Millions of South African women who depend on the public healthcare sector are subjected to using contraceptives that are not suitable for their bodies, a phenomenon described by some as an injustice.
Activists and medics on Tuesday described the disinvestment in reproductive health and shortage of birth control options for women as alarming after a new survey showed contraceptives accounted for at least 40% of medicine stockouts in seven provinces.
Findings of the survey, conducted by Stop Stockouts in more than 400 healthcare facilities in April, show while there are generally fewer stockouts, contraceptives now represent the biggest share of them in the public health system and continue to form a barrier to women’s sexual and reproductive health rights.
It found that injectable contraceptives and oral birth control pills were commonly out of stock at 76% and 19% respectively. The research also revealed that other commonly reported stockouts include HIV medication at 16% and pregnancy tests at about 10%.
During the report’s release, they described the continuous shortage of contraceptives in SA as tantamount to denial of health care and a blow to women’s constitutional rights, which include “access to reproductive health and bodily autonomy”.
Lucy O’Connell, key populations adviser at MSF Southern Africa, described the shortage as a “visceral blow” to women’s constitutional rights and not a way to celebrate women’s month.
“It is concerning when the lowest common denominator contraceptive option, Depo-Provera, a three-month injectable, is out of stock. It indicates lack of stewardship on the part of the national department of health.
For some of the most vulnerable women in our country, this lack of access [to contraceptives] can be catastrophic.
— Lucy O’Connell, MSF Southern Africa
“For some of the most vulnerable women in our country, this lack of access [to contraceptives] can be catastrophic. Women who take contraception have made a choice not to get pregnant. When supplies are not there, we take away their agency. It’s often risky to change from a long-acting method to a daily method, and it can be costly and time consuming to women and girls to ensure future continuous access.”
O’Connell said it was not just inadequate supplies of medicines that affected women, but services such as abortion, where there is unwillingness to train and offer these procedures adequately.
“It is my hope that as we continue to unravel the challenges and barriers to access to sexual reproductive healthcare in SA, we eventually take a close look into this,” she said.
Sihle Shabalala, Mpumalanga provincial manager at the Treatment Action Campaign, said not getting the contraceptive of choice and taking alternatives, as study findings suggest, meant many women ended up not taking contraceptives.
“Women either had to go with the available contraceptives or go home empty-handed. This has impacted women badly because the switching and stopping is not good for our health.”
She said others ended up with unplanned pregnancies and this negatively affected their self-esteem. Not only did unplanned pregnancies affect their physical and emotional health, it ruined relationships and put more financial strain on women.
Having different options minimised the side effects of contraception.
Dr Indira Govender, of the Rural Doctors Association of SA (Rudasa), said while the results showed healthcare workers did their best to ensure patients did not leave empty-handed, switching to alternatives was not a sustainable solution and could have detrimental effects on the lives of women and girls. This through side effects such as hormonal changes, as well as the inconvenience of making significant and sometimes risky changes to their lives.
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