The health workers who provide abortion services within primary healthcare facilities face an array of challenges, including the stigma that continues to shroud this aspect of sexual reproductive health in many communities. 

Building health systems means creating a culture of non-judgment, peer support and networking, according to Dr Kathryn Grammar, director of the southern/western substructures of the Western Cape Department of Health and Wellness.

“[W]e need to be co-creating services that you and I… and people who are very vulnerable in our communities, can access without judgment,” she said. “Probably one of the biggest challenges is to try to build a cadre of professionals… to enhance and further grow capacity.”

Grammar was speaking at a gathering of sexual reproductive health and abortion service providers from the Western Cape metro health district on 10 March – Abortion Provider Appreciation Day. The event was hosted by the provincial metro health services and partners.

Attendees gather at an event intended to celebrate sexual reproductive health and abortion providers operating in the Western Cape metro health district on Friday, 10 March. (Photo: Tamsin Metelerkamp)

Healthcare workers from across the metro district – including the Southern, Western, Klipfontein, Mitchells Plain, Khayelitsha and Tygerberg subdistricts – came together with civil society partners and health experts to share experiences and information about abortion services.

“It takes champions [in] making sure that we hold the flag for… comprehensive reproductive rights, so each stakeholder in this room – each individual, each team, each organisation, wherever you find yourselves in the health system… I salute you and acknowledge you for the work that you do in making the realisation of sexual reproductive health a reality,” said Grammar.

Judiac Ranape, a clinical nurse practitioner, nurse trainer and abortion provider in the southern/western substructures of the provincial health department, was one of the organisers of Friday’s event. Her own experience of becoming an abortion provider motivated her to create spaces where such practitioners could find support.

When abortions first began to be offered in primary healthcare facilities, Ranape did not become a provider due to her religious beliefs. Later, when she decided to undergo the training and take on the role, she found that some members of her church did not want to associate with her as a result. 

“I did the procedures but it was hard, and at that time, I had no support at that [health] facility where I worked,” Ranape told Maverick Citizen. 

“The only support I got was from outside, from [the Sex Workers Education and Advocacy Taskforce], from the [Sexual and Reproductive Justice Coalition] and from End Abortion Stigma.

“It was difficult. There were days when I would come home and I’d be so down and the only people I could actually tell [about] how I felt… were partner [organisations].”

In training other nurses, Ranape found that many abortion providers struggled with similar issues. Abortion Provider Appreciation Day has become an opportunity to recognise these practitioners and to create a more open culture around discussing abortion.

Nosipho Mondi, a nurse and abortion provider at False Bay Hospital, said it made a big difference to be acknowledged and hear about other practitioners’ experiences.

“I was recording some of the things that I’m going to let my colleagues hear… It makes a huge [difference to] the burden that is always on your shoulders,” she said.

There were some community members who believed young girls who fell pregnant should have to give birth, to “teach a lesson” and prevent them from falling pregnant again, said Mondi on the challenges providers face.

“Some of the patients, it’s their own families that want them to have kids,” she continued. “I had a [pregnant] patient, she was 14 [years old], and then the grandmother said, ‘You must have a child because your mother died… now I need a child and I’ll bring up that child for you’.

“I had to involve a social worker, and the grandmother didn’t like that.”

When Dr Nomafrench Mbombo, Health MEC in the Western Cape, addressed the assembled abortion providers on Friday, she emphasised that they were part of a bigger cause.

“You are the people who are preventing the majority of these unsafe, septic abortions,” she said. “We know that it’s part of the… direct causes of maternal mortality, these unsafe abortions.”

Abortion services are not only about human rights, but also justice for women, according to Mbombo.

“Do not lose focus, because you are doing it for the women,” she said. DM/MC