- A SECTION27 and Treatment Action Campaign report found that only 21 facilities in Limpopo are currently providing abortion services, even though 52 are listed as designated facilities.
- Women in some areas have to travel between 30km and 300km for services, while waiting periods of five to seven weeks are reported at some second-trimester facilities.
- The report found that shortages of staff, equipment and medicine, as well as the arbitrary use of conscientious objection by healthcare workers, are limiting access to legal abortion services.
Access to legal abortion services remains out of reach for many women in the Eastern Cape and Limpopo. Some travel hundreds of kilometres, wait weeks for appointments or are turned away altogether, despite South Africa's progressive abortion laws.
These are the findings of a new report released by SECTION27 and the Treatment Action Campaign. The report assessed abortion services at public health facilities across the two provinces and concluded that government health authorities have failed to remove significant barriers preventing women from accessing reproductive healthcare.
The research was prompted by repeated complaints from women who could not get abortion services at their nearest clinics and hospitals. In many cases, women were referred to facilities between 30km and 300km away, only to find that services were unavailable when they arrived.
Severe shortage of facilities
Researchers monitored 15 facilities in the Eastern Cape and 65 in Limpopo. In Limpopo, 52 facilities were listed by the provincial health department as designated abortion facilities. However, the report found that only 31 met the necessary clinical and infrastructural requirements.
Of those, 11 had suspended services indefinitely while waiting for replacement providers. As a result, only 21 facilities are actively providing abortion services across the entire province.
The situation is particularly serious for women needing second-trimester abortions. Limpopo has only three facilities providing second-trimester services, all located in the Waterberg District. The Eastern Cape also has only three second-trimester facilities.
Researchers found that three of the 15 monitored facilities in the Eastern Cape had stopped providing abortion services. According to the report, the findings reveal a significant gap between the facilities officially listed as providing services and the reality experienced by women seeking care.
Long delays and lengthy travel
The report found that systemic failures are creating long waiting periods, even though the law does not impose formal waiting periods for abortion services.
Women living in rural areas often wait weeks or even months after their first consultation before receiving treatment. At second-trimester facilities, waiting periods can be as long as five to seven weeks.
Researchers documented cases where women travelled more than 100km to reach functioning facilities because there were no second-trimester services closer to home.
The report warns that such delays put women at risk and may push some towards unsafe abortion providers when legal services remain inaccessible.
Conscientious objection under scrutiny
One of the report's strongest criticisms is the way conscientious objection is being applied in public healthcare facilities.
According to the findings, healthcare workers sometimes refuse to provide abortion services in ways that are arbitrary, discriminatory and punitive.
Researchers reported cases where women and girls were berated, stigmatised or denied services because of healthcare workers' personal beliefs. The report also found that ancillary staff, who are not permitted to refuse routine care under national guidelines, sometimes obstructed access to services.
SECTION27 documented a case involving a pregnant minor seeking a second-trimester abortion in the Eastern Cape. Nurses refused to provide care because of objections related to the girl's age and pregnancy stage, even though the procedure was lawful. She was eventually transferred to another hospital, where she allegedly faced further discrimination and later developed serious medical complications after being instructed to self-administer abortion medication.
The report argues that the National Department of Health has not adequately regulated conscientious objection, which allows women to be denied access to lawful healthcare.
Women in rural areas hardest hit
The report highlights how poor and rural women bear the greatest burden when services are unavailable.
Researchers found that shortages of abortion providers, equipment and medicine, together with weak referral systems, are creating barriers that disproportionately affect women who already face transport and financial challenges.
The report concludes that women in the Eastern Cape and Limpopo continue to face significant obstacles that prevent them from exercising their constitutional right to reproductive healthcare, even though abortion has been legal in South Africa for nearly three decades.
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