Ten years hence--has the South African choice on Termination of Pregnancy Act, Act 92 of 1996, realised its aims? A moral-critical evaluation.

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.