Jozi City Feature

Selling abortion pills underground

In the past, desperate young women would subject themselves to dangerous rituals in dirty environments to rid themselves of unwanted pregnancies. Women in South Africa have won the right to safe abortions at no cost in the public health system. Tebogo Mahlaela finds out why the trade in illegal abortions is still rife in the centre of Johannesburg. 

 Nelly* was given four pills. She placed two under her tongue and inserted two into her vagina. After about half an hour, she felt terrible pain, as if she were giving birth, she said. Then she bled heavily.

Despite abortion being legal in South Africa, women in the Johannesburg CBD and elsewhere still opt to buy abortion pills on the streets.

The proliferation of illegal abortions is ironic as one of the core reasons touted by lawmakers and pro-abortion groups for legalising abortion was to prevent “unsafe” backstreet abortions.

Posters advertising abortion

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The city is crammed with posters offering “safe and pain-free” abortions.

 Why women have illegal abortions

Women have abortions for different reasons: some because their pregnancy was unplanned, or they are pregnant by an abusive partner. Some face financial challenges.

One of the main reasons given for taking the illegal route is discovering the pregnancy too late for a legal termination. Other women say they opt for these pills because they are “the same pills” doctors give their patients. They claim they are cheap and involve less time than going to the hospital or clinic.

Nelly was dismayed at finding she was already four months pregnant. She could not bear the thought of having another child with her abusive boyfriend. She felt her only option was to buy abortion pills in the Johannesburg CBD to terminate the pregnancy.

The 22-year-old woman from Maputo in Mozambique says her boyfriend cheated on her while she was carrying their first child. “He would spend days not sleeping at home and didn’t financially support me or our child.”

Nelly plaits hair on a street in the CBD. The money she makes is not enough to support two children, she says. Her son lives with her mother in Maputo and she would be a “disgrace” to the family if she were to have another child.

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Nelly* is plaiting her client’s hair at a street in the CBD.

Other women have stories similar to Nelly’s. Anna*, also a hairdresser, says “abortion was the best option because I didn’t want to struggle even more by having another child with that man”. The 32-year-old Maputo-born woman says her boyfriend and the father of her three children died. Then she dated another man who became the father of her fourth child.

After she gave birth, the man started abusing her physically and emotionally. “He would beat me up and I found out that he was dating another woman.”

Her boyfriend told her that he would marry another woman as she was not wife material. When the mother of four fell pregnant with her fifth child, she aborted it. The money she makes is not enough to pay her R1 000 rent and to support all her children. She says her boyfriend does not support her financially, nor his child.

She bought abortion pills from a woman in a Johannesburg flat because she felt it was easier and took less time than going to a hospital.

The pills are called Cytotec. Anna was instructed to insert three inside her vagina and one under her tongue. She never experienced any problems after the abortion but the pain she felt before bleeding was horrible, she says.

Cleo*, also from Maputo, says she aborted her fourth child because the money she makes from plaiting hair isn’t enough and her boyfriend is not financially stable as he survives from selling sweets on the CBD streets. She decided on an illegal abortion because she believed legal abortions cost too much, despite the fact that an abortion at a government hospital or clinic is free.

“I don’t regret aborting the child as I don’t want my other children to suffer. I send them R500 every month,” she says. The 39-year-old says her children, aged, 22, 10, six and five, stay with her mother in Maputo.

Her boyfriend refused to give her money to buy the Cytotec pills on the streets. “The doctors are expensive, they charge about R600 to R2 000 and I don’t have that money.” She bought the pills for R200 without his permission and he broke up with her when he found out.

While many women admit to buying Cytotec off the street, some do opt for free abortions offered at government hospitals. Cynthia*, also a hairdresser from Maputo, says she aborted two of her children in hospital. She says she wouldn’t use those pills as she isn’t sure if they are safe.

“Most people in the CBD use those pills. I won’t use them because I don’t want to mess with my womb.” Her pregnancy was terminated surgically while she was under anaesthetic.

Her first and only child was a year old when she fell pregnant with their second. She terminated because the child was still young. She terminated her third pregnancy because she and the boyfriend were not financially stable.

How Cytotec is used

Nelly says she placed two pills under her tongue and inserted two inside her vagina. Anna and the other women say they placed one pill under their tongue and inserted three inside their vaginas.

Cynthia says the abortion process isn’t completed after the bleeding. She bought 15 ” cleansing pills”  for R25. She took five pills for three days. Nelly says she bought 18 “cleansing pills”  for R20, and took five pills for two days and four pills for another two days. They say the cleansing pills are meant to remove the ” remains of a foetus”.

Brenda Bamuza, a nurse and clinic co-ordinator at Marie Stopes in Ghandi Square, says all illegal procedures are extremely risky. “Back door” abortions can cause death and may also lead to infertility, she says.

