Reproductive Rights: Discussion with International Delegation (IPAS)

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Health

14 May 2001
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Meeting report

HEALTH PORTFOLIO COMMITTEE
15 May 2001
REPRODUCTIVE RIGHTS: DISCUSSION WITH INTERNATIONAL DELEGATION (IPAS)

Chairperson: Dr. S. Nkomo

Documents handed out:
None

SUMMARY
IPAS is a non-governmental organization founded in 1973 that works globally to improve women's lives by focusing on reproductive health and safer abortion methods. It also strives to empower women by increasing access to services that enhance their reproductive and sexual health.

An international delegation of IPAS representatives (five from Ethiopia, eight from Kenya, five from Nigeria and one from the United States), came to South Africa to study the implementation of the 1996 Choice on Termination of Pregnancy Act (CTOP). The group is made up of parliamentarians, physicians and other activists from these nations. The purpose of this meeting was to unite this group with parliamentarians in South Africa that were dealing with the troubles and successes since the passage of the Act.

The meeting was a culmination of the group's two-day tour of Cape Town. It provided an opportunity to share their knowledge and ask questions about abortion issues in their respective countries. Many topics specific to implementation and logistics of the Act were asked and there was a general sense of cooperation within the members of the group as each will soon return to their nations to share this wealth of information.

MINUTES
Challenges to the CTOP Act.
Dr. Baloyi (IFP) began by explaining the numerous challenges that have arisen since the introduction and implementation of the CTOP Act in 1997, among the challenges were:
Adequate designation of facilities to all provinces of South Africa.
Conscientious objectors from the medical field who refuse to treat a patient that is seeking an abortion.
Training workers properly to handle abortion cases, both in nursing and in counseling.
Anticipating the increased workload on medical staff.
Curbing illegal "back street" abortion procedures that are dangerous to the woman's health.

Specific Problems in the Health Care Profession
Dr. Baloyi elaborated on problems specific to the Health Care profession. He spoke about the hierarchical nature of nursing, so that if the head nurse disagrees to the CTOP Act, then her entire staff will most likely agree. It is often up to the senior management of a hospital to dictate specific patterns of care for their patients. South Africa has adopted a "Plan B" approach to conscientious objectors that only give the option of non-participation to those who object to the CTOP Act. There are criminal penalties for refusal of medical care based on the disagreement with the CTOP Act, but those were not elaborated upon by the committee.

Some Members of Parliament then spoke about the status of implementing the CTOP Act in their specific provinces. The representative from the Free State, Ms. Mnumzana (ANC), mentioned how they were staffing their abortion clinics with nurses who had volunteered their services. This process of volunteering to work at the clinic allowed Free State to avoid forcing unwilling nurses to perform procedures that they did not wish to do. She added that there has been an overwhelming response of support from nurses there.

A report from the Northern Cape stated that a major issue there was the lack of information provided to women over general aspects of pregnancy. It also stated that many women were uninformed about the new CTOP Act and the services provided by it. Access to health facilities was a major problem for the Northern Cape. Overall, there was a sense of too much bureaucracy and an endless circuit of referrals that wasted too much time for the patient.

Dr Boniface from Nigeria explained how abortion procedures are integrated into the basic Obstrectic/Gynecologist functions of a clinic. He compared the integration to a similar case, those of STD clinics in Nigeria. He claims that by incorporating abortion procedures into the general processes of a hospital or clinic, there will be a reduction in stigma caused by having an abortion. He also explained that conscientious objectors in Nigeria are held responsible for any complications that may arise due to a refusal of care. He feels that a system like Nigeria's would work well in South Africa.

Dr. Baloyi responded to Dr Boniface's remarks by stating that South Africa has many powerful labour unions that prevent government interference with medical facilities, procedures and labor. However, he noted that those who support the CTOP Act are in fervent and whole-hearted support, to the extent that they are extending their office hours to treat abortion patients.

