TERMINATION OF PREGNANCY by DR KD DELE

Abortion remains a topical issue, globally, primary because it affects one of the fundamental rights. This presentation is not for debate, but simply highlights the South African laws and regulations as they relate to Termination of Pregnancy (TOP), and the different methods available.

1. Termination of pregnancy BY: DR KD DELE | DEPARTMENT OF FAMILY MEDICINE | DORA NGINZA HOSPITAL

2. TERMINATION OF PREGNANCY: INTRODUCTION Termination of pregnancy (also known as induced abortion) is one of the most commonly performed gynaecological procedures

3. TERMINATION OF PREGNANCY: INTRODUCTION “Because I was able to get an abortion, I moved beyond being the typical girl from the township who gets pregnant. I made it. I made it out of that poverty and patriarchy.” - Puleng ___________________________________ Puleng credits being able to access a safe abortion during high school with allowing her not only to matriculate but go onto graduate from university and have a successful career. https://serve.mg.co.za/content/documents/2018/05/07/i8jNT5fVReGoh4Uray3r_Bhekisisa_SafeAbortion_final_2018.pdf

4. INTRODUCTION, contd.

5. Choice of Termination of Pregnancy Act

6. epidemiology

7. epidemiology Tens of thousands of safe, legal abortions happen every year in South Africa. In 2017, 73 072 abortions were performed at state health facilities, according to the national health department There is a challenge in documenting or tracking which health facilities provide services regularly. This is because abortion services are so fragile they often rely on a single trained nurse such that when that nurse goes, the abortion services collapse, It is unknown for sure how many people undergo illegal abortions or how many women die each year from illegal abortions. Such data basically don’t exist.

8. epidemiology There has since the legalisation of abortion on demand been a decrease in deaths from backstreet abortions However, the number of deaths following abortions are still quite high — 5% of maternal deaths following childbirth are abortion related, and 57% of these are related to illegal abortions.

9. epidemiology https://www.isdscotland.org/Health-Topics/Sexual-Health/Abortions/

10. When do women have abortions?

11. Legal position

12. 1. Legal position: 0 – 12 weeks In South Africa, any woman of any age can get an abortion by simply requesting with no reasons given if she is less than 13 weeks pregnant.

13. 2. Legal position: 13 – 20 weeks If she is between 13 and 20 weeks pregnant, she can get the abortion if (a) her own physical or mental health is at stake, (b) the baby will have severe mental or physical abnormalities, (c) she is pregnant because of incest, (d) she is pregnant because of rape, or (e) she is of the personal opinion that her economic or social situation is sufficient reason for the termination of pregnancy.

14. 3. Legal position: > 20 weeks If she is more than 20 weeks pregnant, she can get the abortion only if her or the fetus' life is in danger or there are likely to be serious birth defects

15. Other provisions A woman under the age of 18 will be advised to consult her parents, but she can decide not to inform or consult them if she so chooses. A woman who is married or in a life-partner relationship will be advised to consult her partner, but again she can decide not to inform or consult him/her. An exception is that if the woman is severely mentally ill or has been unconscious for a long time, where consent of a life-partner, parent or legal guardian is required.

16. Some components of the TOP acts

17. Illegal “backdoor” abortion “A gap remains between the legally enshrined rights of women and their actual access to legal and safe abortions. The supply and demand of unsafe, illegal abortions thrive on this divide, mostly through brazen advertising to which no counter-narrative exists to inform women that abortion is legal and can be done safely in most public hospitals.” - Dr Indira Govender, Family Medicine Physician

18. Some components of the TOP acts: Illegal “backdoor” abortion

19. Some components of the TOP acts: CONSCIENTIOUS OBJECTOR

20. Some components of the TOP acts: CONSENT

21. Some components of the TOP acts: CONSENT

22. Some components of the TOP acts: COUNSELLING

23. Some components of the TOP acts: COUNSELLING

24. Some components of the TOP acts: ULTRASOUND SCANS

25. Top: the process

26. TOP: THE PROCESS MEDICAL ABORTION

27. TOP: THE PROCESS MEDICAL ABORTION Health workers may perform medical abortions up until nine weeks of pregnancy. This involves the use of medication, namely Mifepristone and/or Misoprostol, to end a pregnancy. MIFEPRISTONE: Mifepristone is also sold under the name Mifeprex – blocks the hormone progesterone MISOPROSTOL: Misoprostol is also sold under the brand name Cytotec – causes the uterus to contract and expel the embryo/foetus There are usually used together to achieve a medical TOP

28. TOP: THE PROCESS MEDICAL ABORTION Health facilities may offer a different abortion services depending on their protocol. But Generally: Mifepristone is given orally at the clinic or hospital, while Misoprostol is the TTO which they will take between 24 and 48 hours later. Patients will experience abdominal cramps and vaginal bleeding Side effects also include nausea, vomiting and diarrhoea, Patients are advised to take analgesia such as NSAID (e, ibuprofen but not aspirin) immediately after Misoprostol/Cytotec

29. TOP: THE PROCESS SURGICAL ABORTION

30. TOP: THE PROCESS SURGICAL ABORTION This is done after 9 weeks to minimize the risk of retained products/ incomplete abortion. In South Africa these types of terminations often use the same drugs, Mifepristone and Misoprostol, used in medical abortions. But they also include an additional procedure – such as manual vacuum aspiration Mifepristone is given, then 24 and 48 hours later, the woman returns to the facility for the procedure. At the facility, they receive Misoprostol, and after about 4 hours, the MVA is done. Surgical abortions also involve prescription of analgesia and antibiotics following the procedure

31. THANK YOU For listening