B72 2003 - CONCERNS

Submitted by Healthcare Christian Fellowship: Presented by Mr Mncedi Mdolo Associate Staff Worker and Provincial Leader of HCF in Eastern Cape.

30 July 2004


The Healthcare Christian Fellowship (HCF) of South Africa is an International Organization which seeks to provide spiritual support to Health Workers and patients at all levels of the Healthcare system.

Its membership consists mainly of Healthcare professionals from differing church affiliations and cultural backgrounds.

The Fellowship regards the Bible as the Word of God and therefore the ultimate authority pertaining to all matters of life and morality.

The Fellowship further believes, in line with Biblical teaching, in the sanctity of life from the time of conception until natural death. It thus equates the termination of the life of an unborn child with that of any other living person and is therefore opposed to all form of termination of pregnancy.

Members of HCF are however, virtually without exception patriotic members of civil society who desire to contribute to the development and prosperity of South Africa as a strategic country on the continent and internationally.

It is in this context and in the conviction that this will be achieved through God’s blessing on the country, that the following concerns are raised regarding the CTOP amendment bill under discussion.

On behalf of our members, we submit the following concerns regarding the proposed legislation:

1. Increased Pressure on Health Workers

Health workers in South Africa experience a variety of stressful working conditions. The HIV/AIDS pandemic, insufficient funding, equipment, medicines and staffing, crime and corruption all contribute to the pressure health workers experience. South Africa’s health care professionals, dedicated to saving lives and improving health, find it difficult to work in these conditions. Abortion, performed on otherwise healthy mothers and babies, in many cases, undermines health workers’ noble personal objectives of improving health and saving lives, thus increasing the pressure.

Throughout South Africa, there is very little support for abortion among health workers. The majority of health workers are clearly opposed to abortion. Across the country, very few health workers participate in performing abortions (and not even all of these do so willingly). No provision is made in the law to accommodate those who have religious and/or moral objections to formally register their objections to abortion. This is a serious deficiency in the law and it needs to be addressed. Unwilling health workers are easily drawn, forced, pressured or deceived into performing or assisting with abortions.

Further roll-out of provision of abortion (via automatic qualification of facilities to perform abortions) will create a bigger platform, but with a more thinly spread staff willing to perform abortions. This will serve to further divide the health force on this issue and create further alienation between the government and the health workers.

Abortion undermines morale amongst hard working and dedicated health workers. We fear that forcing abortion on more unwilling workers will force workers out of the health services, and thus undermine the provision of all much needed medical care to South Africans. In the final analysis, the government will undermine its own credibility as an effective service provider, as they endeavour to load more abortions onto a workforce generally opposed to the existing practice.

2. Qualifications to Perform Abortions

Manual vacuum aspiration abortions (commonly used in South Africa) are inherently risky. The gravid uterus is soft and easily perforated by the hard tube of the aspiration equipment. Such a perforation can cause severe bleeding, even leading to the need for an emergency hysterectomy. The perforation of the uterus or other internal organs will not necessarily be noticed by the abortion operator. Other possible serious complications include bleeding and infection from pieces of the baby or placenta left in the uterus after the abortion.

We do not believe that midwives are properly qualified to perform the delicate and risky operation of abortion. Abortion is significantly riskier to the mother than post-miscarriage or post-birth suctioning, since for these procedures the uterus is hard and already contracting.

Further, to have ordinary registered nurses perform abortions after a short course is reckless and shows a disregard for the complexities of the female reproductive system. For example, an attempted abortion in the case of an undiagnosed ectopic pregnancy can lead to a life-threatening ruptured ectopic pregnancy. The presence of sexually transmitted infections can cause serious post-abortion complications. Undetected Rhesus sensitization can lead to life-threatening complications in future pregnancies.

Due to the AIDS pandemic, South Africa will face a situation of population shrinkage in the near future. Injuries caused by unqualified operators can lead to both long-term morbidity and infertility. It is short-sighted to undermine the long-term fertility of our population by allowing unqualified operators to perform abortions.

We propose that neither registered nurses nor midwives be considered qualified to perform abortions.

3. Culture of Secrecy and Under-reporting of Complications

Due to the significant religious and moral objections to abortion, neither abortion patients nor abortion operators promote a culture of openness. This makes post-abortion follow up impossible, despite potentially serious complications. This also unnecessarily hinders the post-abortion treatment of complications, since it can be difficult to identify that the patient has recently had an abortion.

Further, given the culture of secrecy, it is difficult to identify an incompetent operator and/or system. Maternal deaths have occurred as a result of legal abortions, but it appears that these have not been recorded and/or reported as such.

We propose that abortion records be subject only to normal patient confidentiality requirements. Further, we propose that the statistical requirements in the law be expanded, to include the tracking of post-abortion complications and deaths i.e. that these be statutarily documented. Only if complications and deaths from legal abortions are documented will we be able to properly evaluate whether legal abortion is contributing to maternal health or not.

4. Abortion in the Rural Areas

It is well known that abortions can lead to serious physical and/or psychological complications. Expanding access to abortion in rural areas will place undesirable stress both on staff and patients.

Due to unreliable communications, and inadequate access to sophisticated support services in the event of complications, rural women will be particularly vulnerable to abortion injuries and deaths.

Rural clinic staff, often very dedicated and self-sacrificing individuals, will be pressured to perform abortions. Abortion will serve to divide rural staff, who already face many difficulties. The lack of infrastructure in rural areas will also undermine the staff’s ability to provide a health-improving service when complications do occur, and will undermine morale.


In summary, we thus appeal to the government to scrap the 1996 Choice on Termination of Pregnancy Act, so that health workers are not under any pressure to perform abortions, against their freedom of conscience. If the government will not scrap the 1996 CTOP act, we appeal to the government to:

  1. Increase the qualifications required to perform abortions, so that neither registered nurses nor midwives perform abortions.
  2. Make specific provision for health workers to conscientiously object in participating directly or indirectly in the performance of abortions.
  3. Limit the provision of abortions to hospitals with full surgical facilities, where sufficient staff (who volunteer without any pressure or coercion) to perform abortions and related activities (including administration, pharmaceutical services, etc.) will be available, 24 hours a day, so that pro-life staff are not drawn into performing or completing abortions.
  4. Improve records by subjecting abortion records to no further confidentiality requirements than other medical records.
  5. Record legal abortion-related injuries and deaths, so that the real impact of abortion on maternal health can be assessed.
  6. Redirect resources intended to expand abortion sites into abstinence programmes and alternatives to abortion, currently underdeveloped and insufficient. In depth counseling with sufficient available counselors for those wanting to make a choice of TOP, with particular emphasis of the consequences.

HCF would be happy to cooperate with government on further exploring and developing these options.