South Africa Changes Abortion Law (1996): Warnings ignored
Letter to Mr. Edzi Ramaite
Portfolio Committee on Health
2 October, 1996
Reproduced with permission
Major problems with proposed New Abortion law.
Before passing the proposed Termination of Pregnancy Act, the Government is
advised to consider the following problems which if left unaddressed will
threaten to disrupt the service and polarise the staff. The procedure at any
gestational age is not simple and uncomplicated as any of those who are
currently required to perform them knows. Trained midwives are proposed to
be allowed to do this procedure.
1. Does this include the use of Ultrasound to accurately diagnose the
presence and age/s of the fetus/es? Will machines be available at every
facility operated by capable sonographers? The law and the procedure are
both heavily dependant on accurate gestational ageing.
2. The administration of local analgesia for dilating the uterine cervix in
the form of cervical or paracervical block is difficult. Current research
suggests that it may be insufficient even in experienced hands. Does this
imply that analgesia may have to be inadequate at times or will general
anaesthesia be required to be on standby? If so, what back up services are
3. Consent will legally be required for the procedure. Is
consent from a minor, legal ,without the parental sanction? In the event of
complication, transfer to another hospital, or further surgery, how can
parents be kept uninformed? Consent is currently required for a minor to
undergo evacuation of the uterus following an incomplete miscarriage.
4. In the event of complications, such as perforation of the uterus due to
incorrect gestational ageing, or missing the fetus at suction evacuation, or
profuse bleeding needing transferral and hysterectomy can the midwife be
sued? If so, what is the opinion of Medical Defence associations and the
South African Nursing Council? Are prospective trainees informed of this?
5. Conscientious objection: The Act provides for those who do not wish to
participate in pregnancy termination to do so but the Government has not
ascertained whether or not there are sufficient numbers of well-trained AND
willing personnel at the institutions designated by the Minister. Current
referral patterns suggest that there are very few practitioners who perform
terminations even under current legislation outside State Hospitals. Has the
Government surveyed State Hospital Staff to determine the extent of
conscientious objection? This involves medical and nursing staff. What does
the State do when no person willing to perform abortions can be found in a
given region? If referral is needed ,who pays ? Will consent to perform
abortions (or to train those who will) , be a prerequisite for employment in
Public Service for obstetricians? Will students wishing to specialise in
Obstetrics and Gynaecology be required to perform abortions as per the act
in order to qualify?
The Above questions are practical issues that will face the medical staff at
point of service. The Government would do well to ensure that there are
satisfactory answers before plunging the medical profession into a serious
crisis by prematurely enacting this bill.
Harvey Ward - Bsc (Med), MBChB, DMCOG
Registrar: Gynaecology and Obstetrics