Until 1975, abortion was prohibited in South Africa, except in the case of absolute necessity to preserve the woman's life.
In 1975, the Abortion and Sterilisation Act extended the grounds to include rape, incest, when the woman is mentally handicapped, or there is a risk of foetal deformity.
The newly elected African National Congress introduced The Choice of Termination of Pregnancy Act in February 1997. The Act allowed for abortion on request during the first 12 weeks of pregnancy.
Second trimester abortions including the 20th week, are effectively available on request. The woman consults with a doctor who believes that the pregnancy would pose a risk to her physical, mental, social or economic well being, or is the result of rape and incest.
Most second trimester abortions are performed by Cuban doctors.
Despite the liberal law, relatively few doctors and nurses are willing to be involved with the service. For example, a September 2003 report reveals that only three doctors in the Western Cape province perform abortions. One of them, a Dutch woman specialist in abortion, set up services and offers to train doctors.
Dr Eddie Mhlanga of the National Department of Health mentioned in the report that abortion providers are 'often overlooked for promotion, enjoy little support and face constant victimization and intimidation by managers and the community'.
After six years of the Act, Dr Mhlanga says that most black South African women resort to illegal abortions. He identified key challenges:
-Designated facilities that still refuse to provide abortions
-Limited numbers of health care providers prepared to undertake training, leading to burn out and high stress levels among existing providers
-Lack of access to second trimester abortions
-Conscientious objection is mainly among individuals, not institutions
-The health system is over burdened.
In retrospect, it is admitted that health care providers should have been consulted during the drafting of the abortion legislation.