SOUTH AFRICA: THE SA PHARMACY COUNCIL (SAPC) HAS ISSUED A NOTICE THAT PHARMACISTS MAY NOT - BASED ON PERSONAL BELIEFS, MORAL REASONS OR RELIGIOUS GROUNDS - REFUSE TO DISPENSE DRUGS TO PATIENTS WISHING TO TERMINATE THEIR PREGNANCY; ALLEGED NEWS. [1] Thirteen NGO's and legal centres reportedly penned an open letter to the Council and National Department of Health regarding reports of pharmacists declining to dispense abortifacients; Alleged News. [1] The South African Pharmacy Council is a statutory body mandated in terms of the Pharmacy Act to regulate the profession in the country; Alleged News. [1]
Abortion in South Africa
Between 2014 and 2016, public health facilities reported a total of 538 230 abortions, according to the Department of Health's District Health Information System (DHIS); Alleged News. [2] From 2017 onwards, the number of abortions recorded for women pregnant between 0 and 20 weeks approached one million, reaching a cumulative total of 929 538 by 2024: Alleged News. [2]
Legal framework governing abortion services
Health Minister Aaron Motsoaledi addressed the legal framework governing abortion services, emphasizing that healthcare professionals have certain rights and obligations under the CTOP Act; Alleged News. [2]
Not obligated to perform abortions
Medical practitioners and nurses are not obligated to perform terminations of pregnancy (abortions) in South Africa. [2] According to Health Minister Motsoaledi, as reported on 13 December 2024, 346 public health facilities nationwide comply with the CTOP Act, ensuring they can legally provide termination of pregnancy services; Alleged News. [2]
In South Africa, Kwazulu-Natal has 63 facilities which carry out abortions, the Western Cape has 57 facilities, Limpopo has 51 facilities, Gauteng has 49 facilities, the Eastern Cape has 37 facilities, Mpumalanga has 35 facilities, North West has 33 facilities, the Free State has 14 facilities, Northern Cape has 7 facilities; Alleged News. [2] These are the legal facilities which carry out abortions.
Abortion support South Africa
Ms Victoria Satchwell leads Abortion support South Africa, a tele-abortion service launched in February 2023; Alleged News. [3] The organisation provides online consultation for women seeking an abortion and connects them to a healthcare professional registered with the Health Professionals Council of South Africa (HPCSA); Alleged News. [3]
The healthcare professional assesses the woman's situation and based on eligibility, prescribes abortion pills that have to be collected from a pharmacy, with a script; Alleged News. [3]
Abortion support South Africa difficulty in accessing misoprostal
Abortion support South Africa reportedly ran into difficulties to access home-use misoprostol treatment from pharmacies; Alleged News. [3]
This is probably due to the fact that in South Africa, the 14 health facilities in the Free State which carry out abortions according to the Choice on Termination Pregnancy Act (updated to 18 February 2008), stock requirements as per the Act in order to carry out abortions. In South Africa, clients who wish for termination of pregnancy are referred to a facility approved under the provisions of the Act. Pharmacies are not an approved facility for termination of pregnancy, according to the Choice on Termination Pregnancy Act (updated to 18 February 2008).
South Africa: Abortion may take place only at compliant facility
Pharmacies in South Africa are aware that the law in South Africa is that termination of a pregnancy may take place only at a facility which complies with the following: The Choice on Termination of Pregnancy Act (updated to 18 February 2008) directs that termination of a pregnancy may take place only at a facility which a) gives access to medical and nursing staff; b) gives access to an operating theatre; c) has appropriate surgical equipment; d) supplies drugs for intravenous and intramuscular injection; e) has emergency resuscitation equipment and access to an emergency referral centre or facility; f) gives access to appropriate transport should the need arise for emergency transfer; g) has facilities and equipment for clinical observation and access to in-patient facilities; h) has appropriate infection control measures; i) gives access to safe waste disposal infrastructure; j) has telephonic means of communication; and k) has been approved by the Member of the Executive Council by notice in the Gazette. [4]
Pharmacies thus are not the required venue for an abortion to be carried out, as per the law in South Africa according to the provisions of the Choice on Termination Pregnancy Act (updated to 18 February 2008).
14 facilities in the Free State, South Africa
In the Free State, where Vredefort is situated, there are 14 facilities which carry out abortions according to the directives of the Choice on Termination Pregnancy Act (updated to 18 February 2008), to which a healthcare professional may refer a client as needed, thus there is no provision under the CTOP Act to refer to a Pharmacy (which is not an approved health facility for abortions).
