Image: Marie Stopes/Pain Free Abortion

28 MARCH 2018

The Ongoing Struggle for Reproductive Justice in South Africa 

Today South Africa is renowned among feminists for having one of the most liberal abortion laws in the world: the Choice on Termination of Pregnancy Act (CTOPA) allows for abortion on demand without restriction as to reason but with gestational limits. The law was passed in 1996 by the recently elected African National Congress government that won the country’s first democratic election in 1994 after the downfall of apartheid, the national policy that separated “races” spatially, politically and socially in the interests of maintaining white supremacy. The CTOPA has rightly been hailed as a major triumph by women’s health advocates around the world and it had an immediate and major, positive effect: the annual number of abortion-related deaths in South Africa soon fell by 91 percent. 

The CTOPA was long overdue. From the beginning of South Africa’s existence as a British dominion in 1910 until 1996, the South African state placed severe restrictions on women’s right to terminate unwanted pregnancy, to the extent that the vast majority of girls and women were forced to do so using clandestine, often dangerous methods.  

It is important to remember that the criminalisation of abortion in African countries is a relatively recent phenomenon, one of countless negative effects of European colonial rule. Prior to colonization, fertility was highly prized in most African cultures, especially in labor-intensive agricultural communities. Premarital pregnancy, however, was commonly considered a serious violation of social norms that had the potential to derail marriage plans arranged by families, therefore sexuality was regulated to ensure reproduction occurred within marriage. When pregnancy occurred outside of marriage, various methods could be utilized for procuring abortion in societies across the continent. The situation changed radically when Europeans brought their laws against abortion with them to newly conquered African colonies. Nevertheless, regardless of the law, women – indigenous and settler alike constantly circumvented the law, not just in South Africa but in colonies across the continent. 

In South Africa the criminalisation of abortion applied to all women, regardless of race, ethnicity or class, thus all women shared in the experience of being denied control over their reproductive sexuality by patriarchal colonial authorities. But when faced with unwanted pregnancy, women’s racial classification fundamentally shaped the options available to them: a maid and her madam from the same household could share a feeling of panic when faced with unwanted pregnancy, but they had very different choices for solving their predicament. Black women, especially young and rural women, had far less access to safe, medical abortion than many white women, consequently they suffered much greater harm and hardship. Black girls and women, along with poor-white women, were forced to use clandestine, often dangerous methods to procure abortion and as a result unsafe abortion became extremely widespread, especially from the 1960s onwards. For decades, countless hospital admissions were related to unsafe abortion. Women’s health advocates estimated that by the 1970s, 200,000 women, the vast majority black, were illegally procuring abortions annually, and many experienced pain, humiliation, and sometimes horrible deaths. Derk Crichton, the doctor in Durban who was in charge of the Gynecology and Obstetrics Unit at the King Edward VIII Hospital, for Africans only, estimated that between 1954 and 1972 he treated an astounding 40,000 African women suffering the effects of criminal abortion he said at least one died every month. By contrast, white girls and women with sufficient financial resources either paid private family doctors to provide illegal but safe abortions or else travelled abroad. 

When apartheid was finally overthrown, women’s health advocates and other feminists inside the African National Congress and in civil society moved swiftly to secure reproductive rights for women. Their achievements, including the CTOPA passed in 1996, are extremely impressive and an inspiration to feminists in countries around the world 

Yet today in South Africa, unsafe abortion continues to be a serious problem. There are clandestine abortion clinics, and posters advertising “safe, pain-free and clean” abortions are plastered in trains and on walls in cities across the country. A woman can arrange a same-day abortion for about 200 ZAR (about US$16). Most commonly, clandestine abortion providers sell stolen or outdated packets of the prostaglandin analogue misoprostol to induce a miscarriage, but back-alley miscarriages induced by sharp objects also persist. A study published in the South African Medical Journal indicated that, although by the late 1990s approximately 50,000 legal abortions were procured annually in South Africa, a similar number of unsafe abortions continued to be performed. According to medical authorities, almost half of the girls ages thirteen to nineteen who had an abortion in 2008 did not use a hospital or proper clinic. The incidence of incomplete abortion per 100,000 women ages twelve to forty-nine remained almost exactly the same: 375 in 1994 and 362 in 2000.  

At first glance, the ubiquity of clandestine abortion seems incongruous. How can a superbly progressive legal framework coexist with a flourishing clandestine abortion industry? The explanation is the ongoing opposition to women’s right to reproductive control, which perpetuates the stigmatization of abortion. About half of the population of South African is strictly opposed to abortion, usually for religious (mainly Christian) reasons, and objection to abortion has resulted in a massive gulf dividing the intent of the law—universal access—and its implementation, especially in rural areas. 

Unfortunately, on the African continent stigmatization of abortion is not limited to South Africa. After winning independence, most African countries retained colonial-era abortion laws; and in countries where laws have been liberalized, they, too, are ineffectively implemented. Globally, there is now a trend toward the liberalization of abortion, including in Africa. However, unsafe abortion continues to be widespread on the continent, which today accounts for 28 percent of the global incidence of unsafe abortions. In 2008, 92 percent of African women of childbearing age lived in countries with limited or no access to safe abortion procedures. At least 29,000 African women and girls die each year as a result of unsafe abortion, a shocking 62 percent of such deaths worldwide. Another 1.7 million are hospitalized, and countless others suffer serious health complications but never seek treatment.  

As the case of South Africa shows, the struggle for access to safe abortion cannot be won simply by replacing patriarchal laws with women-centered ones, although it is of course necessary to pass laws on abortion that respect and protect women’s rights and dignity. To fully succeed, the struggle for reproductive rights must be connected to the broader struggle for social justice and human rights. Simply put, it must align itself with the movement for reproductive justice emerging globally, including in South Africa. And there are fantastic organizations fighting for reproductive justice in South Africa, such as the  Sexual and Reproductive Justice Coalition and the  End Abortion Stigma Initiative. The amazing feminists in groups like these, who network with women’s health advocates across Africa and around the world, are fiercely committed to ending abortion stigma and transforming the public’s attitude towards women’s sexual and reproductive rights. For example on March 9, the two organizations celebrated Abortion Provider Appreciation Day as a way to both support abortion providers who often work under hostile conditions and end abortion stigma.  

While the fight for national liberation succeeded in South Africa, the struggle for women’s liberation continues. 


Dr. Susanne M. Klausen is a Professor of History at Carleton University, Ottawa, and Senior Research Associate, Faculty of the Humanities, University of Johannesburg. Her research focuses on the history and politics of reproduction in the South African and international context. She teaches courses on the history of Africa, South Africa, the Atlantic World, and medicine. Her 2016 book Abortion Under Apartheid: Nationalism, Sexuality, and Women’s Reproductive Rights in South Africa (Oxford University Press, 2015) won two prizes; best book on Women’s History published in 2014 and 2015, awarded by the Canadian Committee on Women’s History, and the Joel Gregory Prize for best book in African Studies published in 2014 and 2015, awarded by the Canadian Association of African Studies. The book was also shortlisted for the Wallace K. Ferguson Prize, awarded to the outstanding book in non-Canadian history by the Canadian Historical Association. She is also the author of Race, Maternity, and the Politics of Birth Control in South Africa, 1918-1939 (Basingstoke: Palgrave Macmillan, 2004).