Social networks played an important role in women’s abortion seeking trajectory and in supporting and advising women how to access an informal abortion. Upon considering themselves pregnant, most women disclosed and sought advice about informal abortion options from friends who had personal experience accessing informal abortions, knew someone who could perform the informal abortion or knew how to self-induce using a self-prepared herbal mixture or substance.
Advice and assistance in obtaining an informal abortion was further underscored by friends vouching for the safety of a provider or particular method. Women discussed how knowing a friend who had successfully had an informal abortion without health complications influenced their decision to opt for an informal abortion.
A participant recounted how her friend endorsed an unlicensed provider based on his perceived safety. The unlicensed provider provided her with two white tablets.
She [friend] also had the same abortion … like 10 or so months before and I knew about it that was why I spoke to her. And then she showed me okay, it’s this doctor, she showed me like in the paper, he’s got a regular ad in there and the same doctor’s also got stickers all over in the train, … so she just showed me that’s the one that she used. The reason why she encouraged me to use him because when she went there, compared to the other places that she’s heard of or the other stories, his place was clean … I trust her and somehow it made me feel a little bit better knowing that one of my friends went to the person.
Another participant discussed her need for an abortion with a trusted friend who in turn suggested a traditional herbal medicine and offered to help in sourcing the herbal medicines.
I bought some things, there was a friend of mine she had an abortion also, so she told me what to do what to buy…and then she escorted me to go and get them…”
Participants sources of information extended beyond their social networks to include the proliferation of advertisements for “safe and quick abortions” in public spaces (trains and community newspapers) which were often endorsed by friends. These unlicensed providers all provided unknown oral tablets to induce abortion presumably misoprostol.
“I saw an advert and then I spoke to a friend who had also been to the same person, they call him, like a herbalist … he had an advert in the paper and also on the train, these stickers that they give out and it said there are abortions for R 300 like in 30 minutes…”
Method of abortion
Participants discussed employing three different methods when attempting an informal abortion. These included: drinking a mixture prepared by a traditional healer; contacting a non-licensed provider who provided oral abortifacients and preparing or buying a mixture for a self -managed abortion. Trusted social networks again played a crucial role in guiding women in accessing these methods.
Some participants described utilizing the services of a traditional healer recommended by friends who had previously accessed their services for an informal abortion. Participants who utilized the services of a traditional healer mostly described the abortion mixture as brown or white in colour, having an offensive taste and in some cases using dried aloe vera.
I go to traditional doctor near the taxi rank to give me some, aloe vera…I drink that aloe vera. it tastes horrible…I take only a spoon because it is too much strong…if you take the three spoons you are going to die that guy [traditional healer] tells you…
Some participants however discussed paying a traditional healer for a list of reportedly easily obtainable herbal and other ingredients and received instructions on how to prepare the mixture themselves.
Unlicensed providers who advertised their services illegally online, on trains and other public spaces most commonly supplied participants with unmarked tablets of varying sizes, shapes, and colour to terminate their pregnancy. Some participants were instructed to swallow the tablets at specified times and to expect vaginal bleeding.
He gave me two pills and told me I must take one when I leave his office. The second one [tablet], I must take it when I get home…it was two of the same pills to me it looked the same, I didn’t see any name on the tablet …He just said to me it will basically be like getting period pains and then the bleeding will come down. He said most of the bleeding should happen in a space of 24 hours…it should be complete and then just like normal periods, they can last up to 2 weeks …
All participants who attempted an informal abortion using a self-abortion mixture were informed of the method by a friend who had successfully used the mixture to induce an abortion.
A friend of mind told me how to do an abortion because she had one and she did it the same way…She told me how to prepare the mixture…and we made it at my friend’s place.
Some participants reportedly sought formal medical intervention after attempting an informal abortion. Reasons for doing so included experiencing complications such as a possible infection or bleeding or when they considered the informal abortion to be unsuccessful.
