de Roubaix M
Centre for Applied Ethics, Department of Philosophy, University of Stellenbosch, South Africa.
Med Law. 2007 Mar;26(1):145-77.
The South African Choice on Termination of Pregnancy Act (Act 92 of 1996) (CTOP) passed by parliament ten years ago, aims to promote female reproductive autonomy through legitimising free access to abortion up to 20 weeks' of gestation. The article critically evaluates CTOP and highlights three societal concerns: the effect of CTOP on the self-esteem of nurses who perform abortion; the effect on general societal morality, and its desirability. CTOP has enjoyed mixed success. On the plus side, it has furthered female reproductive autonomy, has decreased early pregnancy maternal mortality and has advanced non-racialism through equal access to safe abortion. On the minus side, it remains controversial; the majority of the population opposes abortion on request, predominantly based on religiously-informed intuitions on the value of ante-natal life. Officials and managers of public health care facilities are often obstructive, and TOP personnel victimised and socially stigmatised. An unacceptably high rate of unsafe abortion prevails, particularly in rural areas and amongst adolescents, but also in certain urban areas. The prime causes are inadequate public education, attitudinal problems, and lack of psychological support for TOP personnel, the segregation of ante-natal care and abortion services, inadequate training, research, communication and contraceptive services, absence of incentives for TOP personnel and "traditional" gender roles and male power-based domination in reproductive choices. Corrective measures include a goal directed educational programme and initiatives like value clarification workshops which have been effective in changing negative attitudes of participants, and may thus address stigmatisation, improve working conditions of TOP personnel, promote societal tolerance and acceptance, and informed consent. Of particular concern are the questions of informed consent, minors, promotion of counselling and contraceptive services (particularly for adolescents), conscientious objection and the protection of compliant (and non-compliant) personnel.
十年前议会通过的《南非终止妊娠选择法案》（1996年第92号法案）旨在通过使妊娠20周内的堕胎合法化来促进女性生殖自主权。本文对该法案进行了批判性评估，并突出了三个社会关切问题：该法案对实施堕胎手术的护士自尊的影响；对社会总体道德的影响以及其可取性。该法案取得了好坏参半的成效。从积极方面来看，它促进了女性生殖自主权，降低了早期妊娠产妇死亡率，并通过平等获得安全堕胎服务推动了非种族主义。从消极方面来看，它仍然存在争议；大多数民众反对随意堕胎，主要基于对产前生命价值的宗教直觉。公共卫生保健设施的官员和管理人员常常从中作梗，实施堕胎手术的人员受到迫害且遭社会污名化。不安全堕胎率高得令人无法接受，尤其在农村地区和青少年群体中，某些城市地区也存在这种情况。主要原因包括公共教育不足、态度问题、对实施堕胎手术的人员缺乏心理支持、产前护理与堕胎服务的分离、培训、研究、沟通及避孕服务不足、对实施堕胎手术的人员缺乏激励措施以及“传统”性别角色和男性在生殖选择上基于权力的主导地位。纠正措施包括有针对性的教育项目以及诸如价值澄清研讨会等举措，这些举措在改变参与者的消极态度方面已见成效，从而可能解决污名化问题、改善实施堕胎手术人员的工作条件、促进社会宽容与接纳以及知情同意。特别令人关注的是知情同意、未成年人、咨询和避孕服务（尤其是针对青少年）的推广、良心拒服兵役以及对顺从（和不顺从）人员的保护等问题。
