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South Africa: Women and girls risk unsafe abortions even though abortion is legal

Women and girls are risking their lives through unsafe abortions in South Africa, despite the fact that abortion was legalised in the country 20 years ago today said Amnesty International and the University of Cape Town in a new briefing
The briefing highlights how one of the key barriers to accessing an abortion is the failure of the government to regulate the practice of health professionals refusing to carry out the procedure due to their personal views. Other barriers include lack of access to good quality health care for people on low incomes and the stigma and discrimination surrounding abortions. 
These obstacles look set to increase since Donald Trump reinstated the so-called ‘global gag rule’ which bans international NGOs with US funding from providing abortions or offering information. This controversial order was issued only two days after worldwide protests for women’s and girls’ rights.
In 2015, South Africa received more than $400 million from the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR) for HIV related services. In this context, the impact could be devastating for women and girls in South Africa.  
Today marks 20 years since the adoption of the Choice on Termination of Pregnancy Act (CTOPA) in South Africa. 
However, according to the Department of Health, only 264 of the 505 health facilities designated to provide abortions actually do so. This makes it extremely difficult for women and girls to access safe and legal abortions because of long distances and expensive travel costs. Meanwhile, there are a plethora of illegal abortion providers advertising in public spaces and online. 
Muleya Mwananyanda, Amnesty International’s Deputy Director for Southern Africa, said: 
 “The National Department of Health must urgently intervene to ensure women and girls’ access to abortion is no longer at the mercy of health professionals’ personal attitudes.”
The failure of the government to make abortion services more readily available could result in violations of the government’s obligations under international human rights law. Under regional and international human rights standards, South Africa has a duty to ensure that conscientious objection does not impact on access to abortion services and that a functioning referral process guarantees timely and appropriate quality care to every person seeking an abortion. 
The briefing also highlights the confusion around the limits of conscientious objection and health care professionals’ duties in relation to providing abortion care. 
Under the right to Freedom of Conscience in the South African Constitution, health care professionals are understood to have the right to refuse to perform an abortion in certain cases, but never in emergencies, or where the woman or girl’s life is at risk. 
The CTOPA further stipulates that any person who prevents or obstructs access to legal abortion services is guilty of an offence, punishable by a fine or imprisonment. 
“The lack of clear policy guidelines to service providers creates a vacuum and allows conscientious objection to be applied inconsistently,” said Muleya Mwananyanda.
“A woman’s right to life, health and dignity must always take precedence over the right of a health care professional to exercise conscientious objection to performing an abortion. This is not the reality in South Africa. Regulation and clear policy guidelines are urgently required to correct the current vacuum.”
Amnesty International is calling on the South African authorities to issue clear guidelines and protocols to all health care professionals which clarify the limits of conscientious objection and enforce the ethical duties of health care professionals to prioritise the right of women and girls to access health care. Anyone who exercises their right to conscientious objection must provide accurate information and referrals as well as emergency services when required.
The Choice on Termination of Pregnancy Act (CTOPA) of 1996 came into force on 1 February 1997. The Act gives women and girls the right to have an abortion on request until the 12th week of pregnancy and with certain conditions before the 20th week. The legislation has been credited for advancing women's health and rights.
Abortion related deaths and injuries are estimated to have been reduced by over 90% since the CTOPA came into force.
The research for this briefing was carried out by the Women’s Health Research Unit of the School of Public Health and Family Medicine at the University of Cape Town and Amnesty International. 

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