The African IPAS vice-president from Ghana read from a report by the South African Society of Gynecologists that detailed the following:
Staff moral and the effect of having an increased work load.
The approach of training as many caregivers as possible to relieve the increased work load.
The importance of post-abortion care and counseling.
The challenges in having a governmental stance on abortion while having many hospitals that are operated by religious missionaries or descendants of missionaries who may object to abortion.
The Residency Training Program which mandates that medical school students to have rounds in all sectors of the hospital, including the family care sector where they are faced with abortion cases regularly. Also, all post-graduate medical students must serve one year in community service, which provides more exposure to abortion cases, particularly in rural and urban areas that need more medical care professionals.

At this point in the meeting, the Deputy Speaker of Parliament stopped by to visit.

Challenges from the Religious fraternity
Many anticipated challenges came from various religious groups, particularly fundamentalist Christian groups. But the relationship between the church and the abortion-supporting state has been evolving since the Act's passage in 1996. Dr. B Mbulawa (ANC) foreshadowed that the church would have to begin complying or at least accepting the provisions of the Act or else they would be left behind. She noted that the wisdom and counseling services provided by the church would be necessary to implement the post-abortion care procedures that were included in the Act. She mentioned one church in Port Elizabeth that got involved with its local abortion clinic with positive results.

The CTOP Act in a Democratic South Africa
Dr Nkomo and other members of the committee stressed the significance of having the CTOP Act as a facilitation of democracy in South Africa. Abortion was described as a Constitutional right and a movement towards the complete liberation of women. Dr. Nkomo anticipated the isolation of objectors in the future.

Mr T Yengeni, the Chief Whip of Parliament visited the meeting for a few minutes and gave his remarks. He stated that South Africa, stressing its upholding of democracy, relies on a system of checks and balances to preserve its new Constitution. He also mentioned the importance of labour unions in this process of preserving democracy.

Discussion
A delegate wanted to know what the country is planning to do with conscientious objectors in the health sector given the fact no one should impose his or her beliefs on other people.

One member of the Kenyan delegation of IPAS posed a question concerning the logistics and time frame involved in an abortion procedure. This included pre and post abortion counseling as well as the actual abortion procedure.

Dr. Mbulawa (ANC) responded that the procedure is to first correctly establish the pregnancy and to determine the woman's duration of pregnancy. The pre-abortion counseling comes next and is designed not to direct but to ensure that the woman is making a decision with which she feels most comfortable. The abortion process itself only takes a few hours, which is then followed by the post-abortion care and counseling. This counseling, like the pre-abortion counseling, can go on for an indeterminate amount of time until the woman fully understands the nature and implications of the act of abortion.

The American Policy Director of IPAS, Charlotte Hord, wanted to know how South Africa, a multi-party nation with a history of political discord, was able to come to a consensus on a topic of such inflammatory nature.

Dr. Rabinowitz (IFP) responded that the Act was part of a large body of flagship legislation that represented South Africa's transitional politics, a movement towards the liberation of oppressed. She said women's rights were a representation of the expanding notion of democracy in general for all South Africans. She noted that all sectors of society had a stake in the passage of this Act and viewed it as a chance to further the individual rights promised under the Constitution. She proclaimed that it was an individual conscience and the ideals of liberty that ruled this democracy.

Closing Remarks
Nkomo reiterated the importance of fighting for the rights of women, which would, in turn, further the liberties of all South Africans. He promised that the adjournment of this meeting would not be an end to international cooperation and dialogue on the issue of abortion and women's rights.

Ms Gxowa gave the closing remarks on behalf of the South African parliament. She focused on how the 1996 act gave everyone access to abortion rights that were not provided by the 1975 Sterilization and Abortion Act. The interests of the patient are to be held at highest importance. She made reference to the Freedom Charter, which provides for the comfort of all citizens, including the health care of women. She praised Dr. Nkomo for his dedication to providing all South Africans direct access to vital medical care. She stressed the importance of South African unification over many crucial health care issues.

The Kenyan parliamentarian gave a thankful response that heralded South Africa as a leader in abortion legislation. She acknowledged the reliance many African countries will have on South Africa when trying to sort out their own abortion issues.

The group from IPAS will move on to Pretoria and Johannesburg to continue their study of federal and provincial responses to the need for safe abortion care.

The meeting concluded with a joyful exchange of gifts between the international IPAS members and the members of the South African Parliament portfolio committee.

The meeting was adjourned

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