Two-Stage Abortions Overload Hospitals and Kill Mothers


With the abortion debate in the public eye once again after the passing of the Abortion Amendment Act, it is maybe appropriate to leave aside the emotive ethical and moral issues for a while and focus on practicalities.

Abortions can be done either for profit (as by the private sector and by backstreet abortionists) or not (as by state institutions and a few philanthropists). However, a third reality has emerged in South Africa for which no law makes adequate provision: the two-stage abortion.  

What is a two-stage abortion? Many, if not most South African abortions nowadays are initiated by Misoprostil.  This is a prescription medication registered for the prevention of peptic ulcers and normally costs less than R4 a pill. It has the side effect of inducing labour (and therefore is contraindicated in pregnancy). Misoprostil does not normally kill the baby; it merely expels the child (often still kicking) from the womb. The drug is provided at high cost by GPs, pharmacists (often without prescription) and by backstreet abortionists to pregnant women desperate for a discreet and quick solution. I have heard quotes for two tablets of Misoprostil ranging from R250 to R1000.  

The pill provider typically tells the woman how to use the pills and advises her to visit a state clinic if bleeding persists after the baby is delivered (and presumably flushed down the toilet). The pill provider then pockets the profit.  

But that is not the end of the business in many cases. The woman takes the drug, thinking it will be a discreet, one-stop solution to her dilemma. She avoids going to the state clinic because of privacy concerns. She even goes to extraordinary lengths to get the money together.  

But when the bleeding doesn't stop, she has no choice but to report to a state facility with a "miscarriage" and has to undergo an emergency evacuation in theatre under general anaesthesia. This involves her being admitted to hospital and taken to theatre, where remnants of the pregnancy (such as the placenta) are removed.  She would often have to stay in hospital for a day or two. Since she waited for a long time for the bleeding to stop, she most likely requires a blood transfusion at R1,000 per pint. All this on the state budget.

The problem is that the Misoprostil-induced "backstreet" abortion is not confined to a few cases but has become a fully fledged industry. And the victims are clogging up limited theatre space in state institutions.  

Logically the increase in two-stage abortions translates into more women needing theatre time for evacuations of their wombs. The problem is that, since 1997, when abortion was first legalised, theatre capacity at state facilities has actually decreased (staff shortages being a main reason). The express purpose of the Abortion Amendment Act was to broaden the availability and accessibility of abortion services to the general public. So now we are seeing an even greater demand for increasingly limited theatre space - which leads to patient backlogs.  

But there is an even more serious consequence. One of the Millennium Development Goals' indicators is the maternal mortality rate - the number of women who die during or shortly after childbirth. The goal is to reduce this indicator by three quarters by 2015. But this rate has actually been increasing (not dropping), from an average 128 per 100000 births in a 2000 research estimate to 147 per 100000 in a StatsSA report from 2004 (with some provinces reaching a whopping 364 per 100000).  All of this is conveniently blamed on Aids, but things are not quite so simple. It is my contention that two-stage abortions are a significant cause of the increase in the maternal mortality rate.  

Let me give a real-life example. Under conditions of anonymity, doctors from a hospital in the KwaZulu-Natal Midlands revealed to me that five mothers - not those undergoing abortions, but those in labour - recently died in a 10 day period at their hospital. For that period, for that hospital, these five women represented a horrific maternal mortality rate of about 1,250 per 100,000.  During that same period, about 50 women required theatre time for evacuations.  Most of those needing evacuations confirmed to my colleagues that they had indeed used Misoprostil to induce their abortions. In total they required 40 pints of blood to resuscitate and as a group, these 50 women took up some 50 hours of theatre time (an average theatre only operates 40 hours a week).  

The result was that the women with complications during labour could not be rushed to theatre, but had to wait while the emergency evacuations were taking place. Five mothers died. This is not an isolated incident. Similar scenes are repeated in one state hospital after another in the rural areas. Wherever you go, you find that critical staff shortages are made far worse by abortion overloading. Clearly legalised abortion will be with us for a long time to come.  But steps need to be taken to prevent two-stage abortions from killing more South African mothers. Mothers should not be dying in order to "liberate" women. 

Dr Frank Muller

Dr Frank Muller is a medical doctor, pharmacologist and medicinal plant expert with extensive links to rural African hospitals. He is a member of the Christian Medical Fellowship and can be reached at: This email address is being protected from spambots. You need JavaScript enabled to view it. . 

References: Maternal mortality rate for 2000: Maternal mortality rate for 2004: 

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