Government still lags on access to sexual and reproductive health services

In a space of about three years, 25-year-old Lulama Shongwe has changed her birth control four times. But, this was never really her choice. In 2013, she was a first-year student looking for the perfect birth control at her campus clinic. She opted for the three-month injection Depo-Provera, for its convenience.

But a nurse at her clinic insisted she try the subdermal implant, simply known as Implanon. The implant was recently new and the nurse was raving about it, she said. Shongwe eventually caved in and got the implant.

But after a year of endless sporadic menstruation, she removed the implant and started using the two-month injection, known as Nur-Isterate. Soon after – in early 2018 – her campus clinic told her they were out of stock. Again, Shongwe had to change her birth control method. She has now – against her personal preference – started using a contraceptive device.

This is a story that’s all too common for women in South Africa, activists argue. While the country has progressive sexual reproductive health policies, there’s a lot of frustration with the way some of these policies are implemented. Some result in no impact and others not even being implemented at all.

Activists say the country has good policies and implementing them has not always worked out smoothly at facility level. Sibongile Tshabalala, who is the chairperson of the Treatment Action (TAC), monitoring the availability of essential medicines at clinics and hospitals across the country has revealed that women aren’t properly educated about their choices.

Lulama Shongwe in conversation with Health-e's online and digital editor Pontsho Pilane. Image supplied.

“We’ve been having discussions with the Department of Health and [district] facility managers because the Stop Stockouts Partnership monitors shortages and accessibility [of medicine in health facilities],” Tshabalala explained.

“The department will tell us that their system shows there’s stock in facilities, but when we go into the clinics and hospitals, it’s not there. This is what is causing the rising number of women falling pregnant without planning those pregnancies.”

Nur-Isterate has been in short supply since the new tender for contraceptives was awarded in October 2017.

According to Tasniem Patel, Bayer’s Head of Communication, the shortages issues were resolved in December. 

Makua said this is a direct result of the shortages. The country’s rate of deliveries in the past three years was tapering down at a minimum of 925,000, she explained. But in the previous year, it shot back to up to 1.1-million.

“The minute these figures go up, then this has an impact on all staffing issues. It is a complex issue. But the worst-case scenario is that we will also not see any reduction in the maternal mortality rate.”

While some women may die in this situation, others may die seeking out unsafe abortions, activists argued.

For example, the stigma around termination of pregnancies at public health facilities persists despite progressive legislation on women’s rights to access abortion services in South Africa, said Section27’s National Strategic Plan Advocacy Officer Vuyokazi Gonyela.

Women are particularly affected by these ineffective policies and are currently bearing the brunt of the inconsistent supply of contraceptives in the country as well as the lack of access to abortion services, she explained.

“There is so much stigma attached to going to a clinic to demand reproductive health services like abortion. The impact is going to backyard abortions which will result in women and young girls dying because of stigma at health facilities,” she said.

Both Tshabalala and Gonyela argued that the lack of contraceptives and abortion are interlinked issues, which need to be addressed in order for women to have comprehensive sexual and reproductive health services.

But this will not happen if the country’s progressive policies aren’t implemented.

“When we have five as a minimum standard we’re setting ourselves up for failure. So, there was an agreement to say let’s double up, then we decided, let’s add five new methods to bring each to 10. So that when we have a challenge [with one type of birth control], as we did in the previous year, health facilities can still compete with the minimum standard of policy of five methods,” she explained.

But, activists are concerned that this, again, will not work out smoothly on the ground.