Prominent health journalist Pontsho Pilane wrote a feature piece about pregnancy crisis centres in 2018 as an undercover patient. She experienced directional counselling in a clinic linked to Unisa in Pretoria. In her article she quotes Dr Jabulile Mavuso, who conducted research in the Eastern Cape and documented how pervasive the influence of US modelled pregnancy crisis centres are at three public health facilities in the Eastern Cape.

Pilane and Mavuso’s findings correlate with abortion being framed as “dangerous, immoral and irresponsible, and women were directed towards adoption and parenting instead”.

Fast forward to February 2020, with the release of openDemocracy’s global research documenting the work of Heart Beat International and Human Life International in exporting the programming and implementation of pregnancy crisis centres’ globally after reviewing activities in 18 countries. The centres try to dissuade women from having legal abortions, and, in some cases, even from accessing contraception. 

Kerry Cullinan, working for openDemocracy in uncovering the infiltration of these groups in Africa including SA, referred these findings to the SA health department, which seemed shocked and surprised by these findings, noting that these anti-abortion centres are violating SA law. She reported it to deputy director-general Yogan Pillay, who “urged members of the public to report the illegal actions of these centres to the [health] department”, which he said can then write to these centres and “ask them why they are breaking the law”.

A doctor is being investigated for refusing to care for a woman wanting an abortion and counselling against contraception

In taking the reporting further Tamar Kahn, health writer at Business day, unpacks the findings further reporting that there are almost 80 pregnancy crisis centres operating in SA. In referring her questions to Pillay, he said “the health department will investigate the issues exposed by openDemocracy, and urged the public to report organisations that are breaking the law to the relevant authorities, such as the Health Professions Council of SA (HPCSA). We can only intervene if a complaint is laid with us”. 

These three, eminent health and science reporters track that the implementation of reproductive justice services — contraception and abortion — are on the back foot in SA. Lack of access to these basic health services exacerbates inequity in the country. The main focus of the health department remains implementing National Health Insurance (NHI) as an attempt to pool health financing and to redress our legacy of perverse incentives and inequalities.

Following the re-imposition of the US gag rule in 2000 and in 2016, by presidents Bush and Trump, the department took its foot off the gas in relation to sexual and reproductive justice services. The pre-eminent attention over the past two decades has been on chronic diseases, with funding flows from the US public and private donors making up the bulk of international aid to the department. 

While the government does not sign the agreements regarding the Mexico gag rule with the US government, it has chosen the path of least resistance in steering away from well-planned and managed sexual and reproductive health programming. These services have been left to mostly international NGOs who have come in well-intentioned to provide technical programming and services, which has led to decreased local sustainability.

Unplanned vs Planned Parenthood

This malaise is linked to the infiltration of the health services. The popularisation of US right-wing agendas at SA universities with groups such as Students for Life handing our instructions to classes on to how to object to reproductive justice services is being left unchecked by the government. 

In SA, conscientious objection litigation has been focused on the personal expense by white boys who refused to serve in the military. This term has been co-opted by the US right-wing and interpreted differently from freedom of conscience to mean health workers can, on a whim, refuse to care for women needing an abortion — even if it is an emergency.

Currently, a case is before the HPCSA in which a doctor is being investigated for refusing to care for a woman wanting an abortion and counselling against contraception. Last year, in the Pretoria high court, non-profit Cause for Justice and the Catholic Church litigated to enable each woman to be offered the option to bury their foetus following an abortion. The state argued that this would put undue burden on women and the health system.

Unplanned, a movie documenting the contested story of Abby Johnson and her experience at Planned Parenthood in the US, is to be shown in cinema’s in SA, Namibia and Zambia in March this year. The movie is viewed as propaganda from Heart Beat and has been reviewed and dismissed in a range of articles.

There are numerous times when communications to the health ministry remain unacknowledged let alone responded too. It is alarming when Pillay suggests that the public and civil society must come forward and raise concerns when a dystopian Handmaid’s Tale ideology is clearly being exported into our region.

A number of questions remain:

  • Did the health department take note of Pontsho’s article and investigate pregnancy crisis centres in SA in 2018?
  • What help will it do to write a letter to these clinics and remind services of the law?
  • What investigations and remedial actions will they take in ensuring that clinics are compliant with our law?
  • How will the health department strengthen their links with the department of social development in monitoring services?
  • Where is the political leadership, stewardship and commitment to sexual and reproductive justice for SA women?

We should not be a colony of the US public and private health industrial complex. #Blessedbethefruit #nolite-te-bastardes-carborundorum (“don't let the bastards grind you down ”).

Stevens is director at the Sexual and Reproductive Justice Coalition.