Exploration of the Views of Traditional Healers regarding the Termination of Pregnancy (top) Law

Curationis 29(3): 56-60 The NorthWest Province is predominantly a rural area, and traditional healers remain the most important and influential members of the rural communities. A qualitative, explorative, descriptive and contextual research design was used. In-depth, individual focused and interactive interviews were held with eight traditional healers from the rural areas of Mmabatho-Mafikeng. In addition, field notes and observations were utilised. The objective of this article is to explore the views of the traditional healers regarding termination of pregnancy (TOP) law. The results reflected the following themes: termination of pregnancy is killing; a child is a precious gift from God and the ancestors; there are alternatives to TOP; people who had any type of abortion should be cleansed with " dipitsa " or herbs; TOP may be allowed only in case of rape and incest, rape and incest offenders should be severely punished; and the traditional healers were not consulted during formulation of the TOP Law. It is therefore recommended that traditional should be involved in TOP workshops and educational programmes to enable them to provide counselling before and after abortion. Opsomming Die Noordwes Provinsie is 'n hoofsaaklik plattelandse gebied en tradisionele genesers bly die belangrikste en mees invloedryke lede van die plattelandse gemeenskappe. 'n Kwalitatiewe, verkennende, beskrywende en kontekstuele navorsingsontwerp is gebruik. Indiepte, individuele, interaktiewe en fokusonderhoude is met agt tradisionele genesers van die plattelandse gebiede van Mmabatho-Mafikeng gevoer. Voorts is daar van veldnotas en waamemings gebruik gemaak. Die doelstelling van hierdie artikel is om die menings van die tradisionele genesers in verband met die bee'indiging van swangerskap in te win. Uit die resultate het die volgende temas na vore getree: beëindiging van swangerskap is moord; 'n kind is 'n waardevolle geskenk van God en die voorvaders, daar is altematiewe vir die terminering van swangerskap; persone wat enige tipe van aborsie ondergaan het moet met " dipitsa " of kruie skoongemaak word, beëindiging van swangerskap mag slegs in gevalle van verkragting of bloedskande toegelaat word en oortreders van verkragting en bloedskande behoort emstig gestraf te word; en die tradisionele genesers is nie gedurende die formulering van die Wet op die Beëindiging van Swangerskap geraadpleeg nie. Dit word dus aanbeveel dat tradisionele genesers by werkswinkels oor die Beei'ndiging van Swangerskap en an d er o p v o ed k u n d ig e program m e ingesluit moet word om hulle daartoe in staat te stel om berading …


Introduction
The North-West Province is 60% rural.In this region the traditional healers remain the most important and influential m em bers o f the rural com m unities.According to Abdool Karim, Ziqubu and Arendse (1994:14) they are the custodians o f the A frican b e lie f system .The traditional healers were also identified as im portant com ponents o f the South African broader primary health care team (Draft Bill no. 24704,2003:3).Their views regarding term ination o f pregnancy (TOP) are crucial, especially in that the g o v ern m e n t re q u ires com m unity participation in the delivery of the health care services.
Under the previous Act, the Abortion and Sterilisation Act, Act, No. 2 of 1975, abortion was only available for reasons like rape or incest or where there was a su b stan tial risk that the con tin u ed pregnancy would pose a threat to the health of the mother or the child or in the case where the child would be severely mentally or physically disabled.This Act did not accommodate any woman with an unwanted pregnancy (Potgieter & Andrews, 2004:21).
In the research of Potgieter and Andrews (2004: 25) with 22 TOP providers one of the the participants m entioned many women, irrespective of the contraception they took, had unplanned children which became street children.These women also had backstreet abortions, tried to do the abortion themselves and many died.

Problem statement
From 1 February 1997, the Choice of Termination of Pregnancy, Act No. 92 of 1996, became a law.The Act allows A w om an to re q u e st term in atio n of preg n an cy w ith o u t co n su ltin g the partner or the parent, in the case of a m inor, in the first tw elve w eeks of pregnancy.
The success of TOP depends on the view s o f the h ea lth w o rk ers, the communities and the traditional healers.The essential point here is that the traditional healers form part of the people who may contribute to the success of failure o f TOP.They are influential members of the community, thus their opinions are very important.In this research the following research question became relevant: "What are the views o f the traditional healers regarding TO P?"

