Inaugural speech
Danida report

Country Overviews
South Africa




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Section 1. Law and Policy

  • 1-8. Ipas responds to re-election of President Bush
    Without pressure, President will fail to confront global problem of unsafe abortion Elizabeth Maguire

    November 3 , 2004 – Elizabeth Maguire, president of Ipas, today said the following about the re-election of President George Bush:

    “For the last four years, women worldwide have suffered needlessly because the Bush administration has obstinately refused to acknowledge the harsh reality of unsafe abortion. Every minute, forty women have an unsafe abortion. Each year, 70,000 women­the majority poor­die needlessly from unsafe abortion and millions more are injured. The president has turned his head away from this tragedy­one that is wholly preventable­in favor of promoting a faith-based ideology and policies, such as the Global Gag Rule, that only do more harm than good. If the president’s next term is anything like his first, we can only expect things to get worse for the world’s women.

    “We urge President Bush to chart a new course for women during his second term. This will not come without pressure from citizens and elected officials who understand that women are central to global health and stability. We must urge President Bush to lift the Global Gag Rule, which has harmed countless poor women worldwide by withholding vital reproductive-health services, and to pay the $34 million the United States has pledged to UNFPA for family-planning programs to prevent maternal and child deaths worldwide.

    “We must demand that the president uphold a woman’s right to choose. Ipas urges everyone to tell their elected officials to only support a nominee for the Supreme Court who supports reproductive rights and health. Women around the world must have the opportunity to determine their future, protect their family and manage their fertility. It is time for the president to face the truth about unsafe abortion.”

    For more information, contact:
    Marty Jarrell
    Manager, Communications Unit
    phone: 919.960.5575
    fax: 919.929.7687

    1-7. Abortion & Common Sense
    Ruth Dixon-Mueller, Ph.D. Paul K. B. Dagg, M.D.

    About the book
    Abortion and Common Sense cuts through the rhetoric and misinformation surrounding the abortion debate to look at the facts. Four of every ten women in the United States will have at least one abortion in their lifetimes. Worldwide, an estimated 46 million women terminate their pregnancies every year, some safely, some dangerously.

    Showing that placing arbitrary restrictions on girls' and women's access to safe early abortion is illogical, unworkable, and unfair, the authors urge that the humane treatment of problem pregnancies be integrated into health and family planning programs as a routine element of good medical care and of an equitable social policy.

    Chapter titles:
    PART I: PRIVATE LIVES. Regulating our fertility: ancient customs, current practices. Making the abortion decision. The Procedure. Psychological consequences of abortion and the myth of regret.
    PART II: PUBLIC SETTINGS. When is abortion against the law and what difference does it make? Inside the medical profession. Private opinion and public debate: who decides who decides? Why safe abortion is a global issue.

    About the authors
    Ruth Dixon-Mueller is the author of numerous publications in women's employment and reproductive health, including Population Policy and Women's Rights: Transforming Reproductive Choice and Rural Women at Work: Strategies for Development in South Asia. Formerly Professor of Sociology at the University of California, Davis, she now lives in Costa Rica and works as an independent consultant.
    E-mil: dixonmueller@yahoo.com

    Paul K. B. Dagg, Fellow of the Royal College of Physicians and Surgeons (Canada), is Associate Professor of Psychiatry at the University of Ottawa and Director of Clinical Services at the Royal Ottawa Hospital. His publications on abortion and on therapies for sexual abuse survivors include articles in the American Journal of Psychiatry, International Psychiatry Today, and the American Journal of Psychotherapy.

    To order: Xlibris Corp. 436 Walnut St. 11th floor, Philadelphia PA 19106; tel 1-888-795-4274 ext 276; fax 215-599-0114
    e-mail: Orders@Xlibris.com

  • 1-6. International Confederation of Midwives. 1999. ICM


    Declaración de postura

    La Confederación Internacional de Matronas cree que debe haber una legislación adecuada sobre el trabajo de las matronas en todos los países.


    La legislación que se aplica a la práctica de las matronas debe
    • garantizar que la profesión esté dirigida por matronas.
    • apoyar a la matrona que, en diversos entornos, utiliza sus conocimientos y técnicas para salvar vidas, en locales donde no hay acceso a apoyo médico.
    • respaldar la aplicación de una formación continuada.
    • exigir una renovación periódica y regular de los registros
    • adoptar una "Definición de Matrona" apropiada para su país y que esté dentro de la legislación.
    • conseguir una representación del consumidor en el órgano rector.
    • reconocer que todas las mujeres tienen derecho a ser atendidas por una matrona competente.
    • permitir que la matrona desarrolle su trabajo por derecho propio.
    • fomentar la revisión y el análisis regular, a cargo de las propias matronas, de los resultados perinatales, maternales y de recién nacidos, dentro del proceso legislativo.
    • identificar la importancia de regulación de matronas y legislación distinta que fomenta y aumenta el trabajo de matronas para mejorar la salud maternal, infantíl, y pública.
    • suministrar un conjunto regulador gobernado por matronas cuyo objectivo es proteger los derechos del consumidor.
    • conseguir una revisión periódica de la legislación para comprobar que continúa siendo adecuada y no anticuada mientras sigue avanzando la formación, la práctica de la obstetricia y los servicios sanitarios.
    • fomentar el uso de evaluación y análisis de resultados perinatales, maternos, e infantiles dentro del proceso de análisis legislativo
    • proporcionar programas de formación intermedios en relación con la adopción de una legislación nueva que exija de las matronas un grado de competencia superior.

