Termination Of Pregnancy

TERMINATION OF PREGNANCY

Abortion or Termination of pregnancy has been legal in South Africa since 1996.  According to the Choice on Termination of Pregnancy Act of 1996. Women are entitled to terminate pregnancy as informed by conditions outlined in the law at no cost at government hospitals or clinics during the first three months of pregnancy. 

The Choice on Termination of Pregnancy Act recognises that the right to decide whether or not to have children is fundamental to women’s physical, psychological, and social health. It calls for universal access to reproductive health care services which should include family planning and contraception, termination of pregnancy, and sexuality education and counselling services. 

Abortion services 

  • Abortion treatments 
  • Medical abortion 

Medical abortion allows for the termination of a pregnancy using medication (pills/tablets) only. It is available for women who are between four and nine weeks pregnant. The length of the process is different for each woman but usually takes a few days, during which a woman will experience symptoms similar to a miscarriage. The process involves pre-care counselling and a clinical examination with a post-abortion check-up appointment. 

  • Surgical abortion 

Surgical abortion in the first 12 weeks may be performed by a medical practitioner or by an appropriately trained nurse or midwife; after 12 weeks it may only be performed by a doctor. It involves pre-care counselling and a clinical examination after which the procedure is performed using a gentle suction method to remove the contents of the uterus. The procedure may take longer further in the pregnancy as the doctor will need to provide medication that helps to dilate the cervix.  

  • Abortion treatment advantages and disadvantages 

Making the decision to have an abortion is not an inherently easy one to make. Having options available and being as informed as possible beforehand assists women choose a method that will work best for her.

Termination of pregnancy

  • Medical abortion 

Advantages

  1. No anaesthesia, instruments, or vacuum aspirator machine
  2. Will be used to end pregnancy as early as 3-4 weeks
  3. Being at home instead of a clinic may seem more comfortable and private 
  4. Any support person can be there during the abortion process 

Disadvantages 

  1. Infection-Endometritis (infection of the lining of the womb) is a rare complication of medical abortion, occurring in 0.1 – 0.9% cases only
  2. Failed abortion where the abortion drugs fail to work and the pregnancy continues. This happens between 1 and 14 in 1000 cases after medical abortion
  3. Heavy bleeding/hemorrhage; requiring a blood transfusion. This is a very rare complication but if you’re experiencing heavy bleeding after a medical abortion you should attend an emergency department immediately
  4. Cramping can be mild to severe – differs from person to person – and usually lasts longer than with a surgical abortion
  5. Two visits to the provider are necessary, and possibly more 

    Surgical abortion 

Advantages

  1. The procedure is quicker than a medical abortion
  2. There’s less bleeding and cramping than with a medical abortion
  3. Can be done up to 12 weeks

Disadvantages 

  1. Anaesthetic and drugs used to manage the pain during the procedure may cause side effects such as diarrhoea, nausea, vomiting, dizziness, chills, hot flushes and headaches.
  2. Retained pregnancy tissue, this happens in less than 1% of abortions and usually requires another procedure or some medication to help remove the retained pregnancy tissue 
  3. Rhesus isoimmunisation; women with a certain blood group (rhesus negative) are at risk of isoimmunisation after an induced abortion
  4. The woman has less control over the abortion process and who is with her during the procedure
  • Post-abortion care

Every woman is unique in how she feels after an abortion. Most women report feeling a sense of relief that they have made the best decision under the circumstances. This is the most common response. For some women, however, abortion can raise a number of emotional responses including sadness, guilt, rage, shame and regret. Abortion facilities usually offer counselling as part of their pre- and post-abortion services.

  • Pain management after Termination of Pregnancy 

Most women experience cramping on and off for about a week after an abortion. You can take the pain medicines if needed as prescribed by the healthcare practitioner where you accessed your abortion service. You can buy these over-the-counter pain medicines from a pharmacy, supermarket, and many other shops without a prescription. Always read the patient information leaflet that comes with these medicines, and take them as directed.