Objective of the study
The objective of the study was the following: • to explore and describe the views of the traditional healers regarding TOP.

Operational definitions
The following terms are used to convey the meanings of the main concepts in this study:

Traditional healers
According to Steyn and Muller (2000:5-6) traditional healers are diviners guided by th eir a m a d lo zi (a n c e sto rs) and co n su lted by p eo p le o f all strata regardless of race, age, gender and level of education.They rely on the bones to make a diagnosis and use herbs for which they were sometimes guided to go and dig in the veld for the ingredients.

Termination of pregnancy (TOP)
Termination of pregnancy (TOP) refers to the act of bringing a pregnancy to a final end preventing the birth of a live baby.The m anual vacuum (MVA) techniques is used m ostly Dickson-Tetteh, 1999:20).

Ethical considerations
All the participants were informed that the information given would be treated with the strictest confidence.Their names would not be written or used to ensure anonym ity.The p artic ip a n ts also received the report o f the research project.

Research method
A qualitative, explorative, descriptive and contextual research design was used.Indepth, individual focused interviews were held with the participants in their hom es or w ork in g places d uring N ovem ber -D ecem ber 1998.The participants were purposefully selected to provide their views regarding TOP.
Only eight participants were reviewed because they were the only traditional healers in the rural areas of the North-West Province that were w illing to participate in the research, Audiotapes, which were transcribed later, were used.In addition to interactive observation field notes were utilised.

Results
Eight participants aged from 40 -75 years, from the rural areas participated.Fifty percent (n=4) w ere m ales and the remaining fifty percent were females.
The fo llo w in g them es reg ard in g termination of pregnancy were identified from the traditional healer's views:

Termination of pregnancy is killing
Almost all the traditional healers, with the ex cep tio n o f one, w ere against term ination of pregnancy because of moral and religious beliefs.
They believed that abortion is murder, or killing a child or a human being: "According to the Botswana culture and Christian religion, that is killing.We take TOP like killing... ".

"...T h o u sa n d s o f o ur p e o p le view abortion as a crime, worse than murder, because they say that by committing abortion, you are killing som ething w hich w as th o u sa n d tim es m ore precious than an a d u lt. . . ".
The results supported the conservative view stated in Olen and Barry (1992:164), that abortion is never morally justifiable.This view is commonly associated with the Roman Catholics, although they are ce rtain ly not the only g ro u p that espouses it.The view is also in line with w hat H ord and X aba (2000: 16), mentioned when they stated that nurses who are against TOP choose not to be trained because abortion is against their religious beliefs.
Poggenpoel, M yburgh and G m einer (1998:2) in their study conducted in Gauteng Province indicated that the majority of nurses were of the opinion that the women, as well as the health services d elivery sta ff involved in abortion are murderers.The traditio n al healers, nurses and doctors had the same voice regarding TOP: "Batho ba iphetotse mabitla ka go ntsha dimpa (People have turned themselves into graves by terminating pregnancy) ".

"The government is surprising. It has cancelled death sentence but they kill innocent children. A person has lived, experienced life and committed offences, he is left and not killed, but an innocent child who had never been given a chance to live is killed".
Newburg, head of the South African Pro-Life Association (Tancred, 1997:36), shares the same sentim ents with the traditional healers when he states that the president founded the children's fund, but at the same tim e denies a number of children life through legal abortion.

