CMScript 4 of 2023: Termination of Pregnancy

Abortion in South Africa is legal on request. The Choice on Termination of Pregnancy Act No. 92 of 1996 (The Act) gives all women the right to have a safe abortion.

Abortion should be provided to women on request with no conditions during the first 12 weeks of pregnancy. The procedure can be performed by a medical doctor, nurse or registered midwife.

The Act also allows for the abortion to be performed between 13 to 20 weeks of pregnancy by a doctor if, after consultation with the pregnant woman, the healthcare practitioner believes that:

• Pregnancy poses a risk to the woman’s physical or mental health.
• The risk of severe physical or mental abnormality in the unborn baby is substantial.
• Pregnancy resulted from rape or incest.
• The continued pregnancy would significantly affect the social or economic circumstances of the pregnant woman.

After 20 weeks of pregnancy, abortion can be performed by a medical doctor if the pregnancy endangers the woman’s life or the unborn baby’s health.

“Voluntary termination of pregnancy” is a PMB condition under Diagnosis and Treatment Pair (DTP) code 296M. The treatment component specified for this DTP is “Induced abortion; medical and surgical management”. 

The medical schemes must pay for the consultations, tests, medicines, medical or surgical abortion, and follow-up consultations and treatment in full if the services were obtained from a designated service provider (DSP). The healthcare practitioner must assist the member in completing the forms to register for PMB benefits which must be funded by the medical scheme from risk benefits. Funding of PMB claims from the Medical Savings Account (MSA) contravenes the Medical Schemes Act. 

Download the CMScript here