Abortion may only be carried out by medical practitioner or registered midwife in certain cases
According to the Choice on Termination Pregnancy Act (updated to 18 February 2008), an abortion may only be carried out by a medical practitioner, except for a pregnancy referred to in subsection (1) (a), which may also be carried out by a registered midwife who has completed the prescribed training course. [4] Pharmacies are aware of the provisions of the CTOP Act, as well as of the offences and penalties under law regarding non-adherence to the Choice on Termination Pregnancy Act (updated to 18 February 2008) Act. According to the provisions of the CTOP Act, if anyone other than a medical practitioner or a registered midwife who has completed the prescribed training course facilitates an abortion, offences and penalties apply as follows:
Offences and penalties, according to the CTOP Act
Offences and penalties according to the Choice on Termination of Pregnancy Act (updated to 18 February 2008) sets out the following;
Any person who - a) is not a medical practitioner, or a registered midwife or registered nurse who has completed the prescribed training course, and who performs the termination of a pregnancy referred to in section 2(1)(a); (b) is not a medical practitioner and who performs the termination of a pregnancy referred to in section 2(1)(b) or (c);...(d) terminates a pregnancy or allows the termination of a pregnancy at a facility not approved in terms of section 3(1) or not contemplated in section 3(3)(a), shall be guilty of an offence and liable on conviction to a fine or to imprisonment for a period not exceeding 10 years. [4]
Constitution of South Africa ensures freedom of conscience
According to the Constitution of South Africa, 15.1 states that everyone has the right to freedom of conscience, religion, thought, belief and opinion. [5]
Misoprostol may cause uterine rupture
UTERINE RUPTURE HAS BEEN REPORTED WHEN CYTOTEC (MISOPROSTOL) WAS ADMINISTERED IN PREGNANT WOMEN TO INDUCE LABOR OR TO INDUCE ABORTION; ALLEGED NEWS. [6] The risk of uterine rupture associated with misoprostol use in pregnancy increases with advancing gestational age and prior uterine surgery including Caesarean delivery; Alleged News. [6] Maternal shock, maternal death, foetal bradycardia and foetal death have been reported with the use of misoprostol. [6] Misoprostol may cause anaphylactic reaction, Alleged News. [6] This means the woman who takes the misoprostol may have an allergic reaction to it which may prove life-threatening, and she may die.
Adverse events
The following adverse advents were reported with the use of misoprostol, Alleged News. [6] Causal relationships between Cytotec (misoprostol) and these events have not been established but cannot be excluded. [6] This means that reports were received after individuals took misoprostol that the following symptoms were experienced. As per the Cytotec misoprostol information it is unsure if the misoprostol caused these adverse events, yet it cannot be excluded that misoprostol may have caused the adverse event.
- Body as a whole; aches and pains, asthenia (body weakness), fatigue, fever, chills, rigors (severe shivering), weight changes
- Skin: rash, dermatitis (conditions that cause inflammations of the skin), alopecia (hair loss), breast pain
- Special senses: abnormal taste, abnormal vision, conjunctivitis (inflammation or infection of the transparent membrane that lines the eye and eyelid), deafness, tinnitus (ringing in the ears), earache
- Respiratory: upper respiratory tract infection (illness caused by acute infection, which involves the upper respiratory tract, including the nose, sinuses, pharynx, larynx or trachea), bronchitis, bronchospasm (a condition where the muscles lining the airways in the lungs tighten, causing the airways to narrow. This can lead to symptoms like coughing, wheezing, chest tightness and difficulty breathing), dyspnoea (shortness of breath), pneumonia, epistaxis (nose bleeds)
- Cardiovascular: chest pain, oedema (swelling caused by excess fluid trapped in the body's tissues), diaphoresis (excessive sweating), hypotension (low blood pressure), hypertension (high blood pressure), arrhythmia (irregularities in the heartbeat, including when it is too fast or too slow), phlebitis (inflammation in the vein, usually in the legs), increased cardiac enzymes (increase of the heart enzymes in the blood may be a sign of heart damage, stress or inflammation), syncope (fainting), myocardial infarction - some fatal (heart attack, sometimes resulting in death), thromboembolic events such as pulmonary embolism, arterial thrombosis, and CVA (when a blood clot breaks loose, and blocks a blood vessel affecting multiple organs. It may cause blockage of the main artery of the lung, formation of a blood clot in an artery, and cerebrovascular accident also known as a stroke. The latter is an obstruction or bleed from a blood vessel in the brain that causes damage to the brain)
- Gastrointestinal: GI bleeding (gastrointestinal bleeding), GI (gastrointestinal inflammation/infection), rectal disorder (problems with the anus or rectum), abnormal hepatobiliary function (problems with the liver, gallbladder or bile duct), gingivitis (gum disease), reflux (the sphincter at the bottom end of the oesophagus relaxes and allows stomach acid to back up into the oesophagus, leading to heartburn and other problems), dysphagia (difficulty in swallowing), amylase increase (can be a sign of problems starting in the body such as inter alia with the pancreas)
