SUBMISSION TO

THE PARLIAMENTARY PORTFOLIO COMMISSION ON HEALTH

 

REGARDING

 

THE CHOICE ON TERMINATION OF PREGNANCY AMENDMENT BILL, [B21-2007]

 

 

 

 

 

Marieta de Vos

Executive Director

Mosaic Training, Service and Healing Centre for Women

P.O. Box 18460

Wynberg

7824

 

 

November 2007
1.         Introduction

This document serves as the submission of the Mosaic Training, Service and Healing Centre for Women to the Public hearings on the Choice on Termination of Pregnancy (CTOP) Amendment Act; Act 38 of 2004 (hereinafter referred to as the CTOP Amendment Act).

 

Mosaic is a not-for-profit non-governmental organisation based in Cape Town with the overall aims of:

-          Improving (social, health, legal, economical) living conditions, quality of life and status of abused people, mainly women and girls.

-          Reducing the incidence and impact of domestic violence and abuse in the Metropole Region of the Western Cape

 

The organisation’s staff is delivering a range of integrated educational, social, sexual and reproductive health and para-legal services to survivors of domestic violence and abuse. Mosaic’s services address both the symptoms and root causes of sexual and domestic violence against women and girls.  The organisation’s SRH clinic is a registered designated 1st trimester TOP facility that performs on average 60 first trimester terminations per month. 14 Social Auxiliary/Community Workers conduct awareness raising activities in and around Cape Town about abuse/domestic violence. SRH and rights messages are integrated into messages. The staff are also trained TOP counsellors.

 

2.         Background and focus of submission

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 CTOP Amendment Act and makes a few recommendations in terms of Section 2 of the amendment.

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Mosaic is expressing its full support to the Amendment Act.  It is important for policy makers to hear the voice of NGOs working in the termination of pregnancy (TOP) field in South Africa. Mosaic is one of the very few NGOs in the Western Cape offering termination of pregnancy services to clients and has to represent the hundreds of women who have benefitted and will still benefit by the original CTOP Act; Act 92 of 1996 and CTOP Amendment Act; 38 of 2004. 

 

3.         Comments on the CTOP Amendment Act; Act 38 of 2004

 

This section contains Mosaic’s comments on the amendments as listed in the Amendment Act.

 

Section 2: Section 2 of the amendment amends section 3 of the principle act. The amendment further defines a place where termination of pregnancy may take place.

The Amendment is supported as provincial approval of facilities for TOP will simplify and accelerate the process.

 

The fact that undue restrictions by a Member of the Executive Council may be repealed by the Minister of Health acknowledges that legalisation of TOP does not guarantee access. This section is also supported as it is an additional measure for protecting women’s rights at local level.

 

The requirements that are now incorporated in the Act provides a clear, readily available guideline for service managers and providers on the criteria for facilities where termination of pregnancy may occur.

 

The “Transitional provision” is supported as it guards against disruption of services due to re-applications.

 

The following quotations from women who made the choice to terminate a pregnancy at Mosaic’s clinic illustrate how essential TOP facilities are and that Government must provide these facilities without unnecessary red tape and protracted application processes. 

 

♀      “I would actually not have a life”.

♀      “(I needed a TOP) Because I have two babies, and my sister’s babies depend on me and my parents”

♀      “I decided to get the TOP because of financial problems, and if this service was not available, I would suffer”.

♀      “I’m not ready to support a child and give the child the best things in life”

♀      “If this service wasn’t available then my family wouldn’t have spoken to me because (they) would have said I disgrace them. Which means that I’m no longer part of the family.”

♀      “I decided to get a TOP because I am not ready to be a parent. I have so many dreams and goals that I want to achieve and if it wasn’t for TOP I would not have been able to achieve those goals. This has given me a second chance in life because now I can continue with my studies and make a success of my life. This has allowed me to correct my mistake and it has taught me never to find myself in this situation again. THANK YOU!!!”

♀      “We have 2 children, my hubby just got sterilised and that period I fell pregnant.”

♀      “I already have 2 kids and financially I cannot provide them and it would be unfair to add another one to that problem. And I’m also in the process of getting divorced.”

♀      “Because I know that a baby needs finance and I have no-one to look after my kid. As the partner said no for the responsibility.”

♀      “This service is a real life saver. Had I not receive this service I would have been forced to do things I didn’t want in life.”

 

Section 3 of the amendment Act amends Section 7 of the principal Act: Notification and keeping of records

 

The amendment is supported as it ensures that TOP statistics will be readily available at all levels. Data is critical in planning, monitoring, evaluation, research and improving health services. This data should also be made readily available to the broader public.

 

This section also links to the all important Goal 5 (Improve maternal health), Target 6 of the Millennium Development Goals namely “Reduce by three-quarters the maternal mortality ratio.” Safe termination of pregnancy and post-termination care are integral to this international agreement. Research in South Africa has undeniably shown that the CTOP Act has decreased maternal mortality as a result of unsafe abortions by 95% and Maternal Morbidity by 50%. The CTOP Amendment Act will further support the achievements made towards this goal by the CTOP Act.

