In December, Nomthandazo Zulu* was excited. She would be welcoming a baby in the new year and, after an earlier miscarriage, was relieved the pregnancy had entered its fourth month.
Zulu and her boyfriend, Bongani Mtshali*, had been trying to have a baby. The two shared in the initial joy of discovering Zulu’s pregnancy. But he had become distant in recent weeks.
“He wasn’t returning my calls or coming to see me. When I asked him why he just said he was just very busy at work,” Zulu recalls.
Towards the end of the month, Mtshali finally asked to see her. Zulu thought it was to reconcile. They went to Mtshali’s home where he disappeared for about half an hour, saying he had to fetch something. When he returned, the two had sex. “We started kissing and touching. He fingered me and then we had sex.”
Later that night at home, Zulu started having sharp abdominal pains. She thought it was normal, but then the cramps became unbearable. Zulu and her sister took a taxi to the Tshepo-Themba Private Hospital in Soweto, where she was immediately admitted.
While examining her, a doctor discovered partly dissolved white pills in her vagina.
Zulu explains: “The doctor asked me what did I put in my vagina. I told him, ‘nothing’. Why would I put anything there when I know that I am pregnant?
“He looked at the nurse and shook his head and continued checking me. He removed a white substance from my vagina and told the nurse to admit me.
“When the doctor returned, he said, ‘I think your pregnancy is at risk’.”
Zulu is one of 11 women who say they were forced to undergo abortions and recently contacted HIV clinician and patient rights activist Sindi van Zyl for advice on Twitter in response to Van Zyl’s #HeartbreakHotel hashtag. In most cases, women had been unknowingly given abortion medication by their partners, either in drinks or, as in Zulu’s case, vaginally. In one case, a woman reported her family held her down while a doctor administered the pills.
Van Zyl said, although she had heard rumours of forced abortions, she had never encountered a case.
“As a medical doctor, I had never seen this in person. It’s one thing to hear about it but another to experience it.”
Nomthandazo Zulu says she is certain that her boyfriend inserted abortion pills in her vagina when she was 16 weeks pregnant. (Demelza Bush)
In South Africa, women can request an abortion during the first 12 weeks of pregnancy by a midwife, a trained registered nurse, a general practitioner or a gynaecologist. Doctors can also surgically terminate pregnancies between 13 and 20 weeks if, for instance, it poses a danger to the woman’s health or socioeconomic status, or is a result of rape or incest. Abortions after 20 weeks are performed in limited medical circumstances.
The Choice of Termination of Pregnancy Act stipulates that only a pregnant woman can give consent to get an abortion, even in cases where she is a minor – except in cases where the woman is severely mentally disabled or unconscious for a prolonged period. The Act’s wording is deliberate and is meant to protect those who are underage or vulnerable, says Andy Gray, a senior pharmacology lecturer at the University of KwaZulu-Natal.
In hospital, Zulu met her gynaecologist after losing the pregnancy. The doctor told her it would only be possible to determine after a month whether her miscarriage happened naturally or was the result of the white substance found in her vagina. “I sent Bongani a message telling him I lost the baby. He never replied. He never came to see me at home. He was not even answering my calls,” Zulu says.
When can you get an abortion and who should perform it in South Africa? Here’s what you need to know.
Although her now ex-boyfriend denies inserting the pills in her vagina, Zulu has opened a case against him. But the police didn’t know what charge could be laid against him.
“One of the male police officers said, ‘That guy has a right [to abort the pregnancy] because that’s also his baby’ but I pretended not to hear him,” she remembers.
“Eventually I opened a case of assault, but the captain said they have to discuss the charges with their superiors.”People who force women to terminate their pregnancies can be charged with assault with the intent of doing grievous bodily harm, says Rethabile Mosese, an attorney with the gender-based violence organisation Lawyers Against Abuse. If convicted, perpetrators can be fined or be jailed for up to three years.
Mosese warns in cases where forced abortions posed a threat to the mother’s life, those convicted could be charged with attempted murder. If convicted, they could face up to seven years in prison.
Victims of forced abortions have the right to open cases at their nearest police station and, because of the sensitive nature of the crime, can request to speak to a woman officer and be interviewed in a private room, she explains.
Abusive partners and family members aren’t the only ones who can be prosecuted. Health professionals who are directly involved in administering medication to induce forced abortions can also be charged under the Termination of Pregnancy Act and the National Health Act. If found guilty, they could be jailed for up to 10 years.
The Health Professions Council of South Africa (HPCSA) is responsible for regulating the health profession and acting against unethical healthcare workers. HPCSA spokesperson Daphney Chuma says the organisation has received complaints about health practitioners who have carried out forced abortions but was unable to give exact figures. If the allegations are found to be true, professionals can be cautioned, fined, suspended or removed from the register.
Healthcare workers must be registered with the HPCSA to practice in South Africa. Van Zyl plans to report doctors who women say were involved in forced abortions.
When healing hands hurt
Dodgy healthcare workers in the private and public sector may also be at the centre of illicit networks supplying abortion pills to women’s partners and families and dealing in stolen medication, both Van Zyl and Gray point out.
Theft of medicines from government depots and clinics has occurred. In 2013, the Aids lobby group Treatment Action Campaign and the humanitarian organisation, Doctors Without Borders, highlighted alleged cases of theft at the beleaguered Mthatha medicine depot in the Eastern Cape. Later that year, the national health department issued a statement welcoming the arrest of two Gauteng health officials dealing in stolen antiretrovirals.
Gray says, although theft is not unheard of in the private sector, electronic stock-taking systems make it less likely or more easily detected.
“The biggest problem in the state is that we are still reliant on paper-based systems. Although we have a better idea of what stock is in the storeroom, as soon as the stock is transferred to the dispensaries, wards or emergency rooms, all the accountability and recording of who gets those doses is paper-based,” he explains.
Public health facilities use both paper-based and electronic systems for ordering stock as a way to control theft, the health department’s director of communications, Foster Mohale, says.
In recent years, the national health department has also instituted programmes to try to better monitor medicines and reduce stock-outs, including piloting the use of electronic barcodes to track medicines and using private courier companies to ensure patients receive chronic medication.
Mohale says, although the department is not aware of forced abortions, victims should report the crimes to the police. He adds there is no evidence that government drugs are being used by unethical providers or illegal abortionists.
In South Africa, two prescription drugs are used to perform medical abortions, Mifepristone and Misoprostol, and both are schedule four drugs. Countries use medicine schedules to regulate drugs. The more likely a medicine is to be misused or to carry a risk of addiction, the higher it is scheduled and the more difficult it should be to get.
But tighter regulation of abortion drugs by moving them to schedule five or six could curb even legal access to the medication.
“This would restrict the ability of nurses to prescribe the drug and nurses are important for those requiring early-stage abortions. We have enough of a problem in this country with people not having access to safe abortions the way they should, particularly in public sector facilities,” Gray warns.
Van Zyl says, even if new regulation could decrease forced abortions, it would take years to pass. Meanwhile, this seemingly new form of assault on women speaks to a larger war on women’s bodies and the society in which it’s being waged.
She explains: “It is a social question of women’s rights to their own bodies and how their partners treat them. We need to re-examine our relationships. There has to be a better way of communicating, a better way of relating to each other.”