- Metabolic: glycosuria (excretion of glucose into the urine), gout (form of inflammatory arthritis with recurrent attacks of pain in joints), increased nitrogen (increase of the amount of nitrogen which comes from urea, a waste product formed in the liver when the body breaks down proteins), increased alkaline phosphatase (or ALP levels which can indicate potential health issues, particularly related to the liver or bones, such as liver disease, bone disorders, or certain cancers)
- Genitourinary: polyuria (excessive production of urine), dysuria (painful or uncomfortable urination), hematuria (presence of blood or red blood cells in the urine), urinary tract infection
- Nervous system/psychiatric: anxiety, change in appetite, depression, drowsiness, dizziness, thirst, impotence, loss of libido, sweating increase, neuropathy (nerve damage that may affect the limbs), neurosis (mental anxieties), confusion (impaired orientation with respect to time, place or person)
- Musculoskeletal: arthralgia (joint pain), myalgia (muscle pain), muscle cramps, stiffness, back pain
- Blood/coagulation: anemia (blood disorder in which the blood has a reduced ability to carry oxygen), abnormal differential (an abnormal differential blood count indicates an unusual number or percentage of white blood cells, which can suggest infections, inflammations or blood disorders), thrombocytopenia (condition characterized by abnormally low levels of platelets in the blood), purpura (red or purple spots on the skin caused by bleeding underneath the skin), ESR increased (increase in erethrocyte sedimentation rate, which may indicate an increase in inflammatory activity within the body), Alleged News. [6]
Deaths and adverse effects due to Mifepristone
The use of mifepristone for medical termination of pregnancy, has led to adverse events, such as those documented in the Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018: Alleged News. [7]
The information is from United State post-marketing reports received by FDA of adverse events that occurred among patients who had taken mifepristone for medical termination of pregnancy, Alleged News. [7]
The fatal cases after taking mifepristone were related to inter allia sepsis, ruptured ectopic pregnancy, ruptured gastric ulcer, severe haemorrhage, multi-visceral failure, thrombotic thrombocytopenic purpura leading to intracranial haemorrhage, toxic shock syndrome, asthma attack with cardiac arrest, respiratory decompensation with secondary pulmonary infection: Alleged News. [7]
Further patients underwent adverse events after taking mifepristone, such as hospitalization, experienced blood loss requiring blood transfusions, experienced infections or severe infections; Alleged News. [7]
Retained products of conception and haemorrhage
The study by Aultman et al. regarding deaths and severe adverse effects after the use of mifepristone as an abortifacient from September 2000 to February 2019, found that retained products of conception and haemorrhage caused most morbidity; Alleged News. [8]
In other words, most deaths of the mother after the abortion caused by taking mifepristone occurred due to:
- retained products of conception, which means that either some of the foetus or matter within the womb remained behind, causing sepsis (severe infection), which led to death
- haemorrhage (severe bleeding) after the use of mifepristone led to death.
Mifepristone may prove life-threatening with regard to ectopic pregnancy
When mifepristone is taken and a woman is not aware she has an ectopic pregnancy, a rupture of the ectopic pregnancy may occur, which may prove life-threatening. Women have died from a ruptured ectopic pregnancy after taking mifepristone: Alleged News. [7] and [8] The study by Aultman et al., showed that there were 75 ruptured ectopic pregnancies, including 26 ruptured ectopics (includes one death): Alleged News. [8] In the Mifepristone U.S. Post-Marketing Adverse Effects Summary, there were 97 ectopic pregnancies. [8] Deaths due to ruptured ectopic pregnancy were noted. [8]
Administration of mifepristone and misoprostol is contraindicated in patients with confirmed or suspected ectopic pregnancy (a pregnancy outside the uterus). [8]
[1] Sowetan. Kim Swartz. 5 February 2025. Pharmacists told to issue abortion drugs, Alleged News. Page 6.
https://sowetanlive.pressreader.com/sowetan/20250205
[2] The Citizen. Molefe Seeletsa. 13 December 2024. 1.4 million abortions performed in public health facilities since 2014; Alleged News.
https://www.citizen.co.za/news/south-africa/abortions-pregnancy-termination-healthcare-motsoaledi/
[3] Pharmacists think it's illegal to dispense abortion pills: worrying consequences; Alleged News
[4] Choice on Termination of Pregnancy Act (updated to 18 February 2008)
https://www.saflii.org/za/legis/consol_act/cotopa1996325/
[5] Constitution of the Republic of South Africa 1996 - Chapter 2, Bill of Rights
https://www.gov.za/documents/constitution/chapter-2-bill-rights#15
[6] Cytotec misoprostol tablets, Alleged News
https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019268Orig1s049lbl.pdf
[7] Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018: Alleged News
https://www.fda.gov/media/112118/download
[8] National Library of Medicine. Issues Law Med. 2021 Spring: 36(1):3-26. Aultman, et al. Deaths and Severe Adverse Events after the use of Mifepristone as an abortifacient from September 2000 to February 2019: Alleged News
https://pubmed.ncbi.nlm.nih.gov/33939340/
With thanks to sowetanlive, citizen.co.za, health-e.org.za, saflii.org, gov.za, accessdata.fda.gove, fda,gov and pubmed.ncbi.nlm.nih.gov
Image courtesy of Freepik AI generated content with CN Whittle
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