Position Statements: Termination of pregnancy
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For many years women with unwanted pregnancies resorted to unsafe abortion. Many maternal deaths resulted from this practice, which is a tragedy as such deaths are almost entirely preventable. Globally 90% of unsafe abortions take place in developing countries where there are frequently also legal barriers in obtaining safe abortion.

Since February 1997, when the Choice on Termination of Pregnancy Act was introduced in South Africa, termination of pregnancy (TOP) has been legally permitted upon request of the woman up to the end of the 12th week of gestation, and also under specified circumstances from the 13th to the 20th week of gestation. After the 20th week, very limited medical conditions allow for termination of pregnancy.

Implementation of the new Act showed some problems as access to TOP services remained restricted and unequal. At the end of the first year of the new Act, most TOPs were performed in urban areas and in tertiary institutions, and 50% of the total in Gauteng Province. Initially less than one third of designated hospitals did perform TOP.

SASOG supports the wider availability of TOP services to all women in the country, and urges the health authorities to make available dedicated facilities for in particular second trimester TOP. As midwives can legally perform TOP in the first trimester, midwife run services should be extended to rural areas.

SASOG supports the practice of TOP as part of health care provision for South African women. SASOG urges women not to undergo unsafe abortion, but to attend timeously at designated facilities in the public as well as private sectors. Where TOP is performed as a legal service, the maternal morbidity and mortality is much lower as with unsafe abortion. In this regard SASOG supports the recommendation of the Confidential Enquiry into Maternal Deaths of widespread facilities made available for TOP services.

Prepared by Dr Heather Brown.
Edited by Prof Gerhard Lindeque.
August 2001