Written by Yamini Kalyanaraman
My doctoral research relates to developing a training course for nurses in Abortion Counselling. In order to expand on my legal insight into this topic, I am currently participating in an online course held by Stellenbosch University called Abortion: Law and Ethics. So for this month’s blog, my focus will be on this material, what I have learnt thus far, and some insights into my work as a practicing psychologist.
To get an idea of the course, it is helpful to keep in mind that it was developed by lecturers from three diverse backgrounds:
- Malebo Malope, who is a genetic counsellor and a lecturer in clinical training of Medical Genetics and Genetic Counselling at Stellenbosch University.
- Anita Kleinsmidt, who is an attorney who practised medical law in Johannesburg and has lectured medical ethics at Wits and Stellenbosch universities.
- And lastly, Associate Professor Michael Urban, a paediatrician who is currently the head of the Clinical Unit of Medical Genetics and Genetic Counselling at Stellenbosch University.
The course runs over 8 weeks and covers topics from Culture, Law and Religion in Termination of Pregnancy (TOP), to Conscientious Objection, Litigation, and Communication in the TOP setting. Each lesson has a lecture video, a resource list, and a quiz (where one needs to get 70% to pass). Each week relates to one aspect of abortion and the information provided is in-depth and contextualised to South Africa.
Setting the stage, in the introductory lesson Prof. Urban questioned whether certain statements surrounding abortion are true or stereotype:
Following this discussion, he continued by highlighting that the answers are not always simple.
- Unwanted pregnancies happen for complex reasons.
- Only a small minority of women use abortion as birth control.
- Abortion is safe if done in a safe manner but dangerous if done unsafely.
- Whether it is psychologically harmful probably depends on the situation. Emotional and mental health issues after abortion have been investigated (with several variations between studies) which, in part, relates to the context. For example, whether it was an illegal or unsafe abortion, to what extent stigmatising behaviour occurred, and also whether the pregnancy was unwanted.
- It is simplistic to suggest that adoption is an alternative to abortion.
- Criminalising abortion will not prevent it.
- Pro-choice just means pro-choice.
While my research has made me aware of the complexity surrounding the topic of abortion and the stigmatised environment in which healthcare providers offer the service, the first three weeks into the course have been eye-opening nonetheless, shedding light on the wider context and history of abortions – such as the earliest recorded abortion being in Africa (specifically Ancient Egypt).
For example, in the second lecture of the course, I was reminded of how the South African Constitution is the basis for the Choice on Termination of Pregnancy Act, 1996. Section 10 in the CTOP Act states that:
Any person who prevents the lawful TOP or obstructs access to a facility for the TOP, shall be guilty of an offence and liable on conviction to a fine or to imprisonment for a period not exceeding six months.
Additionally, the teaching material of the course has made sure to raise personal reflective questions, such as:
- What are your personal feelings about abortion?
- What abortion services are offered at your institution?
- And how can these services be improved?
Both the CTOP Act and the questions above came to mind in a therapy session where a client who was experiencing several anxiety related symptoms mentioned that she had recently had an abortion procedure. Curious as I was to find out about the service provision, I knew I had to allow her to share what she felt was relevant. The client went on to describe how in order to schedule an appointment she needed to make phone calls daily to check up on availability. When she eventually went to the hospital, she was denied entrance to the hospital twice by security. Stating that she wished to visit the Women's Health Clinic, she was turned away by the guard who told her that that specific nurse was busy with Covid vaccinations.
On her third attempt to enter the hospital, the client took the pragmatic step of informing the guard that that she was going to see a doctor instead. This time, she was let in. After a few more minor obstacles inside, she manged to locate and meet with the TOP nurse who assisted her without further delay. The client shared with me that everything went well after that. Both my clinical judgment as a psychologist, and my insights as a researcher in the field of abortion services, tell me that it was not the procedure or her post-procedural check-up itself that ended up exacerbating her anxiety symptoms but rather the obstruction to access that carried on for over a period of two weeks. I suspect, for example, that the security guard is oblivious to the Bill of Rights that is embedded in the Constitution – yet I wonder if each person that created a hurdle for her is aware of the ramifications of their actions for people (such as my client) trying to access abortion services?
I return to one of the reflective questions: how do I feel about abortion? My answer is that how I feel about abortion should not matter. I do wish for women to have control over their reproductive decision-making. I wonder what a society with equality could look like? What if all the energy invested in contesting abortion was shifted to include early and continuing sex-education in schools, equality in and quality of healthcare, pregnancy support, financial feasibility of childcare, maternal and paternal leave, an effective and efficient justice system for sexual assault and rape, adequate social services for foster children, and so on? Perhaps that is why my mind keeps returning to this quote by Melinda Gates:
Sometimes all that’s needed to lift women up is to stop pulling them down… because when you lift up women, you lift up humanity.