50.50: Investigation

Revealed: US-linked anti-abortion centres ‘violating the law’ in South Africa

Top health official vows to investigate campaigners who target women with dangerous misinformation, as government stands accused of ‘tacit approval’ 

Kerry mugshot.jpg
Kerry Cullinan Masutane Modjadji Christi Nortier
11 February 2020, 2.05am
Video testimony from openDemocracy’s investigation.
Credit: openDemocracy.

A senior South African health official has today vowed action as openDemocracy reveals how vulnerable women and girls are being fed misinformation in US-backed “crisis pregnancy centres” across the world. 

Supported by US Christian campaigners who claim close links to the Trump White House, around the world these centres appear to offer pregnant women unbiased “advice”. But, openDemocracy’s investigation found that staff at some of these centres across continents try to dissuade women from having legal abortions, and in some cases, from accessing contraception. 

In Pretoria, the Crossroads Pregnancy Help Centre says on its website that it offers women “counselling in a safe environment with accurate information about all options available for you to make an informed decision”.

However, an undercover reporter, posing as a vulnerable woman facing a crisis pregnancy, was told “abortion is murder”; that she could be “killing a future president” and that she would “always be haunted by her choice”.

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Meanwhile at the Seasons Pregnancy Centre inside Stellenbosch Regional Hospital, 1400km away, another undercover reporter was warned that she could face “post-abortion syndrome” involving “depression and nightmares”. A range of reputable research has debunked the existence of such a syndrome.

"She was told that she could be
killing a future president"

South Africa’s 1996 Choice on Termination of Pregnancy Act clearly stipulates that counselling of pregnant women must be "non-directive". This means that counsellors cannot push women to make any particular decisions. 

“By offering directive counselling, they are violating the law and the national guidelines and we will take action," says Yogan Pillay, deputy director general at the department of health, responsible for maternal, child and women’s health.

The Seasons and Crossroads centres are among 50 South African affiliates of Heartbeat International, a US Christian conservative organisation created almost 50 years ago as part of the backlash against abortion rights in America. 

Today, an 18-country investigation by openDemocracy reveals how Heartbeat has funded and coordinated anti-abortion organisations around the world. 

At Heartbeat affiliates across continents, undercover reporters were fed inaccurate and misleading information, including false claims that: 

  • abortion increases women’s risks of getting cancer; 
  • a woman needs consent from a partner to access a termination;
  • hospitals will refuse to treat serious complications from abortions. 

Materials from Heartbeat’s trainings, which are available at a discount to its affiliates, show a trainer telling a hypothetical caller to delay accessing abortion and emergency contraception and claiming that condoms don’t work.

A second Heartbeat webinar teaches people misinformation including that abortion increases risk of abuse of other children and can ‘turn’ partners gay.

Responding to openDemocracy’s questions, Heartbeat said “we stand firmly by our Commitment of Care” – a standards document that commits affiliates to accuracy in their information and advertising – “and by all our training resources designed for the pregnancy help community”. 

“Different countries have their cultures and varied ways of communicating, the fact remains that abortion carries risks to women”, Heartbeat added. “With love and truth, our goal is to help the client understand abortion more fully, so that she can truly make an informed decision.”

‘Tacit approval’ for law-breaking

In South Africa, Pillay urged members of the public to “report the illegal actions of these centres to the [health] department”, which he says can then write to these centres and “ask them why they are breaking the law.”

But Marion Stevens, director of the Sexual and Reproductive Justice Coalition, a network of civil society groups, was sceptical about the government taking action. She remembers giving a briefing on these centres to parliament in 1995. Decades later, she says they’re “flourishing in South Africa”.

“Their counselling continues to be directive, they have a clear anti-abortion agenda and are well known”, she says, adding: “I am concerned that the department of health tacitly approves of their services by not ensuring that the services they provide are consistent with our law.”

In reponse, Pillay at the health department says it did not approve of these anti-abortion centres and that it was working with partners to extend access to abortion, as well as training more health workers to perform abortions.

At the Western Cape Health Department, spokesperson Sandra Maritz adds that there is “no relationship” between the Stellenbosch Hospital and the Seasons crisis pregnancy centre that operates on its premises.

It has an office in the hospital’s administration block, she says, due to a separate space-sharing agreement between the centre and another mental health services NGO. “We will engage the service provider on the alleged advice given [by Seasons to clients] to determine the way forward”.

Seasons billboard on Stellenbosch Hospital grounds
Christi Nortier/Daily Maverick

Abortion is illegal or heavily restricted across most of Africa. The region has the world’s highest death rate from unsafe abortions. At least 16,000 women died from these in 2014, according to research from the Guttmacher Institute. 