 

Record keeping is also essential to monitor repeat terminations and whether 2nd trimester TOPs are increasing or decreasing.

 

Section 4 of the Amendment amends Section 8 of the Principal Act: Allows for the delegation of power from the MEC to the Director General or Head of Department and determines the extent and scope of that power:

The amendment is supported as the administration of TOP services will be simplified and accelerated. While power may be delegated, a Member of Executive Council and Head of Department remain accountable -  we see this as a measure to safeguard against undue restrictions by state officials.

 

Section 5 of the amendment amends Section 9 of the principal act: Allows the MEC to make regulations under the Act in consultation with the Minister.

The amendment is supported. We see this as another route of speeding up the legislative process.

 

Section 6 of the amendment act amends Section 10 of the principal act:  This amendment further prescribes lawful access to TOP services in addition to adding a further offence.

The amendments are supported.

 

Section 6(d) further protects the rights of women to prevent morbidity and mortality due to unsafe abortions. Any person including health care workers will now be liable if they are aware of unsafe abortion practices and not reporting it.

 

Section 7 of the Amendment substitutes certain expressions of the principal act:

The inclusion of specially trained registered nurses for 1st trimester terminations is particularly welcomed as it increases the pool of healthcare professionals who would be allowed to be  trained TOP service providers and in so doing increases access to safe termination of pregnancy TOP. Increased 1st trimester will also decrease the need for 2nd trimester terminations. Mosaic’s registered nurse was trained by the Department of Helath and is implementing a first trimester service very successfully at the organisation’s clinic.

4.         Recommendations

Although Section 2 of the Amendment Act mandates the minimum requirements for the facilities to provide safe TOP services; remarks by Government employed health practitioners about inadequate TOP facilities and services at State clinics indicate huge service delivery challenges. Medical and nursing staff at designated clinics do not necessarily adhere to Sections 4 (non-mandatory and non-directive pre- and post-termination counselling) and 6 (informing women of their rights) of the CTOP Act. Women’s rights to privacy and access to information are too often compromised. It is recommended that:

♀      Responsible leadership and management of TOP services should upheld at all times. The Department of Health should institute vigorous monitoring and evaluation procedures including staff appraisals of health practitioners working in this field. Medical and nursing staff with conscientious objection MUST comply with these Sections and clients need to know what complaints mechanisms they may follow if they do not get the treatment they deserve. The ideal is that clients at all clinics would make statements like the following recorded at Mosaic’s clinic: 
“It’s my first time here and everything about this clinic is excellent because (they’re) very friendly and know how to communicate with people.”

“It was better for me because they explained EVERYTHING to the T and helped me understand a lot.”

“… the quality at this clinic (is) 100% good cause not only are they friendly but you … learn from your experience here.”

“The quality of the service was excellent. The staff was very helpful, understanding and caring. They made me feel at ease and relaxed. They were wonderful!! Thank you very much for the help and support to all the staff members of Mosaic Clinic.”

 

Better application of the human rights principles of participation and non-discrimination is essential in South Africa, especially through fulfilling obligations and accountability in the health sector.

♀      The Department of Health support civil society organisations in monitoring Government policies and performance in terms of TOP. They should also embrace and form partnerships with NGO clinics that provide TOP services and support them financially, especially in the light of staff shortages at Government clinics.

♀      Policy guidelines on counselling and information giving to clients are developed. Guidelines and protocol will further the object of the Act by “affording every woman the right to choose whether to have an early, safe and legal termination of pregnancy according to her individual beliefs” and it will add to the integration of SRH and HIV/AIDS services at clinic level.

♀      Contraception and termination of pregnancy are flipsides of a coin and should be addressed comprehensively to prevent repeat TOP.

♀      Emergency contraception should be promoted on a large scale to reduce the need for termination of pregnancy.

Violence against women not only damages sexual and reproductive health and rights but often lead to unwanted pregnancies and termination of pregnancy. Practitioners at TOP facilities should be vigilant in picking up signs of abuse and violence and refer clients to appropriate resources that may provide additional support and counselling for the woman.

 

5.         Concluding Comments

 

The CTOP Amendment Act; Act 38 of 2004, is an important extension of the CTOP Act, Act 92 of 1996, particularly with respect to:

-                      increasing the pool of service providers, and

-                      accelerating the approval of TOP facilities.

The full implementation of the objects of the CTOP Act depends on the speedy adoption and ratification of the Act. 

 

Please contact Mosaic for additional information if needed. The contact details are provided on the cover page of this document.

Copies of awareness and educational materials used by Mosaic are included for the Committee’s information.

 

Mosaic wants to thank the Standing Committee on Health for consulting the broad public on this important matter. Mosaic appreciates the opportunity to state its support for the Amendment Act and expresses its gratitude on behalf of many women whose right to safe termination of pregnancy is upheld by the Act.