After [attempting informal abortion], I developed an intense fever and I said okay I’m going to go to the clinic just to check it out and to tell them what happened… I went there and I spoke to the Sister [nurse] and I told her everything and she shouted at me, told me how stupid I was, why didn’t I come there. I couldn’t tell her exactly why… She [nurse] checked and I ended up having an infection., so they treated that at the clinic … and then after that the bleeding stopped and it was better.
Almost all women (13/15) who attempted an informal abortion whether through tablets or herbal mixtures reported bleeding post abortion. The duration of bleeding ranged from one day to three weeks. Whilst post abortion bleeding is common, women were not fully aware of what to expect, became concerned and a few sought assistance at health care facilities. A participant was concerned about bleeding for three weeks.
I was still on blood [three weeks after], the blood never stopped…Then I went to the clinic they gave me the tablets to stop me [bleeding] because the blood smelt bad, not like normal blood.
Some participants reported successfully terminating their pregnancy using a mixture of herbs and in one case unknown “white tablets” assumed to be misoprostol.
Yes, it [white tablets with concentrated orange juice] works because… After three days… I went to school, but I was still bleeding that time but not so heavy like before.”
I’m worried because it was the first time, I’m making abortion, but that method [herbal mixtures and vodka] make me nice… Yes, it works.
However, a few participants cautioned against accessing illegal (“backyarder”) providers or using dangerous household cleaning materials even though they had not personally attempted these methods.
What I understand now – go and do a safe abortion to the professionals. Don’t go to the backyarders. Those oro crushes, steel wool, those things, you may end up getting cancer. Instead of going to backyarders go to the professionals.
Whilst women reported diverse outcomes post abortion most felt that certain methods especially if endorsed by friends were still preferable to accessing the formal health care sector where provider attitudes and treatment were unpredictable.
Reasons for seeking an informal abortion
Pathways to seeking an informal abortion for many women, especially those who were involved in work in the informal sector, such as sex work, were informed by social stigma. Fear of judgement and mistreatment by clinic staff or privacy and confidentiality concerns were reported by most women as a major consideration influencing their decision to opt for an informal abortion.
A sex worker explained her reasons for seeking an informal abortion were linked to fear of recognition and judgemental attitudes towards sex workers, further underscored by seeking an abortion. Accessing an informal, “backdoor” provider ensured more privacy and anonymity and privacy outweighed safety issues. In sum, she felt being judged as a sex worker and seeking an abortion.
I don’t like going there [the clinic] because some of the staff, they are familiar with certain female faces, since you are living in the area … And when I go to the clinic then you can feel there’s gossip about you … that makes a person feel very uneasy it’s like judging you. You find it difficult to go to the clinics because of how the staff then treats you according to what they know what you do for a living.
She further explained her reasoning for accessing an informal provider:
…then that’s when I had no choice … I’m too embarrassed and shy and ashamed to go to the hospital to do it the right way, I’m going to do it the backdoor…. at least no-one’s going to know, less people that see me the better, it’s safer for me.
Other reasons reported by women for accessing an informal abortion were avoiding delays, especially related to gestational age screening. This influenced their decision to have an informal abortion.
Sometimes you feel like you take the short way…Sometimes at the clinic you have to go to the scans and those paperwork –it’s a long process. But this one [informal abortion] you know you will do quickly. I know it’s very risky but sometimes when you are desperate you want a short cut.
However, whilst women accessed the informal sector to terminate a pregnancy,
many participants discussed their preference for allopathic medicine if they or their family required medical attention for minor illnesses such as flu and for chronic medication again reinforcing reluctance to access the formal sector for an abortion due to social stigma and associated attitudes towards seeking an abortion.
If you got a flu you go to the doctor to get some medication, Disprin [aspirin] and Panado [Paracetamol].
Similarly, a participant accessing the public sector for antiretroviral HIV treatment explained:
I normally attend a public health care facility when I require medical assistance. I do because I am on ARVS, I am confident with my doctor, I know my doctor, I can tell him anything.