    Declaración guía para las asociaciones miembros

    Se insta a las asociaciones miembros a que utilicen esta declaración para conseguir una legislación adecuada para la práctica de la obstetricia en sus respectivos países.


    • La madre y el bebé: implantación de la Maternidad sin Riesgo en cada país, 1994, OMS.
    • Definición de matrona, 1992, ICM, FIGO, OMS
    • Bryce, G.K., Documento resumen presentado en el taller sobre legislación, mayo de 1983, Congreso de la ICM en Vancouver (no editado).
    • Agenda de la iniciativa para una Maternidad sin Riesgo. Prioridades para la próxima década. Informe de la consulta técnica sobre la Maternidad sin Riesgo, octubre de 1997, Sri Lanka, Atención Familiar Internacional.
    Reemplaza la declaración de la Confederación Internacional de Matronas: Legislación Apropriada para Matronas 90/3
    Adoptado por Consejo de la Confederación Internacional de Matronas, Manila, Mayo 1999.
    Fecha para revisión: 2005

  • 1-5. International Confederation of Midwives. 1996. ICM


    Declaración de postura
    La Confederación Internacional de Matronas cree que las mujeres que hayan tenido un aborto, sea espontáneo o provocado, tienen la misma necesidad de atención que una mujer que haya dado a luz. En línea con esta idea, la matrona debe:
    • Considerar que tal atención forma parte de sus funciones
    • Ofrecer la atención inmediata necesaria después de un aborto
    • Derivar a la mujer a cualquier tratamiento que pudiera necesitar y que quede fuera de los límites de su actuación
    • Proporcionar a la mujer educación sobre su salud futura
    • Reconocer la ayuda emocional, psicológica y social que puede precisar la mujer y responder adecuadamente
    Adoptado por el Consejo de la Confederación Internacional de Matronas, Oslo, Mayo 1996.
    Fecha para revisión: 2005

  • 1-4. Berer M.

    Making abortions safe: a matter of good public health policy and practice.

    Bull World Health Organ 2000;78(5):580-92

    Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives.

    This article examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues.

    The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally.

  • 1-3. Varkey P, Balakrishna PP, Prasad JH, Abraham S, Joseph A.

    The reality of unsafe abortion in a rural community in South India.

    Reprod Health Matters 2000 Nov;8(16):83-91

    Department of Community Health, Christian Medical College, Vellore, India. abraham@cmc.ernet.in

    Though the law in India has permitted medical termination of pregnancy on broad legal grounds for over two decades, unsafe abortions carried out by unqualified providers show no signs of decreasing. A community-based study was undertaken in rural South India to determine the prevalence of induced abortion, women's reasons for seeking abortion, who was providing abortions and whether the procedures were safe or unsafe.

    A cross-sectional study design was used that included focus group discussions with 88 women and a quantitative survey with 195 married women who had a birth interval of two or more years since their last pregnancy. There was a high prevalence of induced abortion (28 per cent) among the study population, mainly among women who were not using contraception. Most abortions were carried out in the first trimester of pregnancy and unqualified practitioners performed 65 per cent of terminations.

    The preference for illegal, untrained providers in a country where abortion is legally available exposes the ambiguity in the status of abortion and how inadequacies in legal service provision have served to promote and sustain unsafe providers and practices. An integrated approach to family planning and reproductive health which includes abortion is imperative if the reproductive health status of Indian women is to be improved. The poor utilisation of existing government facilities suggests the need for improving the quality of services, expansion of abortion facilities and the introduction of safer methods of abortion. To do this, a re-examination and re-framing of aspects of the 1971 abortion law is needed.

  • 1-2. Varkey SJ, Fonn S, Ketlhapile M.

    The role of advocacy in implementing the South African abortion law.

    Reprod Health Matters 2000 Nov;8(16):103-11

    Women's Health Project, PO Box 1038, Johannesburg 2000, South Africa. sharonf@mail.saimr.wits.ac.za

    In order to translate the abortion law in South Africa into services that ensure equity of access and women's right to control their bodies, interventions are needed to change judgemental views on abortion. This paper describes formative research conducted in the Northern Cape Province among 436 community members, 29 women seeking an abortion and 80 health service providers, to develop appropriate interventions to these ends. Based on the findings, two interventions were developed.

