A proposed amendment to the Choice on Termination of Pregnancy Act would require that anyone seeking an abortion first undergo an ultrasound scan. In its draft bill, the African Christian Democratic Party (ACDP) argues making this type of scan mandatory for abortion seekers will assist people to make “an informed choice”.

Passed in 1996, the Act guarantees people’s right to abortion up until 13 weeks of pregnancy. The act also allows for termination of pregnancies after this point if, for instance, the pregnancy is a danger to the fetus or the mother’s physical, mental or socioeconomic health.

The bill, which is open for public comment, would legally mandate healthcare providers to affix photos of ultrasounds to consent forms that would have to be signed by patients before receiving abortions.

The ACDP consulted the US-based right-wing physician group Doctors for Life International in the drafting of its proposal. The group, which has South African members, also recently issued a public statement opposing the government provision of healthcare for transgender people.

Ultrasound machines and the workers who operate them are a scarce commodity in the public sector (Gallo)

In practice, imposing an ultrasound requirement may rule out termination of pregnancy services for many people with uteruses in the country.

Indira Govender is a rural doctor and reproductive health activist in the public sector. She warns ultrasound machines and the healthcare workers trained to use them, are more often than not only found at far away major hospitals and not at the local clinics that are the first place people seek out care.

Govender cautions that this situation could push more people to seek out backstreet abortions, as they won’t be able to access the scans required to get a legal abortion. “They [illegal providers] don’t care about the consequences – they are basically drug dealers in the community,” she says.

But ACDP MP Cheryllyn Dudley argues the amendment’s provisions will ensure that women make informed choices, rather than restrict their access to abortions.

“A significant number of people feel that the original legislation was forced on South Africans. They don’t actually feel that they had any part in bringing it into being,” she says.

While the amendment doesn’t propose a ban on abortions, it does recommend the removal of clauses that allow women to terminate pregnancies on socioeconomic grounds. It would also remove provisions that allow for abortions to occur after 20 weeks in cases in which, for example, fetuses had severe deformities.

The ACDP maintains that many congenital disabilities can now be corrected before or after with modern technology. Dudley believes that several abnormalities would have been picked up long before the 20-week mark.

But almost half of all pregnant women in South Africa will reach an antenatal clinic far too late for this: only about 40% visit such a clinic before their 20th week of pregnancy, show data from the latest District Health Barometer report by the Health Systems Trust.

South Africa has battled stubbornly high maternal mortality rates for years. Although the country has seen declines in maternal deaths recently, about 4 450 women lost their lives while pregnant or shortly before or after delivering between 2011 and 2013, shows the country’s latest maternal death audit.

In 2005, researchers argued in the South African Medical Journal that abortion-related deaths and injuries fell by more than 90% in less than 10 years following the 1996 Choice on Termination of Pregnancy Act’s introduction.

Meanwhile, Govender says that while it is possible to correct some birth defects late in pregnancy, this kind of surgical skill is scarce in the country. “You can count the number of paediatric surgeons on your hand that are available in the public sector.” 

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