  • Post abortion check-up 

A post-abortion medical check-up is three weeks after an abortion. This is to make sure that you have fully recovered from your procedure. A post-abortion check-up normally involves a blood-pressure check and an examination of your abdomen. The check-up will:

    • Confirm that the pregnancy has ended (pregnancy tests can show a positive result for a while after an abortion)
    • Check your bleeding pattern is normal and there is no infection
    • Assist you with your contraceptive needs

  • Contraceptive and family planning services 

You can get pregnant almost immediately after an abortion. Most methods of contraception  start the same day as your treatment, and protected straight away. You may have already discussed a contraception method with a nurse over the telephone when booking your appointment or as part of the post care service. If not, you can arrange a visit to your GP or local family planning service provider to further explore comprehensive sexual and reproductive health options available to you.

Frequently Asked Questions Is it legal to get an abortion in South Africa?

  • All women in South Africa are entitled to terminate a pregnancy legally according to the Choice on Termination of Pregnancy Act (CTOPA). Circumstances and conditions under pregnancy  terminated are stipulated in the CTOPA. 
  • At what age is it legal to get an abortion?
  • The Choice on Termination of Pregnancy Act states that a woman can have an abortion at 12 years of age and older – you should never be denied the service because of your age. If you’re young we advise you to chat to a trusted adult and ask someone to accompany you to a healthcare facility or clinic for your appointment, but this is not required.

    Why are abortion services only offered up to 20 weeks?

  • The law which governs abortion in South Africa restricts procedures at 20 weeks except in some cases where there is a threat to the woman’s health.

13 to 20 weeks:

  1. If the pregnancy endangers the woman’s mental or physical health;
  2. If the foetus may suffer from a severe mental or physical abnormality; 
  3. If the pregnancy resulted from rape or incest and 
  4. If it would significantly affect the woman’s social or economic circumstances

Over 20 weeks:

  1. If it endangers the woman’s life
  2. Foetus is severely malformed
  3. If there is a risk of severe injury to the foetus

    What are the differences between surgical and medical abortion?

  • Medical abortion uses pills/tablets (Mifepristone and Misoprostol) to terminate a pregnancy. The first set of tablets is taken orally in the clinic and the second set is taken later at home. 

  • Surgical abortion at 4-12 weeks involves a gentle suction method, which the practitioner will use to remove the pregnancy from the uterus. This is a very quick and simple procedure that can take less than five minutes. 
  • A surgical abortion at 12- 24 weeks is a surgical procedure where up to 12 week of pregnancy is considered early surgical abortion. At this stage, so a gentle suction method is used to remove the pregnancy from the uterus. This is a very quick and simple procedure, taking less than five minutes to perform. You can choose to have this procedure with a general anaesthetic, conscious sedation, or no anaesthetic. 
  • Surgical abortion (13-19 weeks of pregnancy) if pregnancy is more than 15 weeks advanced, you may be given some medication to prepare your cervix for the procedure. Late surgical abortion (19-24 weeks of pregnancy) at this stage of pregnancy the treatment is performed in two separate stages. You will be asked to arrive at the medical facility early in the morning for the first stage, which involves preparation of your cervix to cause it to gently dilate over a few hours. There is no need to have an anaesthetic for this part of the treatment. But with the second stage, to complete the abortion, will take place later that day and you will be given will take a general anesthetic. It is advisable that you are accompanied home and have someone with you overnight should any complications occur.

    Which option is better?

  • Neither option is better than the other- it’s a question of both personal choice and medical history that will determine the method that is best for you.
  • When can I have sex again after an abortion?
  • We advise that you do not have vaginal intercourse or insert anything into your vagina for one week.
  • Can I fall pregnant after an abortion? And will abortion affect my ability to get pregnant in the future?
  • You can conceive again as early as one week after an abortion so it’s important to talk to a nurse about a contraceptive method that’s right for you. If your treatment is uncomplicated it won’t cause any issues with future pregnancies. There is no proven connection between abortion and future infertility, ectopic pregnancy, or other pregnancy complications. Abortion can be associated with future pregnancies ending before the due date. This like of risk increases with each abortion but the medical evidence is not enough to show a connection. 
  • What if I have started an abortion at home or from an designated service provider?
  • If you have purchased “abortion pills” from someone who is not a designated provider do not consume the medication. If you are already in the process of an abortion, we recommend you present yourself at your nearest healthcare facility for treatment.

    Where can I get a safe abortion?