POLICY BRIEF article
Front. Reprod. Health
Sec. Access and Barriers to Reproductive Health Services
This article is part of the Research TopicAddressing Sexual Health Disparities in Vulnerable Communities: Pathways from Challenges to SolutionsView all 3 articles
Abortion Providers as Human Rights Defenders: Policy Priorities for South Africa's CTOP Act
Provisionally accepted
- 1University of Witwatersrand, Johannesburg, South Africa
- 2University of the Witwatersrand Johannesburg, Johannesburg, South Africa
- 3Universiteit van Amsterdam, Amsterdam, Netherlands
- 4University of Cape Town, Rondebosch, South Africa
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South Africa's Choice on Termination of Pregnancy Act (CTOP) protects legal abortion access, yet systemic service delivery barriers persist, limiting care and contributing to preventable maternal morbidity. This policy brief draws on a 2023–2024 mixed-methods study, including a literature review, online survey, focus groups, and in-depth interviews with 33 abortion providers across seven provinces. Findings highlight chronic underinvestment, staffing shortages, unclear conscientious objection guidelines, facility-based stigma, and inadequate managerial support, alongside discrimination against women seeking services. These barriers drive some women toward unsafe alternatives. Despite challenges, providers remain committed, viewing their work as central to reproductive justice and constitutional rights. Addressing gaps requires integrating CTOP into core services, expanding values clarification training, supporting providers, enforcing rights-based guidelines, and engaging communities to ensure safe abortion care.
Keywords: Abortion, Conscientious objection, CTOP, Health Systems, healthcare providers, Nurses, Pregnancy, reproductive justice
Received: 17 Oct 2025; Accepted: 16 Dec 2025.
Copyright: © 2025 Khofi, Rucell and Matandela. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lucy Khofi
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