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Abortion providers — the custodians of reproductive justice in South Africa

Sunday 10 March marked Abortion Provider Appreciation Day. These are men and women providing a service many health professionals shun. In South Africa, despite a progressive law, abortion providers continue to face stigma and difficult working conditions.

On 10 March 1993 Dr David Gunn was murdered by an anti-abortion extremist in Florida in the United States (See Appendix below annotating assassinations and violence). Three years later, to honour his life and work, 10 March became the National Day of Appreciation for Abortion Providers.

Today, it is a celebrated as a Global Day and in South Africa the Sexual Reproductive Justice Coalition (SRJC) has been working to thank and honour abortion providers all over the country for the past five years. In a partnership with the Western Cape Government, we will host an event this week. Thank you cards are being delivered to providers in the North West, Limpopo, Mpumalanga and Gauteng.

Being an abortion provider is a thankless and unpopular job. Some providers experience stigma daily and talk of being asked to remove themselves from tea rooms as they are judged for the work they do and even endure emotional harassment in the spaces where they work.

Cases of threats of violence and intimidation have been reported to us as the SRJC. That is why this day is important. We acknowledge and salute this work, which is undervalued and not well appreciated. We celebrate these fearless health providers, mostly nurses and some doctors, who are on the frontline of putting women’s health first.

Their showing up and enabling access contributes towards the continuum of reproductive justice in enabling options to determine destinies.

So much work still needs to be done in the context of abortion, even in the basics such as the language used in abortion issues. The language of abortion is important, all pregnancies terminate, and not all pregnancies terminate in an abortion.

Given the stigmatisation of abortion, there has been a phase of using termination of pregnancy or TOP as a euphemism. The World Health Organisation refers to the procedure as abortion and not TOP.

The dodging and diving in using the language of TOP and miscarriages create further confusion and over time has also hindered good monitoring for the Confidential Maternal Mortality Enquiry report used to monitor deaths from septic abortion.

Now it is all a bit muddy with pregnancy-related sepsis and septic miscarriages being used as indicators. Historically the Department of Health has not been able to provide reliable data. For example, in South Africa it is unclear whether an HIV-positive woman who dies from a septic abortion is classified as death from abortion or HIV.

In February of 1997, South Africa enacted a globally renowned law on abortion, motivated to redress the imbalances of the past where 429 black women died each year from lack of access to these health services.

This Act came to be known as the Choice on Termination of Pregnancy Act of 1996 (CTOPA). The political act of passing this legislation was historical in laying the framework for Reproductive Justice in South Africa. Less than 7% of the country’s health facilities provide abortions, creating a barrier to equal access for all, especially those based in rural communities.

Over the past 15 years the SA Health Products Regulatory Authority has failed to register generic medication abortion products, despite these reproductive health commodities being listed as essential medicines. Deaths from abortion are estimated from miscarriages and from pregnancy-related sepsis and account for 10% of direct obstetric deaths. Most of the deaths take place in Gauteng.

Yet abortion is a safe procedure and these deaths are a grave reproductive injustice as this mostly affects black pregnant people. The Department of Health developed National Clinical Guidelines on Abortion in 2018, yet it has not passed these nor planned budgetary allocations to implement them.

These guidelines will be key not only for South African women, but also for providers by creating an enabling working environment. Violence is endemic in South Africa and is also experienced in health clinics. Our efforts in recognising and appreciating providers are working towards destigmatising this essential reproductive health service guaranteed by our constitutional and legal provisions.

We honour these women and men, who continue to be relentless in their pursuit to provide this necessary reproductive justice service. It is not an easy task, but yet they show up on the job, daily.

Mostly, their decision to show up saves the lives of thousands of women annually. As the SRJC we have borne witness to this. That is why together with the FemmeProjects we are also working hard to ensure that all South Africans have equal access to Reproductive Justice services such as comprehensive sexuality education, contraception options, fair treatment by health providers and free public access to abortion services. DM

Here is a link to our reproductive justice election petition. Please sign here and share with your networks.

History of violence against abortion providers in the US

  • Granite City, Illinois — August 1982: Dr Hector Zevallos and his wife were kidnapped at gunpoint by members of the “Army of God” and held hostage for more than a week.

  • Springfield, Missouri — December 1991: A masked gunman shot and paralysed a clinic worker A second person was wounded in the attack. No arrests have been made.

  • Houston, Texas — 1991: Dr Karpen was shot and wounded outside his clinic. Assailant was never apprehended.

  • Pensacola, Florida — March 10, 1993: Dr David Gunn was shot and killed while entering a clinic during an anti-abortion demonstration by Rescue America. Michael Griffin was sentenced to life.

  • Wichita, Kansas — August 19, 1993: Dr George Tiller was shot in both arms at point-blank range by Rachelle “Shelley” Shannon as he was leaving his clinic. Shannon was sentenced to 11 years. During its investigation of Shannon, law enforcement uncovered the “Army of God” manual buried in her backyard.

  • Mobile, Alabama – August 21, 1993: Dr George Patterson was shot to death in a parking lot; police classified his death as the result of a robbery, though nothing was taken from his car or on his body. Patterson owned the clinic in Pensacola, Florida where Dr Gunn was shot and killed, as well as three other clinics.

