Submission by the Democratic Nursing
Organization of
This document serves as the submission
of the Democratic Nursing Organization of South Africa (DENOSA) to the
Parliamentary hearings on the Choice on Termination of Pregnancy (CTOP)
Amendment Bill, 21 of 2007 (hereinafter referred to as the CTOP Amendment
Bill).
The Democratic
Nursing Organization of South Africa (DENOSA) is a national nursing
organization with the head office based in
Background
and focus of submission
The abortion legislation reform was informed by the 1994
Study into Incomplete Abortion by the Medical Research Council with an
estimated 425 maternal deaths from illegal abortions in that year. The study
found that 44 686 women presented with incomplete abortions, that 99% were
Black women and 34% were unsafe abortions.
The CTOPA legislation has had a significant impact in
increasing access and decreasing abortion related mortality and morbidity. A
study in 2000 evaluating the impact of the Choice on Termination of Pregnancy
Act showed a significant decrease in morbidity, infection and a significant
decrease in maternal mortality. The Confidential Enquiry into Maternal Deaths
2002 – 2004 demonstrated a 91%
reduction in deaths from unsafe abortions
As the major representative body of nurses in South Africa, who
are mostly women faced with the same challenges that the Act is trying to
address, it is right and proper that while we advocate as a union, we should
not loose sight of the fact that these providers of health care, who form the
majority of the health service providers, are women who also have the right to
choice about their own reproductive health. It should not be forgotten that
prior to the promulgation of the CTOP Act, nurses had to work hard at caring
for critically ill women admitted as a result of illegal septic back street
abortions. Most of these young women suffered long term complications, had
total abdominal hysterectomies at young ages and remained infertile for the
rest of their lives. The World Health Organization (WHO) also released data
indicating that whether abortion is legal or not, the numbers are almost the
same. The difference is where abortion is legal, it is likely to be safe and
saves women’s lives but where it is illegal, it is more likely to be unsafe and
lead to high rates of Maternal Mortality and Morbidity.
About three weeks ago the WHO released estimates of Unsafe Abortion
Mortality for 2003 (Maternal death rates). The figures are
66, 500 Maternal Deaths globally, noting that 66, 400 were
recorded in developing countries and this means that only 100 women are
dying in the rich developed countries because they all have liberal abortion
laws. The African Region Recorded: 36,000, an increase from
previous estimates for 2000 of 29,800. The sad news is that even the 100
who died in developed countries are mostly women of colour. This is an
unacceptable situation. We cannot close our eyes or ignore the information when
women in their masses continue to die from back street abortions which are
preventable. Many countries, including
by 2010.
The focus
of this submission is on the CTOP
Amendment Act only, its impact and its implications and does not extend
to the original Choice on Termination of Pregnancy Act, Act 92 of 1996. The
submission covers the amendments in the Amendment Bill and acknowledges
Sections with particular relevance to Registered Midwives and Registered
Nurses.
Section 1
The
additions and broader definitions in Section 1, particularly 1 (c) Registered
Midwife and 1 (d) Registered Nurse are significant in providing a legal
imperative for competent nursing practice and quality patient care. The
addition of prescribed training is critical in terms of the task-shifting
component in the legislation and in the clauses that increase access to TOP.
DENOSA acknowledges that while there may be some nurses who have conscientious
objection to TOP, it is important that these nurses be given the right of
refusal to TOP. It is also important that nurses who are willing to undergo the
prescribed training be given the opportunity to do so in terms of this Act.
Section 3
The
Section 3 is supported in the devolution of power from the Minister to the MEC
in the provinces to manage the designation of places where TOP can be performed
to the provinces, to increase access and avoid undue delays in doing so. This
section is strongly supported in the quality control indicators in the context
of termination of pregnancy only at a facility that meets all the criteria in
clauses 3(1) (a) to (j) and for regulating the collection, recording and
management of data. By increasing the
pool of health professionals to include Registered Nurses who qualify to be
trained to provide TOP services, the service should become more accessible to
more women.
Section 7
Amendment
supported in full as it provides for evidence based monitoring and evaluation
of the implementation of the amendment.
Section 10
DENOSA
supports the impact of Section 10 which is to regulate the provision of TOP
services and legal action of against any person who performs a termination of
pregnancy in contravention of the Act.
Concluding
Comments
The CTOP
Amendment Act creates the necessary legislative framework for increasing access
to reproductive health care services as entrenched in the Bill of Rights in the
Constitution. The provisions of the CTOPA have followed a democratic process of
consultation informed by evidence-based research resulting in reduced maternal
morbidity and mortality.
This legislation has been a critical
factor in reducing maternal deaths from unsafe abortions by 91% in 2006 and
contributing to the Millenium Development Goal to reduce maternal mortality by
three quarters (75%) by 2010. It has broaden programmes to reduce the
percentage of unwanted pregnancies by increasing access to TOP services in the
public sector as a key intervention in the HIV & AIDS and STI Strategic
Plan for South Africa, 2007 – 2011 Goal 3: Reduce Mother –to-Child Transmission
as HIV/AIDS remains a significant challenge to maternal health.
Therefore, DENOSA advocates strongly
for the maintenance of the Act and the Amendment in the legislative framework
for the provision of health care including reproductive health care as a
Constitutional imperative enshrined in the Bill of Rights. We further feel it
will be necessary to increase the number of trained TOP personnel in specified
institutions to avoid what is happening now, where one person only is trained
and is overwhelmed by work, leading to frustration and resignation
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