A Guide to Accessing Abortion in South Africa

If you experience an unwanted pregnancy in South Africa, you can opt for a legal abortion.

Due to the challenges that many South Africans face when trying to access legal abortions, though, as well as the lack of clear information, it’s not uncommon for people to turn towards unsafe, illegal abortions. Posters advertising illegal abortions are pasted along sidewalks, street walls, and on lampposts across South Africa. Most of the posters include the text “ abortion⁠ ” in capitalized letters with a phone number accompanying it. But illegal abortions pose numerous and serious health risks, so it’s important that you seek information on how to instead access safe and legal abortions.

Abortions have been legal for all South Africans since 1996 when the Choice of Termination of Pregnancy Act was introduced. While abortions are completely legal across South Africa, that doesn’t mean there aren’t still barriers to abortion. These could include stigmatization from people in your community and even from healthcare workers, or a lack of clear information about where and how you can access legal abortions. Certain costs, both for the abortion or travel costs, may also arise and present challenges to accessing abortion.

I’m going to walk you through your options when it comes to seeking legal abortions and how you might be able to work around any obstacles you may face.

Your Options

Again: every South African has the right to access abortion. No healthcare worker is legally allowed to refuse an abortion based on age, profession, nationality, race or any other criteria. You also don’t need permission from anyone, including partners or family members, when getting an abortion, even if you are a minor.

Since only seven percent of South African hospitals perform abortions, it can be tricky to find a healthcare center where you can obtain abortion. This SizaMap created by Bhekisisa has up to date information on where you can get abortions as well as color-coded markers that show up to which trimester you can get an abortion.

You also have the right to abortion counseling, which you can request from the healthcare center where you choose to get your abortion. These counseling sessions exist to go through your options and help address any worries you may have about getting an abortion.

When you seek a healthcare center for abortion, it’s useful to know your rights. If a healthcare worker informs you that you can’t obtain an abortion at a specific hospital, they are still legally required to assist you, by either referring you to a colleague who will or by directing you to a healthcare center that performs abortions with a booking and referral letter.

If you are HIV⁠ positive, it’s important that you tell your healthcare worker when booking an abortion, as you may require antibiotics when you have the procedure.

There are two types of abortions that are available to you.

The first is a medical abortion — also known as a medication abortion, because it’s done by using pills. This is usually available up to eight weeks after your last period⁠ . In some hospitals, however, doctors may issue medical abortions up to 13 weeks after your period or later.

A medical abortion follows a three-step process.

The first step is visiting the hospital or clinic and taking a pill called mifepristone⁠ at the healthcare center. You will then be given some other pills, called misoprostol⁠ , to take at home, which is the second step. The third step is going in for a checkup 10 to 14 days after the abortion. Your doctor or nurse will check that the abortion is complete and that you are healthy. In rare cases, they may perform a surgical abortion if the medical abortion didn’t successfully terminate the pregnancy⁠ .

A surgical abortion is your other option. It is a same-day procedure that is done at a clinic or hospital.

If you are in your first trimester of pregnancy (up to 12 weeks), a surgical abortion can be performed by a nurse. Between 13 weeks and 20 weeks, a surgical abortion will be done by a doctor. There are two types of surgical abortions. The first, and most common, is called vacuum aspiration. Using a gentle vacuum or handheld syringe, the contents of your uterus⁠ are gently suctioned. You should be given a painkiller prior to the procedure.

In rare cases of an incomplete abortion, which simply means that part of the tissue is retained in your uterus, doctors will perform another method called dilation and evacuation. This method is also used for abortions after 15 weeks.

Abortions in South Africa are legal up to 12 weeks under any circumstances. A surgical abortion up to 12 weeks can be performed by either a doctor, nurse or a registered midwife and a medical abortion can be administered by any of the above. Between 13 and 20 weeks, your surgical abortion has to be performed by a doctor. This can make it more challenging to find healthcare centers that will perform the abortion. There are also certain circumstances you need to meet when getting an abortion after 12 weeks. You can get an abortion between 13 and 20 weeks if you were assaulted, the pregnancy is a danger to your mental or physical health, the fetus⁠ is not viable or if having a baby will significantly affect your social and economic circumstances. After 20 weeks, you can only opt for an abortion if the pregnancy poses a significant danger to your health or the fetus’s health.

