By Laura Stampler and Megan Flemmit
The answer is more complicated than you might think.
It’s been a little over 20 years since the Choice on Termination of Pregnancy Act was passed in South Africa, legalising abortion.
Since then mortality rates for women undergoing abortions has declined by 91%. Over 90 000 legal abortions were performed in South Africa in 2015 (the most recent year for which data is available).
In South Africa a women may terminate her pregnancy for any reason until the 12th week. This abortion may be performed by a registered nurse or midwife. Between 12-20 weeks, women are only allowed to terminate their pregnancy if it was the result of rape, incest or if her health is at risk. This abortion has to be carried out by medical doctor. After 20 weeks, termination is only allowed if the women’s health is at risk, and this must be done at a designated government hospital.
Despite abortion being legal in South Africa, doctors and nurses are not obligated to offer this service. As a result many doctors and nurses refuse to conduct abortions for moral reasons. The lack of registered legal abortion clinics in certain area, coupled with the stigma surrounding the procedure is why 50% of South African women opt to have illegal abortions.
Illegal abortions or ‘backstreet’ abortions, as they’re referred to, are often unsafe, and can lead to injury and death. Which is why registered reproductive health service provider, Marie Stopes recommends making use of a legal abortion clinic. According to their health practitioners, there is a strong correlation between the safety of the procedure and the legality of the clinic.
Worried about the safety of the abortion procedure? Here we breakdown exactly how safe it is to get an abortion at different periods during gestation.
Trimester One (1 -12 weeks)
Women wanting to terminate their pregnancy are encouraged to have the abortion as early as possible. According to Marie Stopes the process is easier at an early stage and a wider range of choices are possible.
Although a surgical abortion can be performed as early as a woman’s first missed period, registered nurse and board member of the American Sexual Health Association, Susan Wysocki, says that many doctors prefer to wait until a woman is five weeks pregnant, and some even prefer to wait up to 12 weeks to do the procedure. This makes it easier for doctors to ensure they’ve removed the entire contents of the uterus. “This involves putting a cannula (tube) through the cervix and suctioning the uterine out contents,” she says.
But women also have another option in the first trimester: a medical abortion, which requires taking two pills to induce a miscarriage if gestation is between four and nine weeks. Medical abortions after nine weeks are illegal in South Africa. Unlike with surgical abortions, medical abortions become less effective as time goes on.
According to American reproductive health organisation, Planned Parenthood, the “abortion pill” is 98 percent effective when taken within the first eight weeks of pregnancy and 96 percent effective between weeks eight and nine. Planned Parenthood also notes that medical abortions are considered extremely safe. Risks associated with taking these pills are very rare, but can include blood clots, bleeding, infection, or an allergic reaction. And unless you have one of these (highly unlikely) complications, there are no long-term side effects.
Second Trimester (13-27 weeks)
About 25% of abortions in South Africa are performed after 12 weeks. The only option available for women looking to terminate their pregnancy at this time is surgical abortion. According to Marie Stopes, the farther along the pregnancy, the longer the procedure will take. They also emphasize that procedures done close to 20 weeks can be painful.
Still, even though an abortion becomes a more complicated procedure around 20 weeks of pregnancy since there’s more that needs to be evacuated, Wysocki says the bottom line is that it is safe to undergo a surgical abortion.
Third Trimester (28 weeks to birth)
Even though it is less common to get an abortion in the third trimester of pregnancy, a woman can safely get one if the pregnancy places great risk on her health.
A late-term abortion looks very different from one that is performed earlier in the pregnancy because more tissues will have to be removed. In the highly rare case of a 24-week abortion, Wysocki notes that the foetus may be removed in parts to protect the woman’s cervix. Although there are some risks at this point—for example, an infection can occur if tissue is left behind in the uterus—Wysocki notes that, “there are websites that list complications of abortions that are untrue. For example, an increased risk of breast cancer and difficulty with future pregnancies is not true. Women should be aware of websites that aim to scare women from making the choice that might be right for them.”
According to Wysocki, the most important thing you can do when deciding to have an abortion is to go to an experienced provider. “The more experience they have, the better they are at it.”
Looking for more ways to look after your reproductive health? Here’s 5 things you NEED to know about the HIV ‘Morning After Pill’, plus read this woman’s account of how herpes affected her life.