It is like something out of The Handmaid's Tale - a war over injectable contraception, as demand for the country's most popular contraception remains high but supply runs low.
The department of health claims that the injectable, Depo-Provera, is at 82% availability across the country, but areas as far-flung as Stanford in the Western Cape and Umlazi in KwaZulu-Natal have been in crisis for much of 2018.
The worst-hit provinces are Limpopo and North West.
A tender was put out by the National Treasury but there were no bidders, according to health department spokesperson Popo Maja. He said the most recent contractor was Fresenius Kabi but "the company has taken the decision to discontinue the product" and "hence did not submit a bid".
This left only Pfizer as a remaining local supplier but the company chose not to bid. Company spokesperson Charmaine Motloung said it was supplying the department on "request only". "The tender to supply it ended in September 2013," she said. Pfizer had "not experienced a stock shortage".
She added: "Pfizer … did not bid for the tender in 2017 as it was not in a position to meet all the tender requirements at that time."
Marianna Steyn, a doctor in the small town of Stanford, said she had raised the alarm with government officials to no avail. Meanwhile, teen pregnancies in the community were increasing.
"When stock of Depo-Provera eventually arrives, it is finished within a few days and then people have to wait for three months or longer for more to arrive," said Steyn.
A civil servant in Stanford, who did not want to be named, said she and her sister had been unable to obtain Depo-Provera from the clinic for six months.
SUDDENLY UNAVAILABLE
"When my family or friends phone, the clinic says they have stock but by the time they get there it is finished. I have a boy of two and a daughter of 12. It was available for more than a decade and I used it between having my two children, but then it suddenly wasn't available. I have a lot on my mind and will never remember to take the pill."
Bella Spandiel, who runs a home-based care facility for families in the area, said: "The mommies are telling me the babies are not planned. And when they are born it is a big financial burden. So we need every type of contraception available and the injectable suits the youngsters."
Western Cape health department spokesperson Mark van der Heever said the province relied on the national department for a drug he called "the mainstay of contraception in the province".
In the absence of a contract, the province was buying "off contract" from Pfizer.
"The department of health's Cape medical depot places buy-out orders on a weekly basis and they have stock on hand. There are intermittent but infrequent stock-outs."..