Updated 02 April 2015

Backstreet abortions: why is it still happening?

Backstreet abortions is a thriving business on our city streets. Why is this still happening in a country where abortions are legal? Dr Owen Wiese, Health24's resident doctor, gives his opinion.


On every second lamp post, wall and telephone box around the city you will find an advertisement for “safe and painless” abortion pills. Some of the “doctors” offer their services for as little as R300. What really disturbed me was one particular advertisement, advertising successful abortions up to eight months. There is no question about it: at eight months a foetus could survive. Legally speaking, abortions without a medical or social reason are permissible up to 12 weeks.  Nowadays, babies born prematurely at 26 weeks can be kept alive. This eight month cut-off filled me with horror.

What is life? How do you define life? And when is it acceptable to end a biological process that creates life?  Although ethical guidelines exist on when life is life, I’m not even going to venture an opinion.


When I worked in the obstetrics and gynaecology department at one of Cape Town’s biggest hospitals, a young girl was brought to the unit with severe abdominal cramping and profuse vaginal bleeding.  On examination we found 8 misoprostol tablets in her vagina.

Misoprostol is registered for use to reduce the risk of developing peptic ulcers in patient using non-steroidal anti-inflammatory drugs. Off-label it is used as a drug for inducing labour. When used by professionals in controlled environments, misoprostol is very effective.

What concerns me is where the “doctors” get hold of this scheduled drug. The black market? Stolen from government stock? Who knows. I’m sure that not a single one of them knows how this drug works, what the side effects are and how to treat any complications arising from the use of the medication.  Some women present with significant vaginal bleeding. Using misoprostol incorrectly can cause catastrophic complications like uterine rupture. No untrained person will have the knowledge to handle this. Even a trained GP will refer these patients to a specialist for further management. Uterine rupture is potentially fatal. 

What happens after the illegal abortion?

I also wonder what happens to the aborted foetuses.  If a women uses misoprostol early in her pregnancy, she will deliver a non-viable foetus, but later in pregnancy (at 8 months for example) she will most probably deliver a viable baby.  I’m convinced these are the babies that are often found in drains or in bushes.  Are the aborted foetuses sometimes used as muti?  We will perhaps never know.

A colleague of mine once told me they tried, in conjunction with the police, to “chase” these so called abortion doctors, but they change their phone numbers so often and never meet their clients at a fixed address, making it almost impossible to track them down.  I can’t even imagine where one would start looking for these dangerous, potential murderers. The women presenting to doctors with complications often refuse to name the supplier of the drugs out of fear that they might be harmed.

Why is it still a problem?

It is hard to understand why women, in a country where abortion is legal, would still turn to illegal methods. One can postulate that they are afraid of victimisation or that they only decide to abort after 12 weeks, when, according to law, there must be a clear medical or social reason for abortion.
I’m sure there are many more reasons, but the fact of the matter is that there are questions that should be asked like:

·         How accessible is the abortion services in our country?

·         How aware are people of the abortion law?

·         How do the illegal “abortion doctors” get hold of the drugs?

·         Is our government actively trying to stop these practices? 

There are some people who use abortion as a method of family planning.  These women refuse to use any contraception and when they fall pregnant, they simply go for an abortion. Is there a solution to this problem? It’s hard to say. The Department of Health encourages condom use and safe sex, but are they doing enough? Do the women opting for abortions have a clear knowledge of the procedure? I doubt it. I yet have to come across a patient that was fully aware of the process and potential complications of abortions. 

I’m not sure if it will ever be possible to entirely stop this practise of illegal abortions, but one should at least try. There are, however, no major awareness campaigns about illegal abortions. I can’t recall seeing a single poster or drive on this issue while I worked in government. Or maybe I just didn’t look hard enough.

The fact of the matter is that young women lose their wombs and even their lives by the hand of illegal money-driven people with no respect for life, including that of the woman they are “treating”.  When, how and by whom this will be stopped is anyone’s guess – perhaps it will happen one day when the problem is big enough for government to step in.

Read More:

Illegal abortion horror continues
3 arrested for illegal abortions

Image: Dirty medical scene from Shutterstock.

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.




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