Your Costs

The healthcare centers listed on the SizaMap offer free abortions.

To find a healthcare center where you can access abortion, type in your town or city on the map’s search bar, and it will provide information about the closest centers that provide abortions. This includes the types of abortion, what trimesters they offer abortions for, the opening hours, and a contact number.

There are also some private healthcare centers that offer abortions, such as Marie Stopes, but these centers will usually charge you for the procedure. A medical abortion is the cheapest while a surgical abortion costs more, and the rate increases the longer you have been pregnant for.

Before traveling to a healthcare center, phone first. Over the phone, you can double-check that the center offers abortions (and if not, ask them to refer you to another center) and you can get important advice on how to proceed with booking an abortion as well as information you need to know to take good care of yourself before, during and after abortion.

Depending on your financial situation, you will need to decide whether you want to get an abortion done at a private clinic or at public healthcare center (where abortions are free).

After making this decision, you may also need to factor in transport costs. If you can access an abortion in your immediate area, travel costs should be relatively low. For those living in more remote areas, the travel costs can be higher.

Overcoming barriers

One of the biggest barriers facing abortion access in South Africa is a lack of clear and reliable information.

Not all hospitals listed to perform abortions actually offer abortion services. This is because of outdated information on hospital websites and internal changes in healthcare centers. The SizaMap is the most up to date resource on which healthcare centers actually perform abortions.

After checking which healthcare centers nearby you offer abortions, the best thing to do next is phone them and ask for clear details about how you can get your abortion done. Important questions to ask include whether there are any costs involved, what kind of abortions are offered, up to how many weeks of pregnancy can you get an abortion, how you can book an appointment, and whether you can receive abortion option and support counseling, if you want it.

Sometimes, healthcare workers may refuse to assist you when you request an abortion procedure. This can happen from nurses or doctors in government hospitals. Sadly, some patients have also faced stigmatization or shaming from healthcare workers. This can make a difficult situation harder. It’s important that you know that you have a right to an abortion and that every government healthcare worker is obliged to, by the very least, refer you to a health center or professional who will perform the abortion. If you have any difficult situations with healthcare workers, remember your rights and ask that they advise you elsewhere. Having a loved one to support you or to talk on your behalf can also make this process easier.

Another potential barrier is cost. Everyone in South Africa has the right to a free abortion at a government hospital. If there isn’t a hospital that performs abortions near you, you might have to pay transport costs, but you can still obtain a free abortion at whatever hospital you can get to. If you cannot afford these costs, it’s a good idea to reach out to people in your community for fund raising such as friends, family or your partner⁠ .

In many communities, you may face stigmatization or judgment from friends or family members. This can make this experience isolating. It’s important to remind yourself that not only do you have a legal right to having an abortion but that this is your decision alone to make. If you have someone you trust who can support you -- either by helping you access resources for an abortion or by accompanying you to the healthcare center -- it is a good idea to reach out. For further support or advice, can also reach out to Scarleteen’s message boards or online chat here.

Moving forward

Once you have a clear idea of what options are available to you, the costs involved, and what barriers you may need to overcome -- you can start planning for your abortion.

You are legally protected in your right to get an abortion and no one else should have a say in this decision. If you want to find out more about abortion access in South Africa, the Marie Stopes website is a great resource. You can also call their number (0800 11 77 85) for advice on how to proceed. Even if you are unable or don’t want to visit a Marie Stopes clinic, they may be able to direct you elsewhere.

Experiencing an unwanted pregnancy can feel scary. Sometimes, an already difficult situation is made harder by certain barriers or because of the stigmatization from people around you. But deciding to have an abortion is your choice alone to make. No one can decide this for you and no one knows your body and circumstances better than you.

No matter how you choose to move forward, it’s important that put your own feelings and priorities first. Remind yourself that this decision affects you primarily. Also, remember that you are not alone. About one in three women have an abortion at some stage of their lifetime. If possible, reach out for support, either from those around you or online.

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