SA might have the edge over US in abortion policy, but is behind on access

As an American, the impending reversal of Roe v Wade, the landmark US Supreme Court ruling that protects a woman’s right to have an abortion, has weighed on me. Reproductive freedom has been flailing in the US for decades. Though it’s an area SA has largely got right, at least from a legal perspective, access is a different story.

SA is one of only four sub-Saharan African countries (out of 44) that permit abortion without having to provide a reason. It is truly an accomplishment, a nod to the country’s position on equal rights. But like most things in SA, access to safe and legal abortions fails along the lines of inequality.

At a non-profit organisation such as Marie Stopes, medical abortions (with pills) cost about R2,000. At private clinics these can cost up to R4,500. In comparison, surgical abortions (which can take as little as five minutes once a cervix is dilated), cost R2,000-R6,500. To exacerbate things, it can be challenging to find private providers that offer these services.

Availability of and access to abortions in the public health system is difficult at best. In 2017 research showed that less than 7% of the country’s 3,880 public health facilities perform abortions — far fewer than the 505 facilities designated to do so by the department of health.

According to women who have had abortions — or tried to have them — in the public health system, it is not easy. At some hospitals you have to join a queue at 4.30am hoping to secure an abortion slot for the day, but they may only take 10-15 women from a queue of 100. If you’re one of the few you’re likely to face poor treatment and mockery from nurses.

Considering access and cost many SA women unsurprisingly turn to unsafe and illegal providers. As many as 143,000 women have illegal abortions annually in SA.

While the US system is breaking down as legislators and the judicial seek to strip away women’s reproductive rights, which has social and economic consequences, SA has it right at the level of law, but access is either cost prohibitive or inaccessible for most.

The law, access and funding must go hand in hand to give women autonomy. Access to a termination is economically empowering for women — both statistically but also in my experience of knowing and working with women who are changing the world.

Most agree that women must have equitable access to labour markets. Agency over our own reproductive rights is non-negotiable for this to happen. Without access to abortions many things suffer, including women’s participation in the labour force, income, and education and training. Women are often forced into part-time or informal work due to the childcare burden. Occupational segregation is a de facto result.

There is also a direct impact on poverty. A recent study followed two groups of women for five years — one group wanting and receiving abortions and another that could not obtain them. The researchers found that those who couldn’t access abortions had significantly worse outcomes. About 66% were living in poverty within six months compared with 45% of those who had abortions.

Breaking barriers

In another study in the US, Experian credit reporting showed that in the months leading up to requested abortions those who received them and those who were turned away had similar financial outcomes. But for the group who couldn’t access abortions there was a 78% increase in past-due debt and 81% increase in public records related to evictions, bankruptcies and court judgments.

Access to abortion can be a game-changer for women. In my five years studying at Cambridge I met and befriended some truly remarkable women, some of whom have gone on to become an executive at an actuarial company, a top-ranked barrister, a partner at an international management consulting company, and a scientist developing cancer treatment. These women have many things in common, including being kind, passionate and ambitious. They are also breaking barriers and entering spaces long occupied by men — and for each of them, that process included a termination.

As the US is set to regress to the dark ages on reproductive rights, I’m still applauding SA. Yet there is still some way to go — 7% of public health facilities offering abortions is dismal, especially given the astronomical cost of terminations in the private system. Economic advancement for women hinges on our access to reproductive rights.

• Dr Baskaran (@gracebaskaran), a development economist, is a bye-fellow in economics at the University of Cambridge.