Researchers probe why so many newborns and foetuses are abandoned in landfills and velds in SA
While discoveries like these rarely make the news, it happens all the time. We asked leading forensic pathologist Shakeera Holland what her team found after studying remains at the Diepkloof Forensic Pathology Service in Soweto.
They were wrapped in plastic or foil or a piece of clothing, tucked inside a backpack or pulled from a burnt pile of rubbish. Those were how some of the remains of newborns and foetuses were found before ending up at the Diepkloof Forensic Pathology Service in Soweto.
While discoveries like these rarely make the news, they are a regular occurrence, discovered in open velds, public toilets and landfills across South Africa.
To help figure out why, researchers from Wits University gathered data about the remains that landed up at the Diepkloof facility between 2020 and 2021 and in 2023. They hope that by tracking where the remains were found and the causes of death, they will better understand why so many women are turning to desperate ways of ending their pregnancies instead of seeking legal and safe abortions.
Abandoned remains are not only a South African problem. But studies show it is extremely rare in countries like Germany (150 cases in 15 years) or Denmark (11 cases in 12 years). Research published in 2014 in the South African Medical Journal (SAMJ) found more than 1,658 cases in Mpumalanga and Gauteng alone between 2009 and 2011.
Of the 158 cases studied in the Diepkloof facility, 68 were found to be nonviable, which means they would not be able to survive outside of the mother; 29 were stillborn – when a foetus dies in the womb after 20 weeks of pregnancy. In one-third of the cases the cause of death couldn't be determined because the bodies were severely mutilated or were too badly decomposed. The researchers – Rachel Gill, Roxanne Thornton and Shakeera Holland – believe the high number of nonviable cases could be linked to illegal abortions, something backed up by the SAMJ study.
Their initial findings point to a lack of information and education about abortion and inadequate medical care, which reproductive health specialists agree are the biggest reasons women are driven to unsafe abortion providers.
In a recent episode of Bhekisisa's monthly TV programme, Health Beat, we spoke with Holland, who heads up forensic medicine and pathology at Wits University and leads investigations of unnatural deaths across eight forensic pathology facilities in Gauteng – the busiest region in the country, which handles about 28% of all the unnatural death investigations in the country.
Mia Malan spoke with her at Soweto's forensic pathology service facilities in Diepkloof. This interview was edited for clarity.
Mia Malan: How many abandoned foetuses and newborns are found?
Shakeera Holland: We don't have accurate statistics about this because there is no digital database of unnatural deaths in the whole of South Africa. What we do know is that we have about 70,000 unnatural deaths in South Africa, and of those, we estimate that about 2% are abandoned neonates [newborns in the first few weeks of life] and foetuses.
MM: In the study you supervised at the mortuary, where were the remains of these abandoned foetuses and newborns found?
SH: The majority of the time, the remains are left where it is convenient, and probably where people think they won't be found easily. So usually in open velds, landfills and dumping areas. It's less common to find them in toilets in shopping centres and other public toilets.
MM: Is there a difference in the number of female remains versus male remains?
SH: Most of the foetuses in our study were male. And most of our paediatric deaths happen to be more common in boys than girls – and this is what we see in international studies as well.
MM: What do your autopsies show? What are the causes of death?
SH: The most common cause that we see are nonviable foetuses. This means that the foetuses haven't completed sufficient time in the pregnancy for them to survive outside of the mother.
We also see a lot of stillbirths. These are babies that have completed enough gestational time in the mom to be considered viable, but they're not born deceased. In a minority of the causes we see trauma, and that can either be accidental or homicidal – but this is in very few cases.
MM: What are the most common causes of the trauma?
SH: A lot of the common causes are head injuries, and a few are related to suffocation, and we've maybe had one or two where there's sharp-force injury. For example, the foetuses or neonates have had their necks cut.
MM: Why did you do the study?
SH: We see these cases of abandoned neonates and foetuses every day. You see newspaper reports about these cases, but they make it seem as if they never happen.
In fact, they are happening every single day. I had a student who was particularly passionate about the topic and wanted to look at what is exactly going on in this area, and hopefully spark research in other places, because we don't know much about it.
MM: So when a foetus or neonate lands here, what happens to it?
SH: They undergo a medical and legal postmortem examination, which includes an autopsy. That autopsy includes any investigations that are necessary to determine the cause and circumstances of death. Once that is completed we compile a postmortem report.
That report then goes to the South African Police Service for further investigation, for them to decide whether or not there needs to be prosecution in this case and what happens to the remains. In foetuses that are less than 26 weeks the remains are discarded as medical waste. Neonates of 26 weeks and older are buried as paupers if nobody claims the remains, which means the state assumes the cost of the burial.
MM: Do you have enough doctors to conduct these autopsies?
SH: At present our doctors are doing between 500 and 600 postmortems per doctor per year. The ideal would be about 250 because we need to take into consideration that the process is not just doing autopsies. In fact, the doctor has to do the autopsy then compile a meticulous report that needs to stand up in court.
MM: We have more than 1,000 unemployed doctors in this country. Why can't you use them?
SH: We do not have enough funded posts for doctors, even though we do have a lot of doctors who would like to come and work in our service.
MM: Have you got a specific policy intervention you'd like to see?
SH: That's exactly why we do these studies. We're hoping that if we are able to shine a light on where the problems lie, we are able to give a basis for policy development to show where intervention is necessary.
I think it's very sad that the law provides for women as young as 12 to have access to contraception without parental consent if the child has a clear understanding of the process. But I feel like perhaps girls do not know enough about it, or they are not getting safe access to the service – and it's the same with termination of pregnancy. So it's a lack of knowledge perhaps, or perhaps it's a lack of access for these young women. DM
This story is based on our Health Beat TV programme, 'Why are thousands of babies dumped each year in SA instead of being safely aborted?' which was broadcast on 29 March on eNCA. Watch the full programme on Bhekisisa's YouTube channel.
If you are seeking information about abortion services, Where to Care has a list of providers in South Africa, which is regularly updated.
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