Gauteng’s compulsory teen contraception plan runs into storm of opposition

Gauteng Health and Wellness MEC Nomantu Nkomo-Ralehoko unveiled plans on Thursday, 16 January 2025 to roll out contraceptive implants for schoolgirls across the province. The controversial initiative, aimed at reducing teen pregnancies, will be carried out only with parental consent. 

During a visit to Tshwane Secondary School in Pretoria, Nkomo-Ralehoko said teenage pregnancy rates, particularly among younger girls, had become a serious concern. The MEC said that Gauteng has already recorded 31 cases of teenage pregnancy in 2025.

Nkomo-Ralehoko reportedly said the Implanon implant would be mandatory once parental consent was obtained. 

“It is going to be compulsory for as long as the mother and the father sign a consent form,” she said. Each Implanon implant costs R3,000 and a full budget for the initiative will be disclosed in March 2025.

Teen pregnancy remains a significant issue in South Africa, and concerns are growing over the age and circumstances of pregnant girls, sparking intense discussions about potential solutions.

In March 2024, the Gauteng Department of Health revealed that at least 150,000 children became pregnant in South Africa during the 2022/2023 financial year. The study also highlighted that Gauteng, and particularly the Ekurhuleni Region, has seen the highest rates of learner pregnancies in the country, with the highest number of deliveries among girls aged 12 to 19.

The department said that teenage pregnancy led to irregular school attendance, poor academic performance, and, in many cases, dropping out of school. 

Read more: How education and support can break the cycle and combat teenage pregnancy in South Africa

‘Violation of bodily autonomy and constitutional rights’

Implanon is a small, flexible rod that is inserted under the skin of a person’s upper arm. It releases a steady amount of progestin, a hormone that prevents ovulation, and can provide effective contraception for up to three years. Health experts consider Implanon to be a safe and highly effective form of contraception. However, the idea of administering it to schoolgirls has raised eyebrows. 

An open letter by SECTION27, endorsed by several organisations including the Cancer Alliance, Sexual Reproductive Justice Coalition (SRJC), Soul City Institute, We Mattah, and the Critical Studies in Sexualities and Reproduction at Rhodes University, raises serious concerns over the proposed approach to curb teenage pregnancy. 

The letter states that the plan is both misguided and unlawful, particularly the decision to make the contraceptive implant Implanon compulsory for learners, based solely on parental consent.

The groups argue that any attempt to forcefully administer contraceptives to young women and girls would violate their constitutional rights to bodily integrity and autonomy. They warn that such actions would amount to gender-based violence and common law assault, echoing the historical trauma of coerced and forced sterilisation practices.

Khuselwa Dyantyi, an attorney in the Health Rights Programme at SECTION27, argued that the proposed plan contradicted the Children’s Act in several key ways. 

“Firstly, the law already allows children over the age of 12 to make their own decisions about their health, including consent for contraception. However, the MEC’s plan to roll out long-term contraceptives and requiring parental consent goes against the Children’s Act right from the start,” Dyantyi told Daily Maverick.

“Secondly, under sexual and reproductive healthcare rights, children who are capable of providing consent have the right to choose which contraceptive method they want to use. You cannot impose a specific form of contraception on children, as this violates their rights as outlined in both the Children’s Act and the Constitution,” she said.

Dyantyi said that while contraceptives could and should be made available, it should be up to the individuals who wished to use them.

Read more: Coerced contraception? Mec’s controversial approach to teenage pregnancy sparks outrage and concern

Children’s rights ‘must come before parental approval’

Rotondwa Mashige, Programme Coordinator at the Centre for Human Rights at the University of Pretoria, emphasised that the first thing that came to mind when she heard about the initiative was “consent, consent, consent”.  

She argued that when it came to any medical procedure, including reproductive interventions, consent had to come from the individual undergoing the procedure. Legally, it was essential that the individual who was directly affected by the procedure – in this case, the child receiving the implant – gave their consent first, with parental consent as an additional step.

Mashige said the first violation in this approach was the right to privacy. By involving someone else — in this case, the parents — in a decision about a child’s sexual or reproductive health, the child’s privacy was compromised. Another violation was the right to bodily integrity, which included the right to make decisions about one’s reproductive health. 

Additionally, the right to access information was potentially violated – if parents were the ones receiving information about the procedure, including its benefits, risks, and side effects, it deprived the child of the opportunity to make an informed decision. The child should be directly informed about what would happen, why it was happening, and what their options were, ensuring that consent was truly informed.

Mashige pointed to legal precedents from 1994, establishing that medical practitioners had to obtain consent before any procedure. Informed consent, she emphasised, required ensuring the child understood the procedure, its long-term effects, benefits, and how it would be performed. 

Crucially, the child’s ability to comprehend these factors had to be assessed. At the age of 12, the law presumed children were mature enough to make decisions about their healthcare, including consenting to medical interventions.

“It’s unconstitutional. Let me just put it that way. It’s unconstitutional for the MEC to say that they’re going to roll out this programme and just the consent of the parents will be needed, because you need the child’s consent,” she said. 

Addressing root causes 

Nkomo-Ralehoko acknowledged that some teenage pregnancies resulted from rape, which is why the Implanon implant was proposed to reduce the need for daily contraception. 

However, Dyantyi said the focus on curbing teen pregnancy through this approach was misdirected. She believed that while addressing teenage pregnancy was important, the proposed method did not adequately address the root causes of the issue. 

“These young girls do not impregnate themselves. Nothing has been said about the perpetrators, the men that actually are impregnating these young girls,” she said.

She highlighted that many learners became pregnant due to sexual abuse, often by older men, which constituted statutory rape. She questioned what the MEC for Health and the MEC for Education were doing to address this issue. 

Read more: Time to call the pregnancy of young girls by its real name – rape, says MP Joy Maimela

Phinah Kodisang, CEO of Soul City, welcomed initiatives aimed at expanding access to contraception and empowering young people to make informed choices about their reproductive health. However, Kodisang  stressed that contraceptive roll-outs had to be paired with comprehensive sexuality education (CSE) that covered consent, bodily autonomy, and gender power dynamics. 

“The consent and bodily autonomy of girls and young women cannot be denied by anyone,” said Kodisang.

Instead of focusing solely on contraception, Dyantyi emphasised the need for a more robust approach to tackling sexual violence and supporting survivors, highlighting that the focus should not just be on preventing pregnancies, but also on preventing abuse and ensuring the protection and safety of young girls.

Dyantyi said that curbing teenage pregnancy required a more comprehensive approach, with various stakeholders needing to be engaged, including the Department of Education, parents and the learners themselves. Additionally, she emphasised the need to examine the underlying issues that led to teenage pregnancies, rather than solely focusing on preventing them.

Department responds

The Gauteng Department of Health issued a statement on Wednesday evening addressing public concerns about its efforts to tackle teenage pregnancy, saying that as part of the back-to-school campaign, Nkomo-Ralehoko had highlighted the importance of sexual and reproductive health education, alongside parental involvement in these discussions.

The MEC had reiterated that, just as parents consent to immunisation and other health services for their children, they should also be aware of sexual and reproductive health services, including contraceptives, STI prevention and management options.
The department clarified that no girl will be compelled to receive contraceptives without her consent, and that parental involvement remains crucial in these decisions.

The Gauteng Department of Education had not replied to questions sent by Daily Maverick by the time of publication. DM

This article was updated at 9.30am on 30 January 2025 to include comment from the Gauteng Department of Health.