The impact of the Choice on Termination of Pregnancy Act of 1996 (Act 92 of 1996) on criminal abortions in the Mthatha area of South Africa

Background: The Choice on Termination of Pregnancy Act of 1996 (Act 92 of 1996) allows abortions to be legally carried out in South Africa. It is not clear how many people are utilising this service. Mthatha is a poverty-stricken area with a high rate of illiteracy. The available infrastructure, such as roads, health facilities and communication, is poor. Method: This was a retrospective, descriptive study carried out at the Nelson Mandela Academic Hospital in Mthatha. The registered criminal abortion cases recorded between 1993 and 2006 were analysed. Results: There were 51 cases of criminal abortions recorded from 1993 to 2006. Of these, 32 were aborted in the fi rst trimester of pregnancy and the rest were in the second trimester. No signifi cant gender differences were observed among aborted babies. 10 of the foetuses were male and nine were female. The highest number (nine) of abortions was recorded in 1993 and in 2005. The highest number of criminal abortions (11) took place in May. Most cases (35) were concealed births and were discovered accidentally either by the public or the police. Conclusion: The Choice on Termination of Pregnancy Act of 1996 (Act 92 of 1996) had no impact on criminal abortions in the Mthatha area of South Africa. INTRODUCTION A total of 26 million legal and 20 million illegal abortions were performed throughout the world in 1995.1 Between 1996 and 1999, public sector clinics in South Africa performed 69 894 abortions.2 Worldwide, more than 500 000 women and girls die of complications related to pregnancy and childbirth every year. More than 99% of these deaths occur in developing countries such as South Africa.3 Incomplete abortions and, in particular, unsafe abortions are important causes of mortality and morbidity in South Africa.4 In view of this high number of deaths related to pregnancy, the South African Choice on Termination of Pregnancy Act (Act 92 of 1996 – herein referred to as the Act) was promulgated in 1996, and this has given women the right to terminate a pregnancy on request. The Act has been associated with a massive reduction in women presenting with incomplete abortions.5 The Act liberalised abortions in South Africa. Whilst an appreciable number of terminations of pregnancies (TOPs) have already been performed in terms of the Act, it has also surfaced that an array of factors of various kinds may impede its further implementation and operation.6 The Act aims to promote female reproductive autonomy through legitimising free access to abortion up to 20 weeks of gestation. An unacceptably high rate of unsafe abortion prevails, particularly in rural areas and amongst adolescents.7 The legalising of TOPs alone cannot ensure the implementation of abortion services. There are still more ‘technically illegal’ abortions than legal ones in South Africa.8 In South Africa, extensive media coverage prior to the passage of the law ensured almost universal awareness of the Act, but little public education took place at the same time. Under the Act, abortion services can now theoretically be implemented, even in conservative rural areas, but successful, practical implementation of these services is still a work in progress..9 Some professional nurses do not want to work in TOP services and do not want to be associated with those who render these services.10 There is an enormous amount of literature in the lay press on abortion, but only a few published studies. There are no published articles about criminal abortions in the Mthatha area of South Africa. People in the area are generally poor and live on very scarce resources. Mthatha (Umtata) was the capital of the former black homeland of Transkei, which is now incorporated into the Eastern Cape Province. The Eastern Cape has a population of seven million, of whom nearly four million inhabit the Transkei region. Almost three quarters (74%) of the province’s population earns less than R1 500 per month, and 41% of households have an income of under R500 per month. The Eastern Cape has the country’s second-highest proportion of the poor (44.5%), with the equivalent fi gure in the Transkei no less than 92%.11 The Nelson Mandela Academic Hospital mortuary is the only mortuary in the area, serving a population of about 300 000. The purpose of this study was to highlight the problem of abortions in the Mthatha area of South Africa. METHOD This was a descriptive study. It reviewed all abortion cases registered in the mortuary of the Nelson Mandela Academic Hospital between January 1993 and December 2006 for medico-legal investigation. The police usually bring a mass of human tissue for determination of whether it is a foetus. The referrals are mainly from the Mthatha, Ngqeleni, Tsolo and Mquanduli magisterial districts. The month and year were recorded in all abortion cases. The genders of the foetuses were identifi ed in some autopsies. All the records of the study period were reviewed, compiled and collated manually. Original Research Meel & Kaswa Vol. 1 No. 1 Page PHCFM http://www.phcfm.org A fri ca n Jo ur na l o f P rim ar y H ea lth C ar e & F am ily M ed ic in e