Intersections and continuums in reproductive justice in South Africa

by Marion Stevens, WISH AssociatesCoalition of African Lesbians, 14 October 2016Within South Africa, more than 20 years post democracy, the legal provisions on reproductive health and sexual orientation have been recognisable gains. It is a challenge though that these legal rights are not well realised and the struggles of many girls, young women and gender queer people remain unrealised in reproductive justice…Within South Africa, whilst abortion is legal it is not accessible.  In 2014 less than 40% of surgical designated abortion facilities were operational. Medical abortion guidelines are only available for the Western Cape. Medical abortion drugs are not on the essential drug lists of all the provinces. Training for health professionals in sexual and reproductive health is ad hoc and not planned for in terms of providing comprehensive contraception, nor is training provided in the provision of abortion.Stigmatising attitudes in relation to abortion are a challenge from managers and leaders in the Health Department to health care providers on the ground. There are some instances of women reporting being forcibly sterilized following accessing an abortion. Black women still die from abortions in South Africa. See on abortion has not been provided regarding the provisions on the Choice on Termination of Pregnancy Act in schools during comprehensive sexuality education nor in pamphlets and information campaigns by the National Department of Health. No information on abortion is provided on flagship m-health programmes, Mom Connect and BWise.  In reality, schools fall desperately short in the provision of comprehensive sexuality education.…We have the rights to abortion in South Africa and if you are a middle class girl, young woman or gender queer person with access to information to determine you have an unintended pregnancy and resources to access medical care in the first trimester you should be able to find your way. The case study below tells another story.A referral from 2014But if you are a middle class adolescent in Johannesburg who has been violated repeatedly by a family member and have been threatened that if you break confidence he will start on your little sister you could well fall in between the cracks. You do now believe that you are pregnant after all the abuse and only when your aunt takes you aside and listens to you establish that you are 19 weeks pregnant and have the right to abortion. Your well-resourced aunt cannot access an abortion for you as there are no providers, your uncle is in jail and social workers are counselling you to ‘give your baby up for adoption’. It is only when at 23 weeks of pregnancy your determined aunt requests an ultrasound that it is determined that the fetus is not viable and you are then induced for labour as no health professionals are willing to provide you with a surgical abortion with anaesthesia.We do not live single issue lives and as such we might find ourselves fitting a number of boxes. Often the LGBTI focus has been in single issues, for example, gay marriage or ARV treatment access. Yet there are layers of complexity and nuance.Abortion access for girls and young women is a challenge, it is even more so for queer people including lesbians and trans men. Comprehensive sexuality education does not address sexual orientation and gender identity at all well and health workers are not welcoming nor well trained in relation to LGBTI persons’ health care. The stigma, judgement and harassment that LGBTI persons receive in public health care settings has been well documented. It demands enormous courage to walk into a clinic if one presents gender queer or non-conformingVISUAL