A Woman’s Right To Choose Under Apartheid And Why It Still Matters
By Manju Soni
Abortion is certainly prominent in the media cycle these days. In light of Whole Woman’s Health v. Hellerstedt being heard in the Supreme Court, a proposed draconian measure in Tennessee that could send pregnant people to prison for ingesting illegal drugs, and efforts by an Oklahoman state senator to make abortion providers subject to first-degree murder charges, many people are discussing and debating reproductive health care.
But often lost in the heated political discourse are the very personal and emotional aspects of abortion — and the fact that women will be driven to the procedure regardless of its legal status.
This is my story.
I was born and brought up under apartheid in Johannesburg, South Africa. At the time, white supremacists ruled the country, and, because we were brown — my ancestors being from India — my family and I were classified as non-white. It was 1983 when I began my medical internship at Baragwanath Hospital, the largest hospital in the southern hemisphere at the time. Bara, as we called it, was the only hospital to serve the population of one million Africans who lived in the Soweto area. I hadn’t made up my mind about what specialty I was interested in yet, but I was young, fresh out of college, and very idealistic about saving lives with my new knowledge and skills.
Eight months into my internship, I was doing my gynecology rotation. My patient was an 18-year-old young black woman I’ll call Selena. The admission notes stated: “? Incomplete abortion. Possible sepsis.” My first thought was that Selena had had a backdoor abortion.
The apartheid government, comprised of orthodox, white men, led by Prime Minister B. J. Vorster, was obsessed with the racial and sexual purity of whites. With strong ties to the church, which gave them a sense of “divine destiny,” these men passed laws banning, at first, interracial marriages, and later, even interracial sex. In 1970, when Roe v. Wade first reached the Supreme Court in the United States, apartheid’s leaders became concerned about “declining moral values” in the West affecting South Africa’s white women.
They passed a law that made abortions illegal, allowing exceptions only in cases of rape, incest, or when the mother’s life was in danger, the caveat being that three independent doctors (generally male) had to reach agreement in these cases. Legal abortion was thus made exceptionally difficult and expensive, driving most abortions into secrecy and the private sector.
It was the bodies of white women that apartheid’s leaders really wanted to control — but poor, black women paid the highest price because they could not afford safe abortions at private clinics.
I looked at Selena, and worried whether she was septic. From my gynecology lectures, I knew an incomplete abortion was a miscarriage where the pregnancy had been disrupted but products still remained in the mother’s womb. The longer the products remained, the more likely they were to become infected. And once the infection spread into the bloodstream, it caused toxic chemicals to be released, resulting in a life-threatening infection — sepsis.
It’s scary how rapidly sepsis can progress to septic shock and death. On average, even nowadays, close to half of all patients who go into septic shock die.
But in South Africa in the 1980s, when patients like Selena presented with sepsis most likely due to an incomplete, backdoor abortion, the mortality was almost 100%. This was mainly because the abortionists used rusty coat hangers and knitting needles to induce abortions, and stigma surrounding the procedure precluded proper care.
Selena was striking — she had high cheekbones and a long face with dark eyes. When I first began my examination, she looked flushed. Her complexion was fair and her rosy color looked almost healthy. But I was suspicious; the early stages of septic shock could cause that appearance. I noticed her red nail polish and for a brief second, an image of this girl sitting on a chair painting her toenails flashed through my mind.
“Can you tell me what happened?” I asked after introducing myself.
Selena responded, startled, “Nothing happened. Why do you say something happened?”
She seemed slightly out of breath. I softened my voice and jotted down the history quickly. She emphatically denied going to a backdoor abortionist. She also denied having a boyfriend or being raped. She did, however, have stomach cramps, which were worsening, as was her vaginal bleeding.
I examined her quickly. Her blood pressure was low-normal. Her skin felt a little too warm, but there were no signs of bruising. Her abdomen was tender. When I did a vaginal examination, I found she had a foul-smelling, bloody discharge. She was definitely pregnant, but her uterus felt rock hard and was obviously causing her pain because she winced when I examined her.
I had an eerie feeling about this girl who was now lying propped up against the pillows, her eyes closed, her eyelashes tight black curls. She looked serene, and yet her temperature, blood pressure, and flushed skin told a different story. I took some blood samples, and asked the nurses to prepare her for surgery. Hitching my intern bag onto my shoulder, I ran out into the night to the lab.
A short while later I scanned the results. Her platelets were dangerously low and her prothrombin time — the time it takes for her blood to clot — was far too high. Selena was going into the most severe stage of septic shock, the released chemicals causing clotting throughout the body. Pulse racing, I set off at a run back to the ward.
I could think only of Selena’s calm face — all while bacteria ran rampant in her blood, causing clots. In no time these clots would disperse and block the arteries to her brain, her heart, and her kidneys. Her kidneys would fight to clear them but eventually succumb to the onslaught. Simultaneously, the rapidly progressing coagulation would consume all her clotting factors, leading to massive bleeding.
Selena’s ward was in chaos. I frantically scanned for her bed. A clump of nurses and doctors were gathered around it. I held my breath as I saw the resuscitation trolley, usually used only when a patient is in cardiac arrest. The grate at the head of the bed was down and I caught glimpses of her, large hands pounding on her chest. An intubation tube snaked out of the corner of her mouth. “STAND CLEAR!” Everyone stepped back and stood still. The only motions were that of the intern applying the defibrillator paddles, and Selena’s naked body thumping with the electric shock that reverberated throughout her.
But the line remained straight and the machine sustained its uninterrupted beep. The head of the team called out the time of death and the team dispersed. Selena lay at an angle, her torso bare, massive bruises on her chest where the compressions and paddles had been applied. Her eyes were closed but her face was still rosy.
In my two-month gynecology rotation at Baragwanath Hospital, I attended to seven women who died of septic abortions performed by backdoor abortionists. The youngest was 13.
In her book Abortion Under Apartheid, Susanne M. Klausen says, “. . . by the 1970s, 250,000 women, the vast majority black, were illegally procuring abortions annually, and . . . pain, humiliation and gruesome death were regular occurrences.”
Since 1994, when apartheid ended, South Africa has passed laws that allow all women, irrespective of age, race, and nationality, access to legal abortion. Although these laws are among the most progressive in Africa, a small number of women still go to illegal abortionists, many of whom are nurses, pharmacists, or traditional healers. The reasons they give vary from still believing abortion is illegal, to not knowing where to find a legal facility, to not trusting staff to maintain confidentiality. Deaths from septic abortions have reduced dramatically because of the use, even by illegal abortionists, of misoprostol, an anti-ulcer drug that induces abortion.
But sadly, in the rest of the world, the mortality from abortion still remains high. According the World Health Organization, about 21.6 million unsafe abortions occurred worldwide in 2008, resulting in 47,000 women dying, almost all of them in developing countries. As of 2013, 66 countries in the world either totally prohibit abortion, or restrict the procedure to cases where the mother’s life is threatened.
As I’d realized by the end of my 60-day gynecology rotation back in the 1980s: When we take away a woman’s right to choose, we leave her with no choice at all. This was true in apartheid Africa, and true today in America, too.