South Africa: Country Context

  • Though South Africa is classified by the WHO as an upper-middle income country, the unemployment rate estimated between 25% and 40%, and one-quarter of the population lives on less than $1.25 USD per day.
  • The state’s public sector clinics are the main source of contraceptive services, which are available at no cost.
  • Since the 1996 Choice of Termination of Pregnancy (CTOP) Act, abortion has been legal in South Africa in the first trimester without restriction; until 20 weeks for pregnancies resulting from violence or involving physical, mental, fetal or socioeconomic risk; and after that for serious maternal or fetal health indications.
  • The CTOP Act had an immediate and positive effect on women’s health: the annual number of abortion-related deaths fell by 91% between 1994 and 1998– 2001.[1]
  • Still, unsafe abortion remains a problem: in 2000, 9.7% of unsafe abortions resulted in severe complications and 30% of cases of maternal mortality were due to self-induced terminations of pregnancy.
  • The number of deaths due to unsafe abortions rose from1% in 2002-2004 to 25.7% in 2005-2007.
  • Health system challenges in implementing the CTOP Act include lack of provider awareness of the law, provider opposition, conscientious refusal of care by providers, shortages of trained personnel and poor management.