Written Submission to Committee on Health

Dear Sir,

Major problems with proposed New Abortion law. (Written Submission)

It is with appreciation that am afforded the opportunity of addressing you with my concerns regarding the proposed enactment of the Termination of Pregnancy Bill.

Before passing the proposed Act, the Government is advised to consider the following problems which if unaddressed will threaten to disrupt the existing service and polarise staff. I believe that even more women will end up being injured , becoming infertile and have life threatening complications - certainly something this intended bill is being proposed to prevent. The abortion procedure at any gestational age is not simple or uncomplicated as anyone currently required to perform them knows. `Trained midwives' are proposed to be allowed to do this procedure which introduces critical issues:

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. It is the experience of all midwives and doctors in the profession that confirmation of gestational age can be very difficult without sure knowledge of menstrual dates. Ultrasound examination is very useful but requires considerable skill. The cost of maintaining and securing such equipment at proposed clinics offers no mean challenge if today's levels of hospital theft prevail in the future. Even simple machines cost in the region of R70 000.

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 just 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. Could parents sue for wilful abduction or assault?

4. In the event of complications, such as perforation of the uterus , incorrect gestational ageing, missing the fetus at suction evacuation, fetal injury in unsuccessful abortions, or profuse bleeding requiring transfusion, transferral and/or hysterectomy due to operator incompetence, can the midwife be sued? Will she/he be required to take out medical insurance? 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? 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?

6.The premature passage of this law will as has happened in every other country liberalising its abortion laws, encourage a relaxation of vigilance to use contraception and result in an increase in the number of admissions daily to gynae firms on intake in Government hospitals. At present the national infrastructure does not have the facilities to cope with, the personnel willing or able to perform abortions as per the proposed act . The time to find out that the service cannot be provided is most certainly not after the right has been given legally to pregnant women.

7.The possible imprisonment of any person including vital service personnel, found guilty of "obstructing or failing to refer a woman eligible for an abortion" exposes a deplorable Nazi style attitude to people of conscience. To expect complicity of this nature is like in the words of Dr.Charles Oettle ordering a man who does not believe in the death penalty to blindfold the prisoner and load the rifles for the firing squad. The law then must be clear. An appropriately advertised venue where abortion services can be confined from diagnosis to counselling to the procedure and its sequelae can be the only logical option.

8. Abortion training for prospective medical graduates. Will the jobs at Government Hospitals be reserved for doctors who have no objections to performing abortions? Will disclosure of a conscience not to participate in abortions end up as grounds for job discrimination for nurses doctors and social workers? Would selection to specialise in Obstetrics and Gynaecology or Midwifery be dependent upon willingness to perform abortions as per the proposed act? If so, is this constitutional?

These are practical issues with grave implications. 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.

Finally it is barely credible, that this body of elected individuals regarded as being people of integrity and role models for the citizens of this nation allow themselves to be dictated to against their consciences. Surely the coercion of elected members of parliament is in itself a gross violation of human rights and unconstitutional. Many MP's in this house inwardly do not support the proposed bill but would appear that they are not allowed to express it. It is depressing that for political parties as supposedly democratic as the ANC and the DP, that the statement that their members on the Committee must vote against their better judgements. There was a time in South African History when brave men and women stood up against the tide of opinion and had the courage of their convictions to state their case. Some lost their lives for this. We would do well to remember that it takes a live fish to swim upstream. Have these elected officials become a grey amorphous herd of YES people? What has the country's leadership come to when they can be coerced into voting against their own consciences? When the sinister agenda of a shadowy group of puppeteers hold sway behind a wall of raised hands, and the will of the majority is subjugated, the electorate begins to ask " Just who is really running this country?"

Harvey R.G. Ward
Bsc (Med). MBChB. DipMidCOG Registrar OBGYN