The ANC's approach to abortion - Bathabile Dlamini

Minister says it is vital for us to be true to the intention of the ANC in 1995 for access to quality abortion services by poor women (June 10)


Ipas South Africa Office Director, Karen Truman and her team, Ipas Regional  Manager for Africa, Uche Ekenna, Ambassador Rd. Eunice Brookman Amissah - Ipas Vice President for Africa and former Minister of Health in Ghana,

Colleagues and distinguished participants

It is a great pleasure for me to be asked to address you at this dinner on the eve of what I can only describe as a timely and important conference. 

A conference that seeks to assess the extent to which the South African government and indeed, the South African society has succeeded in empowering women.  Yes, I use the word empowerment, as we cannot talk of abortion in isolation of the overall goals to empower women socially, economically and politically. 

The right to and of women to have an abortion should always be fully located and discussed as part of the rights and the transformation of society that enables the complete emancipation of women. 

In this speech, I will therefore, in line with the theme of the conference look back at what we have done to emancipate and empower women and raise some issues that can perhaps be discussed further at this conference over the next three days.

As the Minister of Social Development, I should perhaps start with the stance the South African government takes in relation to population development.

The South African Population Policy, in accordance with the South African Constitution and guided by the International Conference on Population and Development Programme of Action (ICPD), emphasises the attainment of sustainable development and places people at the centre of that development.

Development is seen as a process of enlarging people's capabilities and ensuring that they enjoy long, healthy and creative lives. 

This is based on an approach that fundamental human rights and sustainable development cannot be separated if we are to improve the lives of our people.

The words ‘population development' are very important as they mark a sharp departure from the ‘population control' policies of the apartheid government.

Population control policies, aside from making access to abortion illegal, also ironically sought to control and limit the rights of black women to have children. 

Black women were subjected to enforced long term contraception regimes, often without their knowledge, while the social assistance system supported elements of the reproductive choices of white women through supporting their children, through the state maintenance grant. 

As you can see, through starting with the objectives of the Population Development policy, I am going to engage a bit with the notions of ‘choice' as opposed to reproductive justice, which I believe speaks to the reality of the majority of South African women.

But, let's return to the early 1990s, when we were a young democracy and sought to change the world, and of course, the lives of women, through promoting reproductive rights.

There were many forums and processes that led to the passing of the Choice on Termination of Pregnancy Act in 1996.  One of those included the Women's Health Conference in 1994 convened by amongst others, the Women's Health Project, COSATU, the SACC Women's Desk, the National Progressive Primary Health Care Network, the South African Health and Social Services Organisation, the Rural Women's Movement and the Concerned Nurses Association of South Africa. 

This conference was supported by the ANC and the ANC government especially, the then Minister of Health Dr. Nkosazana Dlamini-Zuma.  Some of the statements made at that conference 20 years ago, are still relevant today.

In her opening address, Barbara Klugman stated the following:

"Yes, we will discuss abortion at this conference. We will discuss it in the same way that we will discuss teenage pregnancy, cervical cancer and occupational health".

She continued by saying, "we will be considering abortion as something of a concern because illegality leads to infertility, loss of dignity and privacy and sometimes the death of a woman.

We will be considering it in exactly the same way as we will consider violence against women, the threat of AIDS out of concern to protect women's health and to uphold their rights to control their own their own lives and their own bodies".

At the same conference, Mavivi Myakayaka-Manzini, a former Deputy President of the ANC Women's League and an ANC MP at the time stated, "The importance of such a conference during this period of transformation and reconstruction of our country from the ravages of apartheid and colonialism cannot be overemphasized".

Manzini, further cited the World Health Organisation's definition of health that regards health not simply as the absence of disease, but a state of complete physical, mental and social well-being.

During that same period, the ANC was promoting reproductive rights as part of the constitutional assembly's process of drafting a new constitution. 

The ANC's Constitutional policy document of 1995, made it very clear that the constitutional principle in the Bill of Rights that seeks to protect the right to life and dignity, should in no way be misconstrued as a means to block the right to abortion through enabling legislation. 

The ANC also saw the issue of abortion as a right that was part of the processes needed to empower women and was particularly concerned about the access of poor women to health and abortion services. 

The June 1995 edition of the ANC document, Mayibuye cited statistics that in 1984, 800 white South African women had abortions in England.  So the law prohibiting abortion at that time really only affected the poor and those without the means to travel to access services.  The ANC also stated that if a new law was to be passed, the Department of Health needed to ensure access and affordability of such services to poor women.

Clearly the statements of Klugman, Manzini and the ANC at that time indicated an approach to abortion that was about justice to women and included elements of societal transformation and equity.  This brings me to the issue of reproductive justice as a theme for further discussion and debate as we look at what we have done and what still needs to be done.

Feminists and particularly black feminists across the world are beginning to refer to reproductive justice as a concept that best explains the realities of poor and marginalised women in many parts of the world. 

The Asian Communities for Reproductive Justice suggests that reproductive justice exists when all people have the social, political and economic power and resources to make healthy decisions about their gender, bodies and sexualities. 
African American women include the rights to have children; for the state to support pregnant mothers who have chosen to keep their children; the rights to decent maternity and parental leave; the right to Child Care and Early Childhood Development services for the children and social assistance for children and their care-givers as part of a comprehensive approach to reproductive justice.

It is within this framework of reproductive justice that I would like to initiate a discussion on what we have achieved as a country and what we still need to do.

Although South Africa's population size is still growing, the population growth rate is declining - from 2.1% between 1996 and 2001 to 0.61% between 2007 and 2011, per annum. This decline will continue. This decline is attributed to the negative impact of HIV and AIDS until 2007 and more positively, due to a decline in the Total Fertility Rate (TFR) of the country. The Total Fertility Rate declined from 2.9 in 1998 to 2.35 in 2011.

