midwife with registered nurse will create concern in that even the medical abortions performed by midwives have serious health implications for the women concerned. There are matters related to maternal health that will be familiar to midwives that will not be fully appreciated by nurses, even if they undergo the (short) prescribed training course.

Those not in support of termination of pregnancy:

1. This amendment Bill means effectively is if it is passed, that more babies would be killed by abortion and more health workers will be pressurized into assisting with abortions. One of the most common violation of health workers’ rights comes from the widespread off label use of the abortion inducing drug cytotec (misoprostol), which is encouraged by the Department of Health. Pro-abortion staff frequently initiates abortions and the mothers return later for the completion of the procedure after the drug has killed the baby. Often there is no pro-abortion staff on duty when mothers return and thus pro-life staff is forced to complete the procedure - sometimes to avoid endangering the mother’s life.
2. The Department is requested to seriously consider including a conscientious clause in the Act.
3. This is regarded as a violation of freedom of conscience. To avoid violating the constitutional guarantee of freedom of conscience, the Minister of Health would need to ensure that pro-abortion staff are thus on duty 24hrs per day at all facilities offering abortion. The proposed amendment would increase the number of health workers who’s constitutional rights are being violated in this way by allowing abortion services to be offered by hospitals not especially designated by the minister.
4. The law would also allow all nurses to do abortions rather than only those trained as midwives. This would again increase the chances of medical error and malpractice and also increase the number of nurses pressured to assist with abortions.
5. Anonymous records of mothers of aborted babies also mean it will be more difficult to trace, prove and address abortionist malpractice. This determination must in no way detract from the health care professional’s responsibility to keep accurate and full records of the treatment of the client.

While the extension of services is supported in view of improving access to services, there are not sufficient trained midwifery/nursing personnel to deal with the service need in clinical practice. The implementation of the legislation is therefore the main area of concern for the following reasons:

1. The legislation must be accompanied by an education and training drive that will equip a bigger component of nursing and midwifery personnel to assist with service delivery.
2. Management section of designated institutions does not always agree or support termination of pregnancy and therefore either don’t institute the service, or do not provide adequate support in terms of trained staff, facilities, stock and counseling for both service providers and clients. This has a serious effect on the quality of the service delivered.
3. The support to providers of termination of pregnancy providers is not sufficient, especially counseling services for personnel. This has a devastating effect on the midwifery staff currently delivering TOP services. The impact of the lack of proper support mechanisms is transferred to all aspects of the service, including the client. In practice it is found that counseling of clients are not properly done because there is not enough time for both counseling and service delivery by a limited number of personnel.
4. Of great concern is that it appears that especially the young clients are coming back and use TOP as a contraceptive method. This could be due to a lack of proper councelling, or an absence of counseling.

Other issues of concern:

The consent of minors remains an area of concern, especially if the minor would develop complications that require further treatment after the termination of the pregnancy. The nurses and midwives are at the forefront of the care for all clients who undergone a termination of pregnancy and concerns have been voiced on the silence of the Act in terms of how such a situation should be dealt with.

We trust that you will find this information of value. If there is more information or clarity required, please do not hesitate to contact us.

Yours sincerely,