Last year, the World Health Organisation estimated that three-quarters of abortions in Africa were unsafe and caused up to 13% of maternal deaths. Globally, it added, 7 million women are also hospitalised every year for complications from unsafe abortions.

In South Africa, Heartbeat has an international partnership with a network called Africa Cares for Life (ACFL) which it has given more than $200,000 since 2007, according to openDemocracy’s analysis of its US financial filings. 

It also has affiliates across Africa, including centres in Uganda, Nigeria, and Zambia that are part of a network called the Association for Life of Africa (AFLA) which has received almost $50,000 from the US group since 2013.

In Uganda, abortion is illegal unless the woman’s life is at risk, but the government has programmes to provide free contraception. Yet when an undercover reporter called a Heartbeat affiliate in Kampala, Alma Family Centre, she was told that emergency contraception is an ‘early abortion.”

In Nigeria, staff at two Heartbeat affiliates interrogated openDemocracy’s reporter about who had impregnated her, and staff at one of these centres also offered to pay for her hospital fees if she gave birth.

In Zambia, where the AFLA network is based, its head told a reporter that Heartbeat gave it an ultrasound machine that helps women to change their minds about having abortions. Internationally, undercover reporters were also offered ultrasounds at anti-abortion centres in Mexico and Costa Rica.

In response to requests for comment from openDemocracy, the Crossroads centre in South Africa acknowledged that it was part of the ACFL network. But it said it would only answer questions related to its counselling methods at a face-to-face meeting in Pretoria. The Seasons centre did not respond to requests for comment, and neither did the Alma Centre in Uganda.

‘A centre in every town’

Africa Cares for Life executive director Daniele Gradwell confirmed that Heartbeat is one of its donors, but didn’t give details about how it has spent its money. She calls this network “life-affirming” rather than anti-abortion, and says that its centres give “non-biased, non-manipulative advice”. 

Claiming that it reached 31,000 women between January and October 2019, Gradwell adds: “All our counsellors are trained not to coerce a client but get them to reach a decision that they can live with”. Looking forward, she says the network intends to establish a “pregnancy help centre” in every town in the country, ideally all equipped with ultrasound machines.

Responding to further questions from openDemocracy, she says “pregnancy centre volunteers are trained to perform ultrasounds on pregnant women” but these “are not used to diagnose but rather to offer a window to the womb”.

At the health department, deputy director general Pillay expressed deep concern about the possibility that untrained "lay people" could be conducting ultrasounds on pregnant women. “This is not acceptable. Even nurses cannot do ultrasounds unless they have been specifically trained,” he says.

“You find a lot of the same judgemental attitudes in the public sector, and this needs to be addressed”

Jane Harries, University of Cape Town

Although abortion is legal in South Africa, upon request up to the thirteenth week of pregnancy, these procedures are available at fewer than 7% of public health facilities (264 out of 3880), mainly because many health workers refuse to perform abortion, according to a 2017 report from Amnesty International. 

Jane Harries from the Women’s Health Research Unit in the School of Public Health at the University of Cape Town explains: “South Africa has the highest rate of second-trimester abortions in the world, with over 20% of abortions taking place in the second trimester. This indicates a problem of access.”

“Women need to be seen as soon as possible. There is a need for early access to abortion but the department of health has struggled to roll it out”, Harries says. “There are a lot of the same judgmental attitudes you will find in a crisis pregnancy centre in the public health sector, and this needs to be addressed.”

By using guilt and shame to coerce young women to continue pregnancies, these centres are “placing undue burden on poor women”, adds Marion Stevens at the Sexual and Reproductive Justice Coalition, “it is no wonder we see so many women arrested for late procurement of illegal abortions”.

Responding to openDemocracy’s findings, Eddie Mhlanga, one of the architects of South Africa’s 1996 abortion law, says: “The tactic of actively persuading a woman not to terminate her pregnancy, irrespective of her personal circumstances, is not acceptable.” 

Mhlanga, an obstetrician-gynaecologist in the Mpumalanga health department, who is also co-leader of the NGO Global Doctors for Choice, and trains health workers on how to perform abortions, continues: "In some cases it is simply not possible for a woman to give birth.” 

“It is not God's will that a woman gets raped and then has to give birth – not the will of the God that I serve,” he argues. "This kind of counselling is causing guilt that is harming women's mental health. Women should be supported to make this decision, not coerced, intimidated, judged or threatened.”

But he’s also not entirely surprised by our revelations. “South Africa”, Mhlanga says, “is increasingly in the clutches of the US right-wing fundamentalists”.

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