The therapeutic sterilisation of the mentally handicapped. Experience with the Abortion and Sterilisation Act of 1975.

The Abortion and Sterilisation Act of 1975 gives legal sanction for the sterilisation of persons with a mental handicap, and by 1989, 1,817 such persons had been sterilised in South Africa. In this paper, we review our experience in investigating all 291 persons who were referred to the Pregnancy Advisory Service of Groote Schuur Hospital for this purpose. Referrals included 37 white, 233 coloured and 21 black patients. One hundred and eight (37.1%) were severely retarded, 104 (35.7%) were moderately retarded, 70 (24%) were mildly retarded and 9 (3.2%) were not testable. None could give informed consent and the applications for sterilisation came from burdened families of whom one-third were already caring for illegitimate children born to these mentally handicapped women. Of the 291 applications, 231 (79%) were recommended for sterilisation. The main issues involved in making a decision to sterilise mentally retarded individuals are the valid assessment of the degree of retardation, the availability of alternative means of fertility control, and the complex ethical factors that have to be considered with regard to the sterilisation of persons with a mental handicap.

Therapeutic abortion on psychiatric grounds. Part III. Implementing the Abortion and Sterilization Act (1975-1981).

This article reviews the experience of the Pregnancy Advisory Service (PAS) of the Department of Psychiatry, Groote Schuur Hospital. Demographic and personal data from the women referred to the PAS during the period 1975-1981 (since the passing of the Abortion and Sterilization Act of 1975) are recorded. Follow-up information from many of the 1251 patients seen over this period confirms the findings of a previous report that in a significant percentage of cases in which a woman was refused legal abortion pregnancy did not proceed to term. For reasons which are not clear there has been a fall in the number of cases seen for assessment. The PAS performs a valuable function in enabling women to examine the circumstances of an unplanned pregnancy and in providing expert counselling.