    These interventions appeared to substantially influence personal views by getting people to make a connection between the need for abortion services and the circumstances in which unwanted pregnancies occur. There was a shift towards greater support for women's right to choose in relation to abortion among women community members, though not among men, who resisted this right for married women.

    Amongst providers (almost all women) there was an increase in willingness to support service provision and to support staff working in abortion services. These tools could be used in sexuality education in schools and in nurse-midwifery/medical training, to complement current advocacy initiatives taking place at policy and programme levels in South Africa, to help to reduce the public health problem of unsafe abortion.

  • 1-1. Bhuiya A, Aziz A, Chowdhury M.

    Ordeal of women for induced abortion in a rural area of Bangladesh.

    J Health Popul Nutr 2001 Dec;19(4):281-90

    ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, Bangladesh. abbas@icddrb.org

    The study was carried out to document the context of induced abortion, nature of its management, and post-abortion complications in Matlab, Bangladesh. The study included all 91 cases of induced abortion that took place in the study area from July to October 1995. Information was collected from women within 60 days after the abortion. A physician carried out in-depth interviews and physical examinations of 20 randomly-selected cases.

    The findings depicted a complex context, within which the women had to go for an abortion. In most cases, the complete lack of use or lack of use-effectiveness of family-planning methods resulted in unwanted pregnancies. The women in desperation sought abortion services from traditional sources first. When their conditions worsened, they contacted the available modern service facilities. At times, it was too late and led to serious health consequences. Limited access to safe abortion services, together with an absence of social support, put women in a life-threatening situation. Prevention of unwanted pregnancies and access to safe abortion services are needed to improve the situation.

    Section 2. Abortion technologies

  • 2-3. Twentytwo articles on medical abortion in Journal of the American Medical Women's Association (JAMWA) 2000;55(3): Supplement. See separate page

  • 2-2. Newhall EP, Winikoff B.

    Am J Obstet Gynecol 2000 Aug;183(2 Suppl):S44-53

    Abortion with mifepristone and misoprostol: regimens, efficacy, acceptability and future directions.

    Downtown Women's Center, Portland, OR, USA.

    Mifepristone at a dose of 600 mg followed by 400 &mgr;g misoprostol orally has been used for early abortion by hundreds of thousands of women with success rates at 49 days' gestation. A lower mifepristone dose of 200 mg and in-home self-administration of misoprostol both appear safe and effective.

    Although most research protocols have used ultrasonography to confirm gestational age, the method can be provided safely without routine reliance on ultrasonography. Acceptability of the method to care providers and to patients has been high in all studies. The introduction of medical abortion into general medical practice in the United States will teach us much about the practical aspects of service provision.

  • 2-1. Creinin MD.

    Am J Obstet Gynecol 2000 Aug;183(2 Suppl):S3-9

    Medical abortion regimens: historical context and overview.

    Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburg, PA, USA.

    Medical abortion offers an important alternative to surgical abortion for women with early pregnancies who wish to avoid a surgical procedure. More than 3 million women worldwide have had medical abortions in the past decade alone. The best-studied regimens include mifepristone orally followed 36 to 48 hours later by a prostaglandin analog administered either orally or intravaginally. Because of political and social restrictions related to mifepristone, however, researchers have investigated alternative regimens, most notably methotrexate and misoprostol.

    Mifepristone regimens are approximately 95% effective for abortion at less than 49 days' gestation. Efficacy between 50 and 63 days' gestation varies according to the type and route of administration of the prostaglandin analog. Complete abortion rates among these later gestations are clinically acceptable when mifepristone is followed by intravaginally administered misoprostol or gemeprost. This report reviews the development, efficacy, and side effects of mifepristone regimens.

    Section 4. Providers of abortion services

  • 4-1. Jones BS, Heller S

    J Am Med Womens Assoc 2000;55(3 Suppl):145-50

    Providing medical abortion: legal issues of relevance to providers.

    Center for Reproductive Law and Policy, New York City, USA.

    As early medical abortion becomes more widely used and available in the United States, providers of women's health care are questioning whether, and in what way, existing abortion restrictions apply to medical abortion. Many of these laws, virtually all of which were written before early medical abortion was widely used in this country, make little sense in the context of medical abortion. Nonetheless, most abortion restrictions are broadly written and could be interpreted by state officials to apply to providers of medical abortion.

    This paper identifies and briefly describes common types of abortion restrictions, including physician-only laws, targeted regulation of abortion providers, fetal tissue examination and disposal laws, parental involvement requirements, and mandatory waiting periods, and explains the extent to which these types of requirements may be enforced against providers of medical abortion.

    In addition, because some abortion restrictions are irrational or impose significant and unwarranted burdens on women's access when applied to medical abortion, they may be vulnerable to legal challenge. We also review possible legal efforts to invalidate these laws, as well as legislative or regulatory changes that can be sought in order to make medical abortion truly accessible to women in this country.
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