National Health Laboratory Service Amendment Bill: Final negotiating Mandates; Reproductive Rights Alliance: briefing

Meeting report

SOCIAL SERVICES SELECT COMMITTEE
25 September 2001
NATIONAL HEALTH LABORATORY SERVICE AMENDMENT BILL:FINAL NEGOTIATING MANDATES; REPRODUCTIVE RIGHTS ALLIANCE: BRIEFING

Chairperson: Ms L. Jacobus

Documents handed out:
National Health Laboratory Service Amendment Bill [B56-2001]
Reproductive Rights Alliance:
Various RRA Publications
Report on Public Hearings on Implementation of 1996 Act (November 2000)

Reproductive Rights Alliance Website: http://www.hst.org.za/rra/

SUMMARY
Final mandates on the National Health Laboratory Service Amendment Bill were received from all provinces. The nine provinces supported the Bill without amendment. The motion on the Bill was then passed unanimously.

In its briefing to the Committee the Reproductive Rights Alliance said that there is a trend nationally towards women accessing health services earlier in pregnancies moving from 65% to 75% over a three year period upon the implementation of the Termination of Pregnancies Act.

The Committee was informed that based on the age data available, the trend seems to be that women accessing the Termination of Pregnancies services is decreasing. Women under 18 years decreased 16% over the first year of implementation of services to 14% over the second year to 11% over the third year of implementation to date.There has, however, been a steady increase in the number of abortions over the six monthly periods.

MINUTES
Eastern Province
Mr Sogoni (UDM) tabled the report from the Eastern Province. The final mandate from Eastern Province supports the Bill without amendments. He however reiterated that the Eastern Cape wants employees to be educated on the options available and its financial implications, so that employees make informed decisions.

Free State Province
Dr. Nel (NNP) said that the final mandate from the Free State remains to support the Bill as it is. The Province was satisfied by the explanation given by the State law adviser on the meaning and purport of the phrase 'dormant member'.

Northern Province
Mr Makoela (ANC) delivered the final mandate on behalf of the Northern Province. He reaffirmed that the Province supports the Bill.

Gauteng
The Chair said that she had not received the written mandate from the Gauteng. She noted, however, that the Province has given the final mandate to support the Bill.

Kwazulu Natal Province
Ms Vilakazi (IFP) said the final mandate from Kwazulu Natal is to support the Bill without amendments.

Mpumalanga Province
Ms Themba (ANC) said the Province in its final mandate supports the Bill without amendments.

Northern Cape
Mr Lucas (ANC) said that the Northern Cape has reached its final mandate and that it supports the Bill as drafted.

Western Cape
Ms Witbooi (NNP) for Western Cape said that the final mandate is in support of the Bill as drafted without any amendments.

The Chair thanked members for the mandates and proceeded to read the motion of desirability, which was to pass the Bill as drafted. The Chair also read the report of the Committee, which was agreed upon. The Chair informed members that there would be no debate on the Bill.

Briefing by Ms Judi Merckel
Ms Merckel stated that the Reproductive Rights Alliance is an alliance of organisations and structures, committed to creating and promoting reproductive rights.

The Alliance was established in 1995 when a range of non-governmental organisations came together in recognition of the need for a united and concerted effort to promote reproductive rights being a pro-choice position in South Africa.

The group specifically promotes the right of women to freedom of reproductive choice through its member organisations. She felt that the 1975 Abortion and sterilisation Act was failing women on account of denying them their reproductive rights which resulted in 'backstreet' abortions. It was denying South African women equal access to safe and legal termination

The group strives to play a supportive and catalytic role in providing information, mobilising people and resources, lobbying government and monitoring legislation on reproductive rights.

Ms Merckel said that the main focus of her organisation has been to work towards the 1996 Choice on Termination of Pregnancy Act, defending the legislation and monitoring its implementation.

Briefing by Ms Tamara Braam
Ms Braam said that the Choice Termination of pregnancy Act has been in operation for four years. The Act has, theoretically, enabled South African women, to access a safe, legal termination of pregnancy within the first twelve weeks should they choose not to continue with a pregnancy.

The Act has given meaning to the equality clause within the Constitution and broken down access barriers that result from previous racial classification, geographical location and age.

Ms Braam informed the Committee that during the oversight public hearings that took place in June 2000 regarding the efficacy of the Act, some very enlightening issues emerged.

It was noted that the number of women presenting with septic abortions seems to have decreased. However, the attitudes of many in the rural communities towards abortions are still negative although attitudes are softening among the young. It was also noted that despite denial from certain sectors of the population, illegal abortions have always occurred in these communities.

The hearings revealed that some clinics had problems with women over twelve weeks pregnant. She attributed this difficulty to lack of reliable, accessible second trimester services in some areas. Nurses in these areas reported that they often see women they had turned away return to gynaecological wards for treatment of incomplete or septic abortions caused by unsafe 'backstreet' procedures.

Religious leaders need to be educated about the relevance of the Act and the reproductive rights of women in general so that they become more sympathetic to the difficult conditions under which the majority of women live.

Ms Braam added that value clarification workshops have made a big difference to hospital staff and community members' attitudes. A nation wide total of 4122 pregnancy terminations are performed on average every month of which 79% are early terminations and 21% are late terminations.

She said further that her organisation believes health care workers should not be compelled to refer women for termination of pregnancies. In the public hearings it emerged that some staff members appear to be demoralised and suffering from burnout. It was suggested that support groups should be set up for health care workers.

It also emerged that the average monthly income of just over 70% of the women presenting for termination of pregnancies at Groote Shuur was less than R500. It was noted that health care providers running Termination services need more support in terms of resources and staff.The hearings revealed that 81 midwives have been certified by SANC to provide abortion services and 275 doctors trained in MVA techniques.

Ms Braam concluded the demand for the present Termination of pregnancy services is large and outstrips by far the availability of services. The real solution lies in providing dedicated services in addition to current services. The biggest obstacle to implementation is lack of staff, beds and funds.

Discussion
The Chair asked if the Alliance is networking with the provinces on this effort.

Ms Braam replied that the Alliance documents have been circulated to all provincial directorates for advice and to develop their own action plan.

Ms Ntlabati (ANC) asked if there had been adequate education on what unsafe abortion means. What are the age groups that go for unsafe abortions?

In reply, Ms Braam said that the information campaign is ongoing but one must acknowledge the cultural challenges presented in some rural areas. Much work remains to be done in these areas.The Alliance strategy has been to work with different communities to develop the right language and mode of communication.

Mr. Sogoni (UDM) said that the level of consciousness was still too low in rural areas. Education should be extended to schools and should include men as well.

Ms Braam agreed with Mr. Sogoni that education should reach out to men as well. The question, she said was how to empower men to make informed decisions. A way should be found of talking to men but not at the expense of the women.

As for the age groups, Ms Braam explained that 70% of those who access unsafe abortions are above 18 years but that the highest number is concentrated in the age group between 20-25 years. Women's knowledge of the Act was, however, still problematic. Access to the deep rural areas was a big challenge.

Dr. Nel asked what happened to doctors in the public service who decline to attend to such patients on the basis of religious beliefs.

Ms Merckel admitted that there have been such cases in open obstruction in some cases, in particular on training care givers. Doctors and care providers are expected to refer patients whenever they are unable to attend to them.
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The Chair said that there have been some serious allegations that doctors in the public service deny patients services only to refer them to their clinics where they are over-charged. The questions raised by the Alliance are important. An integrated approach is needed and life skills education has to be taught at schools.

The meeting was adjourned.