Abortion Services in South Africa: Available Yet Not Accessible to All

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Abstract
Men—including minors—have the sole right to consent to an abortion. Because of these provisions, the Act is considered a model for other countries, especially those in Sub-Saharan Africa. Yet its implemen- tation has been slow and has been geared toward meeting immediate service re- quirements: It lacks a long-term, sustain- able plan on how to ensure equity and pro- mote women's right to self-determination. First-trimester procedures, which con- stitute 75% of reported public-sector abor- tions, should be performed at the prima- ry health care level. Nevertheless, abortions are still being conducted mainly in hospi- tals. Of the 248 public health facilities des- ignated by the Minister of Health to pro- vide abortion services, only 73 are doing so, and 99% of these facilities are hospitals. Nearly half (33) of the providing facilities are located in Gauteng and Western Cape. 3 Of South Africa's nine provinces, these two have the lowest levels of poverty, the high- est levels of urbanization and the best- equipped health facilities. The province with the largest proportion of the country's female population—Kwa Zulu Natal— provides only 10% of reported abortions. 4 Reasons why designated facilities are not providing abortions have not been docu- mented, but personal communication with managers suggests that unwillingness of staff members to be involved in abortion is the main problem. The shift from hospitals to primary

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