Submission to

The Parliamentary Committee on Health

with regards to

 

The Choice on Termination of Pregnancy (CTOP) Amendment Bill B21-2007

from the

 

 

Women’s Health Research Unit (WHRU)

School of Public Health and Family Medicine Faculty of Health Sciences

University of Cape Town

 

 

 

 

 

 

                                                                                   

 

 

Submission from the Women’s Health Research Unit (WHRU), School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town to the Parliamentary Portfolio Committee on Health with regard to the Choice on Termination of Pregnancy (CTOP) Amendment Bill B21-2007.

 

The WHRU is involved in research, teaching, technical health service support, and advocacy in the area of women's health. It is made up of a multidisciplinary team of researchers with expertise in public health, epidemiology, psychology, sociology and anthropology. The Unit conducts high level research that is socially responsive and contributes towards understanding and addressing women’s health problems.

 

We believe it is essential for the health of women in South Africa that the CTOP Amendment Act 38 of 2004 should not be invalidated. In an application to the Constitutional Court  it was declared that Parliament had erred by not facilitating public involvement prior to passing the Act. In response, the Court has mandated Parliament to rectify this by consulting with the public with regards to the Amendment Bill. This process is to be completed by February 2008. As a result of this mandate the  Provincial legislatures held public hearings  in the 9 provinces earlier this year.

 

The WHRU supports the Amendment Bill as it addresses current shortcomings with regards to access to termination of pregnancy (TOP) services for women.

 

We have achieved much since the enactment of the CTOP Act in 1996.

  • The Act resulted in a major breakthrough for women’s reproductive rights in keeping with the South African Constitution.
  • There has been a dramatic decline in mortality (death) associated with abortions since the Act’s implementation. In 1994, a study reported 425 deaths due to unsafe abortion, whereas in the Saving Mothers Confidential Enquiry into Maternal Deaths in South Africa in 2006 there were 34 early maternal deaths related to abortion in one year. This translates into a 90% reduction in deaths due to unsafe abortion.
  • There has also been a striking decrease in abortion associated morbidity (illness). In a study of hospital admissions for incomplete abortions conducted in 1994, abortion -related morbidity was recorded as 15%.  A similar study undertaken in 2000 showed that abortion-related morbidity had decreased to 9%.

 

However, in spite of the fact that legal abortions have been performed since 1997, barriers to accessing early legal TOP services still exist, as evidenced by the fact that unsafe, illegal TOPs still occur. Furthermore, a quarter of legal terminations are performed after 12 weeks of pregnancy, these second trimester procedures are medically more complicated, have greater risks and are more costly. In addition, there is the cost of unsafe abortion related ill-health and death. A shortage of resources, both personnel and facilities, are also responsible for difficulties accessing safe legal abortion care services, particularly in rural areas.

 

We believe that The Amendment Bill improves access to safe, legal termination of pregnancy services by:

 

  • Empowering the Member of the Executive Council (MEC) of the province who is responsible for health to approve health facilities where termination of pregnancy may be performed. Previously this function was exercised by the Minister of Health of the National Government. This decentralization should shorten the process of designation of services.

 

  • Allowing registered nurses who have undergone training to perform termination of pregnancies of up to 12 weeks. Previously this was limited to registered midwives. This will increase the pool of TOP service providers and improve women’s access to safe early TOP services.

 

  • Allowing 24 hour maternity services, which comply with certain requirements, to perform terminations of pregnancies up to 12 weeks without having to obtain the approval of the MEC. This will increase the number of services available to women seeking TOPs.

 

We believe it is critical that the needs of women with regards to access to safe abortion services are met, particularly in view of the environment in which many women live where there are high rates of violence and rape as well as the burgeoning HIV epidemic.

 

In conclusion:

It is vital that we maintain the positive results that have been achieved since implementation of the CTOP Act of 1996 by accepting the CTOP Amendment Bill. This will result in increased access through the devolution of power from the National Government to the Provincial Government and by increasing the number of health care providers and services available.