  • Pensacola, Florida — July, 1994: Dr John Bayard Britton and volunteer clinic escort Lt-Col James Barrett were murdered by anti-abortion extremist Paul Hill as they arrived at the clinic. Barrett’s wife and volunteer escort, June Barrett, were also shot and wounded in the attack. Paul Hill was convicted of the double murders and sentenced to death. Hill was executed, becoming a martyr in the Army of God.

  • Vancouver, Canada — November 8, 1994: Dr Garson Romalis was shot and severely wounded in the leg by a sniper with a high-powered rifle fired through the window of Romalis’s home. James Charles Kopp, a member of the Army of God, remains a primary suspect in the assassination attempt.

  • Brookline, Massachusetts — December 30, 1994: John Salvi shot and killed Planned Parenthood receptionist Shannon Lowney. At a second clinic, he shot and killed receptionist Leanne Nichols. Five others were wounded in the attacks. Salvi then drove to a clinic in Norfolk, Virginia and was arrested after repeatedly shooting outside the clinic trying to gain entrance. Salvi killed himself while serving a life sentence.

  • St Louis, Missouri – August 16, 1995: FBI arrests Robert Cook, who was threatening to start a war by killing an unnamed abortion doctor on August 22. Cook is later convicted of an armed car robbery and of using some of the funds from the robbery to buy and store an arsenal of weapons to kill abortion providers.

  • Ancaster, Ontario — November 10, 1995: Dr Hugh Short was shot in the elbow by a sniper using a high-powered rifle to shoot through the window of Short’s home. Army of God member James Charles Kopp charged in the assassination attempt.

  • New Orleans, Louisiana — December 1996: Dr C. Jackson was brutally stabbed 15 times outside his clinic. The assailant was then arrested at a Baton Rouge clinic as he lay in wait for another doctor.

  • Atlanta, Georigia — January 6, 1997: Two bombs explode at Northside Family Planning. The first bomb destroyed the clinic interior and the second, an anti-personnel device, went off an hour later injuring seven, including federal law enforcement agents. Three weeks later a similar double bombing occurred at an area lesbian nightclub, injuring five people. The Army of God claimed credit for both bombings in letters to news media. Eric Robert Rudolph was eventually charged in the bombing after he also bombed a clinic in Birmingham, Alabama in 1998.

  • Winnipeg, Canada — November 11, 1997: Dr Jack Fainman was shot by a sniper with a high-powered rifle while in his home. Missing his heart by centimetres, the bullet tore through his shoulder. Army of God member James Charles Kopp remains a primary suspect.

  • Rochester, New York — October 28, 1997: Dr David Gandell was wounded by flying glass when a sniper with a high powered rifle shot into his home. Army of God member James Charles Kopp remains a primary suspect.

  • Birmingham, Alabama — January 29, 1998: A bomb packed with nails exploded at the New Woman, All Women clinic, killing the security guard and maiming a clinic nurse. Army of God claimed credit in letter to news media. Eric Robert Rudolph was charged and placed on the FBI’s 10 Most Wanted List. He remained a fugitive for five years before he was finally captured in May 2003. Rudolph pled guilty to the Alabama and Atlanta bombings and was sentenced to four consecutive life terms.

  • Amherst, New York — October 23, 1998: Dr Barnett Slepian was shot and killed by a sniper with a high powered rifle while standing with his wife and children in the kitchen of his home. Army of God member James Charles Kopp was charged in the slaying and placed on the FBI’s 10 Most Wanted List. Kopp escaped through Mexico to Ireland and France, remaining a fugitive for three years. He was arrested in Dinan, France where he had taken refuge in a monastery run by a St Pius X Catholic sect.

  • Vancouver, Canada — July 11, 2000: Dr Garson Romalis was stabbed in the back by an unknown assailant as he entered his clinic. Assailant remains at large.

  • Wichita, Kansas – May 31, 2009: Dr George Tiller, a longtime target of anti-abortion extremists, was shot and killed by a single gunshot to his head. Tiller was killed as he was attending services at his church. Anti-abortion extremist Scott Roeder was convicted of the murder and sentenced to 50 years to life in prison. Roeder reportedly had participated in demonstrations organised by Operation Rescue and had a note in his car with Operation Rescue’s Cheryl Sullenger’s name and phone number when he was arrested. According to press accounts, Roeder had also met and been in communication with Army of God members Shelley Shannon, David Leach, Michael Bray and Regina Dinwiddie.

  • Colorado Springs, Colorado — November 27, 2015: Robert Lewis Dear killed three and injured nine at a Planned Parenthood clinic in Colorado Springs. Dear has been formally charged with 179 felony counts, including eight counts of first-degree murder and 131 counts of attempted first-degree murder. Dear’s rampage was one of the worst acts of violence carried out by an anti-abortion extremist in the United States. Dear used the language “no more baby parts” upon his arrest, leading many to believe that his motivation for attacking the reproductive health clinic may have been tied to the release of several deceptive and highly edited videos created by the anti-abortion group Centre for Medical Progress several months before the attack.

Marion Stevens, Sexual and Reproductive Justice Coalition


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