According to statistics gathered by the Human Sciences Research Council for a Gauteng government report, deaths following abortions are high. “Five percent of maternal deaths following childbirth are abortion related, and 57% of these are related to illegal abortions.”

Bamuza says Cytotec, also known as Misoprostol, is a registered medication used to prevent gastric ulcers. It can also be used to terminate pregnancy as it induces uterine contractions. There are different  pills on the market that can be used to bring on  abortions, but they should only be used if the pregnancy is nine weeks or less.

After that, clinics and hospitals use the surgical procedure. She says pills cost about R750 or more at Marie Stopes, depending on the area.

The Marie Stopes clinics in rural areas or townships often charge less, while prices are higher in urban areas like Ghandi Square. But abortion at government clinics and hospitals is free.

The International Journal of Gynaecology and Obstetrics, 2007 edition says that several studies carried out in both developed and developing countries have shown that home administration of Cytotec pill combined with Mifegyne pills is safe and effective up to nine weeks since the last menstrual period.

Bamuza says Cytotec pills must be used together with Mifegyene (abortion pills). Before these pills are administered, the pregnant woman must be examined and her medical history taken, a scan should be done to check the duration of the pregnancy, and she should be counselled.

Then Cytotec ( four tablets) and Aspirin (for pain) will be given as treatment to be taken at home. After three weeks, the woman must go back to the clinic to determine whether the abortion has been completed. If it failed, another four Cytotec tablets will be given.

“If the procedure is still incomplete after repeating the Cytotec tablets, the woman should come back after two weeks when a surgical procedure will be performed.”

The side effects of using this procedure are heavy vaginal bleeding – more than menstrual blood loss – cramping of the uterus, accompanied by pain, passing of blood clots, allergies such as skin rash, nausea, vomiting and diarrhoea, sensation of warmth, and fever and chills may occur, says Bamuza .

The journal also says that there are two ways in which one can take the Cytotec pills – vaginally or orally. The vaginal procedure entails using fingers to put tablets as deep as possible at the back where the womb starts, while orally entails “placing tablets under the tongue or in the space between gum and cheek”.

Bamuza says some women told her the Nigerian men who perform abortions in the CBD use their penises to push the pills inside the vagina. “The woman will put the pills in the vagina and the man will push it inside as if they are having sexual intercourse. This is shocking.”

Where the pills come from

Most people approached in the CBD seem to have knowledge of these pills. A shop called Kwa-Zulu Muti on the corner of Jeppe and Kruis streets, sells traditional muti (herbs). The shopkeeper offered to sell me Cytotec pills for  R250.

Woza sisi ndiku chine” (Come sister, let me plait your hair). This is what you hear constantly when walking in the CBD. Women, most from Mozambique, sit in groups inviting passing women to have their hair plaited. These groups of women are known to sell Cytotec pills on the side.

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Most women approached refused to be interviewed, but one admitted selling Cytotec to earn extra cash. That woman happens to be Nelly. “Business is business,” she says.

She is aware that selling these pills is illegal, but says she is doing it for the money. She begged me not to have her arrested.

After finding out that she was pregnant, Nelly was advised by a friend, who sells these pills, to also start her own business.

They claim to buy 60 Cytotec from a pharmacy in the CBD for R350, and sell four pills for R200. Nelly says the cashiers and pharmacists apparently steal the pills from the pharmacy and sell them at a discounted price.

She sells all 60 pills in a week. Her many customers include students and married women. She says she is well known for selling these pills and people recommend her. She gets more customers in summer as most people tend to find out that they are pregnant during this season.

A cashier at the pharmacy, who spoke on condition of anonymity, says he started working at the pharmacy in 2004. He says Cytotec pills are only sold on prescription. Asked if it was possible that a doctor would prescribe 60 pills to a patient, he said yes.

He says the pharmacy was banned from selling the pills about five years ago and that he has not seen Cytotec pills since then.

According to the Choice on Termination of Pregnancy Act, until 12 weeks of gestation (pregnancy) a medical doctor or registered nurse trained in the procedure can terminate a pregnancy. Women selling abortion pills are in breach of  the law as they are not trained for this procedure.

The department of health issued a report on May 16, 2011 saying that illegal, backstreet abortion facilities are only there to cheat desperate women and rob them of their cash.

The department also urged people wishing to terminate pregnancy to talk to their health worker (a doctor or nurse) who could counsel them on the procedure.

A person breaching the rules set out in the Act can be fined or sentenced for a period not exceeding 10 years.

*- Not real name

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About Tebogo Mahlaela

Tebogo Mahlaela graduated with a BA in political science and law from Wits University. She chose to study honours in journalism because of her passion for writing, her ability to tease the truth out of people and her passion for facts and information. She tackles both her studies and her job as a television show host enthusiastically. She has developed a love for visuals editing and investigative journalism. She hopes to be a well-known, respected, non-biased journalist.

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