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On Women’s Choices, South Africa Should Continue to Lead

Dr. Eddie Mhlanga, South Africa’s chief director of maternal and women’s health, has movingly written about how he, as a conservative Christian, changed his mind on whether abortion should be a crime.

When he was a young doctor, a colleague died in his care after an unsafe illegal abortion, leaving behind a 4-year-old son. This tragedy made him realize that women will find access to abortion, legal or illegal, and that when abortions are illegal, they are often unsafe and even lethal. He also realized that “it is not for us to judge women seeking terminations.”

The United Nations is not always known for clarity, but on October 24 it issued a report that is crystal clear. Women who need or choose to have abortions should not be punished by their governments. Women, the report affirmed, are entitled to information, family planning, and health services that constitute the human right to health.

The report to the General Assembly by the UN special rapporteur on health, Anand Grover, said that dignity requires leaving individuals free to make personal decisions without interference from the state, especially in an area as important and intimate as sexual and reproductive health. He also said that criminal law is not an effective way to deal with sexual and reproductive health issues; indeed, its use can violate international human rights law.  

To its great credit, South Africa supported this groundbreaking message, and said at the General Assembly debate: “These are practical and realizable measures that could be adopted to achieve reproductive health for the benefit of all humanity."

Many women’s rights activists are justly proud of South Africa’s abortion legislation.  The act permits women to have an abortion on demand in the first trimester, and under certain circumstances up to 20 weeks into the pregnancy. Its very name, the Choice on the Termination of Pregnancy Act, implicitly recognizes that women should be able to make their choices without interference of the government, or anyone else, and that the government should support these choices by providing information and services.  Although many challenges exist in implementing this law, there can be little doubt that the act has made a huge difference to many women and girls in South Africa, allowing them to make the right choices for their lives, without fear of punishment or the risk of dying in a botched back-street abortion.

Elsewhere however, extremely restrictive abortion laws undermine women’s health and autonomy, threatening them with punishment if they decide to have an abortion and pushing them away from health care at a time when they need that care most.

For example, in Côte d’Ivoire, the Penal Code provides for long prison terms and high fines both for providers and for women who undergo abortions. In 2007, Human Rights Watch noted an increase in unsafe abortions there, because of rising trends of rape, sexual exploitation, and survival sex, as well as war-related economic pressure. Women sought out these dangerous options, often after they had endured violence, instead of having a safe and understanding environment in which to heal and exert some control over their own bodies.

In Argentina, laws prohibit terminating a pregnancy, with few exceptions. But our reporting shows that women do not have sufficient access to contraception and other reproductive healthcare in Argentina, leading to high levels of unwanted and unplanned pregnancies. Often women end up with no choice but to undergo an unsafe abortion that can cost them their lives.

In Ireland, abortion is legally restricted in almost all circumstances, with potential prison sentences for both patients and service providers. However, we saw that, even for the very few exceptions, there is misinformation, so that many women we interviewed were concerned about criminal penalties if they sought to terminate a pregnancy. The Irish government has also used legal injunctions to prevent women from traveling abroad for abortion, even though that is legal.  Although many women manage to find access to a safe abortion in other countries, this comes at a price, and female asylum seekers and poor women have no such option.

As the UN report said, the use by states of criminal and other restrictions to regulate sexual and reproductive health “may represent serious violations of the right to health of affected persons and are ineffective as public health interventions. These laws must be immediately reconsidered.”

South Africa has already set an example for the world by enacting a law that protects women’s rights, including their right to terminate a pregnancy. It now needs to make sure that women and girls can access these services, that they have information about their rights, and that they have access to other reproductive health care, such as family planning. 

A UN report might seem far removed from the reality of the women that Dr. Mhlanga wrote about, but the message is clear: you should not be punished for exercising your right. Don’t let that message go unheard. 

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