What can I expect during an abortion procedure?

Q. Is abortion legal in South Africa? What can I expect during the procedure?

A. Based on obstetric best practice, abortion is a safe procedure and should be available at all health facilities in the country. 

The protocols that guide health professionals should be available and developed using the evidence base and be implemented in a way that affirms the right of women to autonomy and bodily integrity and without delays or obstruction.

The right to healthcare, including reproductive health, is guaranteed by the Bill of Rights and the Constitution of South Africa.

MEDICAL ASSESSMENT

Before you have an abortion, you need to consult with a nurse or a doctor if the gestation is between 0 and 12 weeks. You do not need to give a reason for your request. There will be a medical assessment by a medical health professional with a clinical assessment, history taking and further tests such as urine or blood tests if indicated, and a sonar if available.

You have the right to receive information, a clinical examination and a referral by other health professionals regardless of gestation. However, if the gestation is above 12 weeks then it must be a doctor who performs the abortion, after consultation.

PAIN MANAGEMENT

All medical procedures require an ethical standard to be met. Evidence-based information, non-stigmatising, non-victimising and non-coercive counselling must ensure that the person requesting an abortion is able to make an informed decision. The counselling includes a discussion about contraceptive needs.

However, a lack of decision in this regard should not result in an abortion being denied.

The level of discomfort and pain differs greatly from woman to woman and options for pain management during and after the abortion should be discussed during the consultation.

CRAMPING

The options for medication vary from oral to intramuscular, intravenous and local. Some refer to what's commonly known as conscious sedation. Not all facilities are equipped to offer this type. Depending on previous history, any current failed attempts and medical history, antibiotics may or may not be used.

The methods of inducing the abortion involve two types of tablets, and if only tablets are used it is referred to as a medical abortion. If a manual vacuum aspiration is then also used, it will follow the initial tablets and is referred to as a surgical abortion.

There will be some bleeding and cramping after the abortion. Before you are discharged, you must get information on where to go for your checkup, what possible complications may arise and where to seek care if the clinic or hospital is not open 24 hours a day.

Depending on whether you choose to start contraception immediately or not, you may return to a predictable menstrual cycle in four to eight weeks. Remember, you can still fall pregnant that soon after an abortion.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za.

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