Dear Sir,

Major problems with proposed New Abortion law.

Before passing the proposed Termination of Pregnancy Act, the Government is advised to consider the following problems which if left unaddressed will threaten to disrupt the service and polarise the staff. The procedure at any gestational age is not simple and uncomplicated as any of those who are currently required to perform them knows. Trained midwives are proposed to be allowed to do this procedure.

1. Does this include the use of Ultrasound to accurately diagnose the presence and age/s of the fetus/es? Will machines be available at every facility operated by capable sonographers? The law and the procedure are both heavily dependant on accurate gestational ageing.

2. The administration of local analgesia for dilating the uterine cervix in the form of cervical or paracervical block is difficult. Current research suggests that it may be insufficient even in experienced hands. Does this imply that analgesia may have to be inadequate at times or will general anaesthesia be required to be on standby? If so, what back up services are expected?

3. Consent will legally be required for the procedure. Is consent from a minor, legal ,without the parental sanction? In the event of complication, transfer to another hospital, or further surgery, how can parents be kept uninformed? Consent is currently required for a minor to undergo evacuation of the uterus following an incomplete miscarriage.

4. In the event of complications, such as perforation of the uterus due to incorrect gestational ageing, or missing the fetus at suction evacuation, or profuse bleeding needing transferral and hysterectomy can the midwife be sued? If so, what is the opinion of Medical Defence associations and the South African Nursing Council? Are prospective trainees informed of this?

5. Conscientious objection: The Act provides for those who do not wish to participate in pregnancy termination to do so but the Government has not ascertained whether or not there are sufficient numbers of well-trained AND willing personnel at the institutions designated by the Minister. Current referral patterns suggest that there are very few practitioners who perform terminations even under current legislation outside State Hospitals. Has the Government surveyed State Hospital Staff to determine the extent of conscientious objection? This involves medical and nursing staff. What does the State do when no person willing to perform abortions can be found in a given region? If referral is needed ,who pays ? Will consent to perform abortions (or to train those who will) , be a prerequisite for employment in Public Service for obstetricians? Will students wishing to specialise in Obstetrics and Gynaecology be required to perform abortions as per the act in order to qualify?

The Above questions are practical issues that will face the medical staff at point of service. The Government would do well to ensure that there are satisfactory answers before plunging the medical profession into a serious crisis by prematurely enacting this bill.

Harvey Ward - Bsc (Med), MBChB, DMCOG
Registrar: Gynaecology and Obstetrics