God and the ancestors
The traditional healers perceived a child as a precious gift from God and from the an c esto rs, and if one te rm in ates pregnancy, one is throwing away the gift: "Ngwana (a child) m eans a shining being, blessed being.In other words an angel.
"This is against the ancestors.A baby is a gift from God, so we must be grateful fo r that.No one is allowed to take away that God had given you ".
"I f one terminates pregnancy, one is playing with a gift that one was given by God.There are so many people who cannot conceive and on the other hand the government kills babies." There are alternatives to TOP The majority of the participants had one voice on alternatives that are available in the place of TOP.They were of the opinion that such a child should be given to relatives, institutions or agencies that can bring it up.They also reported that p re v en tativ e m easu res are freely available.
"There is a Setswana proverb that says 'go botoka go tswala kgoro go nale go bolaya potsana e e ngwegileng' (It is fa r much better to shut the gate o f the kraal than to slaughter the little goat that has managed to escape out)"."Many African men ask themselves this question, and so do women.Now that there are things such as condoms and other contraceptives, why the devil do the hospital people encourage TOP?" Smith (1995:132) supports this view by stating that abortions can be avoided through aggressive family planning in South Africa.Poggenpoel, et al (1998:2) state that contraception saves the lives of thousands of women around the world to avoid unwanted pregnancies.
Women who had an abortion of any kind should be cleansed Women who had abortions of any kind should be c lea n sed w ith h e rb s .Traditional healers spoke in one voice w hen ta lk in g about p o st-a b o rtio n cleansing.They believed that a woman who had an abortion of any kind, be spontaneous or induced, should be clean sed by being given herb s ("dipitsa")- The following statements were made by some of the traditional healers: ".M otho f a a fe te ts w e kg o tsa a sen yeg etsw e o tsh w a n etse go fiw a dipitsa " (If a person has miscarried or had an abortion, she m ust be given herbs to cleanse her)"."I f a woman is not given herbs after termination o f pregnancy and does not abstain from sexual activity fo r some time, the man is going to be sick... ". "Like a person who has lost a baby ( 'a fe te ts w e ') she is su p p o sed to take 'dipitsa tsa Setswana ' (cultural herbs) ".

TOP may be permissible in cases of rape and incest
The participants were of the opinion that TOP may be done in cases of rape and incest.
Som e o f the p a rtic ip a n ts verbalised this as follows:

"It is u n d ersto o d u n d er ce rta in circumstances, such as rape, and in cases w here a p erso n has been pregnated by her father or uncle
''There are always exceptions to the rules.Rape has various consequences.Really, only if there was a clause which says at your choice after rape, and not fo r everybody who wants to terminate the pregnancy...".The traditional healers echoed the same fe elin g s as m any o th e r p eo p le, in particular women, as reported almost daily in the media.
Traditional healers were not consulted during the formulation of the TOP law T raditional healers w ere angry and u nh ap p y b ec au se they w ere not consulted when this important law on TOP was form ulated.
N urses, as reported by Poggenpoel, et al (1998:4) also voiced this feeling.Traditional healers stated: "P lea se u n d e rsta n d me and listen carefully.The government may have consulted oth er people, but we, the tr a d itio n a l h ea lers, w ere n ever consulted... "You are the f i r s t p eo p le fro m the government to come to talk to us about this law... ".This latter statement was verbalised by 87% (n=7) of the participants.
Approxim ately 425 women in South Africa died each year in public hospitals because of the complications of unsafe ab o rtio n (R ees, K atzen ellen b o g en , Shabodien, Jewkes, Fawkus, McIntyre, L o m b ard , T ru te r & The N atio n al Incomplete Abortion Reference Group, 1997:432437.F or m any years w om en in A frican societies have used herbs and other tra d itio n a l m ed icin e to term in ate unw anted pregnancies (P otgieter & Andrews, 2004: 26).
' 'B ut n obody w ho cla im s to be e n lig h te n e d or e d u c a te d sh o u ld condone a baby born o f incest or rape.No, I am sorry.The hospitals must do that duty o f terminating the pregnancy, but it should be with the consultation o f the fam ily Rape and incest offenders should be severely punished The traditional healers were angry and unhappy about the rapists and incest o ffen d ers.T h ey stro n g ly fe lt that offenders should be severely punished: "To have sex with a child or a family member o r a relative is ... and such people should be killed".'"Such offenders should be eliminated from society by killing them... "'Such offenders are in the increase because the law and society are laxed.They need to be killed... ".

2006 Measures for trustworthiness
According to the Collins Cobuild English Dictionary for Advanced Learners (2001) a " person' s world view is the way they see and u n d e rsta n d the w orld, esoecially regarding issues such as politics, philosophy, and religion".57 Curationis August