Aside from reductions in the total fertility rate and the increase in life expectancy, we have also made remarkable progress in reducing maternal mortality due to unsafe abortions.

In South Africa, the annual number of abortion-related deaths fell by 91 % after the liberalization of the abortion law.  South African data shows that 50% of maternal deaths and 40% of under-five deaths are as a result of HIV infections.

In fact, the Southern Africa sub-region, including South Africa, where abortion was legalized in 1996, has the lowest abortion rate of all African sub-regions, at 15 per 1,000 women in 2008.  East Africa has the highest rate, at 38, followed by Middle Africa at 36, West Africa at 28 and North Africa at 18.  Both the lowest and highest sub-regional abortion rates are in Europe, where abortion is generally legal under broad grounds. In Western Europe, the rate is 12 per 1000 women, while in Eastern Europe it is 43 per 1000

These figures are important in that they demonstrates a trend where, the recourse to abortion is lower in countries where abortion laws are less restrictive.

This could also be due to the fact that less restrictive abortion laws are generally part of comprehensive sexual and reproductive health services that include, education and access to modern forms of contraception.

Ladies and Gentlemen;

Where abortion is permitted on broad legal grounds, it is generally safe, and where it is highly restricted, it is typically unsafe.  As the statistics indicate, in South Africa we have reduced mortality and injuries related to unsafe abortion, but, - yes, there is a but - we have some serious issues that we need to address in relation to abortion.

At the level of health systems it is concerning that currently; only 47 percent of designated health facilities are operational. 

If this is combined with the still prevailing negative attitudes of health workers who stigmatise those who present themselves for services then a rise in preventable deaths due to people reverting to unsafe abortions is a real threat that needs to be addressed. 

Part of the stigmatisation is the fact that sometimes we as politicians too, tend to talk about "repeat abortions" as a problem when there is insufficient evidence of this being a large-scale problem.

We, therefore, have to look at improving access through ensuring that all designated facilities are operational and that we reintroduce values clarification and social context training for health sector workers.

This is vital for us to be true to the intention of the ANC in 1995 for access to quality abortion services by poor women as part of its social justice and transformation goals.

In terms of a comprehensive reproductive rights service, we also, have to invest more to improve access to modern means of contraception and sexuality education.  The Department of Health has just rolled out a new dual contraception programme, a cervical cancer vaccination programme, and a school health programme.  The Department of Social Development will work with the Department of Basic Education to design and implement Comprehensive Sexuality Education in schools. In general while there are gaps in these areas, our intentions are clear and implementing these will be important contributors to improving the health and well-being of adolescent girls and women.

We will also, in line with a broader approach to reproductive justice, provide maternal support for expectant mothers as part of the 1000 days campaign. The campaign seeks to contribute in the reduction of maternal and child mortalities through improving access to nutrition for expectant mothers and new-born children.

This will also include universalising access to Early Childhood Development Services for up to four years.  These services will complement the current extensive roll- out of the Child Support Grant, which also contributes to improved mother and child well-being. 

This, ladies and gentlemen is another area within a comprehensive approach to reproductive justice that we are doing well in but where we seek to make improvements through universalising the Child Support Grant so that no care-giver and child are left out of the system.

These kinds of services that improve the economic well-being of poorer women can in fact give them a real ‘choice' in whether they may want to continue or terminate a pregnancy.

Again, one of the challenges we face is the stigmatisation of poor women with children on social assistance programmes through unproven anecdotes.  Our evidence clearly indicates women do not get children to access social assistance benefits.

Ladies and Gentlemen, we are not doing well in the substantive economic emancipation of women. Women and black women in particular, continue to be marginalised by the mainstream economy.

It is for this reason that efforts to transform the economy, including land reform, more inclusive Broad Based Economic Empowerment and other equity measures cannot be divorced from abortion rights as part of a comprehensive and more radical approach to reproductive justice.

Without the broad women's movement being concerned with advocating for abortion rights and access to abortion services as part of the broader women's struggles for economic equality, social justice and violence against women, what we call ‘choice' may just become an elitist individualised response to reproductive rights which would still be mainly, for the middle classes and the rich.

I had better conclude as the subject is so interesting and there is so much more one can say, and in fact has to say.  However, I would like to repeat that our approach to reproductive justice is to ensure we defend the gains we have made through legal reform and work to ensure access to safe abortion services for all, in particular including poor women.

We cannot and should not hide behind the term ‘choice' as it can lead to reproductive rights issues being marginalised and the broader issues of reproductive justice being neglected. 

In the run-up to the 2014 elections, the Catholic Family News put out a ‘Biblical Issues Voters Guide 2014' where they compared the different stances of the various political parties.  In the guide, The DA is quoted as stating, "to be pro-choice, does not mean we are pro-abortion. It is the constitutional right of women to make choices about the very private matter of reproduction".

Within the framework of reproductive justice, the ANC and the ANC government has always been and will always be pro-abortion in the sense that we realise that it is but one of the reproductive experiences of women that needs to be enabled.  We are also concerned about improving other elements of women's reproductive experiences such as improving women's economic and educational statuses, we are concerned about whether women are in violent or abusive situations, whether their children have access to nutritious food, housing, clothing and other social protection services.

Ladies and Gentlemen, I hope that this input is just a primer and that this conference expands on the issues I have raised so that we can develop more robust policies to ensure that the ideal of women's bodily integrity and autonomy is achieved.

Thank you

Issued by the Social Development Department, June 11 2014

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