Still in the backstreets

NEARLY every lamp post, rubbish bin and brick wall in Johannesburg’s downtown is plastered with garish ads offering abortions that are “quick, safe and pain-free”, and just a phone call away. So when Busi, a student, unintentionally fell pregnant while far from home in her first year of university, calling a number from a lamp-post ad seemed the easiest fix. Fear crept in when the “doctor” handed her pills in a shabby room. “I was too ashamed to tell my family,” she recalls. “It could have gone so wrong.”

Abortion, banned during apartheid, was legalised in 1996, partly to stop the dangerous backroom procedures that were taking the lives of more than 400 women a year. But many South African women still find themselves in the shady backrooms and unlicensed clinics advertised on the streets. About half of all abortions happen outside proper hospitals and clinics. “This tells you there is definitely something wrong,” says Shenilla Mohamed, the executive director of Amnesty International, a campaign group, in South Africa. “People don’t feel safe to go to designated health-care facilities.”

Although South Africa’s laws and constitution are progressive, social attitudes do not always match. Women going for abortions worry they will be criticised by nurses and doctors, many of whom treat them rudely. Some say they are told they will go to hell.

Clinicians who perform abortions are sometimes shunned by colleagues and neighbours. Dr Eddie Mhlanga, who specialises in obstetrics and gynaecology, used to think that abortion should not be legalised. It took the death of a close friend from a botched illicit procedure to change his mind. “I opened her up and found her womb was rotten,” he says. Now he is a vocal advocate for safe abortion, but has faced criticism even from officials in the health department. One bigwig said: “Now I am shaking the hand of one who is dripping in blood.”

Some health professionals working for the state refuse to offer abortion services because they are against it for personal and religious reasons. It can therefore be hard to find a place willing to perform a legal abortion, especially in rural areas. Only 264 of 3,880 health facilities in the country are licensed to provide them, according to research by Amnesty International. Moreover, surveys show that a great many women think that abortion is still illegal in South Africa.

For dodgy providers, this shortage is a business opportunity. Some approach women waiting in queues outside state-run clinics. And for many women who brave the queues, long waiting lists mean that by the time they are seen they are too far along in their pregnancies to have a legal procedure (13 weeks is the usual limit unless there are special circumstances).

“The vultures are waiting for them at the gates of the hospital,” says one nurse. Visits to quacks can end very badly. According to the government, “septic abortion” is a major cause of death for women in South Africa, alongside cervical cancer and diseases related to AIDS. Those who break laws are rarely held to account.

Instead of risking dangerous backstreet abortions, some women have babies in secret and then dump them. A charity in Johannesburg runs a “baby bin” where women can leave unwanted children in a safe place.

“We’ve got wonderful laws, a wonderful constitution,” says Edwin Cameron, a Constitutional Court judge. “But at the level of practice, we fall desperately short.”

Source: https://www.economist.com/news/middle-east-and-africa/21736171-still-backstreets-why-south-african-women-are-opting-clandestine?fsrc=scn/fb/te/bl/ed/whysouthafricanwomenareoptingforclandestineabortionslegalyetuneasy