The Stop Stockouts campaign has been working with community-led organisation the Ritshidze project to monitor and collect data on medicine stockouts between April and June 2022. On Tuesday, the campaign released a report titled, Access to Contraceptives in South African Public Health Clinics.

Dr Indira Govender of the Rural Doctors Association of South Africa said at the release of the report that of the more than 15,000 women surveyed in all provinces apart from the Western Cape and Northern Cape, 82% reported having to leave medical facilities without their medication.

Of that 82%, 40% said they did not receive contraceptives, followed by other medicines and tests accounting for 19%, with 17% being vaccines.

Sixty-seven percent of the patients were given alternative medication, with nurses recommending they switch to a different contraception not of their choice, and with no clear indication of when the shortages would be resolved. 

“But whether actual stock is there for the service to be functional is another question,” said Govender.

She highlighted that after male condoms, the second most requested contraceptive was injectables showing that it is the preferred choice for women. However, 76% of patients reported it as unavailable or out of stock.

Govender said there could be a range of reasons for stockouts, from procurement to delivery. The process could also be hampered by staff not knowing how to manage contraceptive treatment, when to expect more stock, as well as supplier contracts coming to an end.

“As women, we use contraceptives not only to prevent unwanted pregnancies, but also to improve our health,” said Treatment Action Campaign nurse Sihle Shabalala, who was on the panel presenting the report.

She said the switching and stopping of contraception methods was not healthy and took an emotional toll on women, as well as having physical side effects. Shabalala said that in her work as a nurse she had noted that some women, when unable to access the contraceptive of their choice, stopped contraception altogether.

Sexual and reproductive health nurse Lucy O’Connell described the report as “alarming”, but said it shone a light on many health system issues affecting contraceptive supplies and shortages. 

She spoke of her experiences of a lack of support for frontline health workers who she said were more than aware of community needs, yet had to deal with issues of under-resourcing, under-staffing and work overload. They often worked without proper supervision and training on contraception methods that would last longer for patients.

Visit Daily Maverick’s home page for more news, analysis and investigations

 Reproductive health rights ‘denied’

O’Connell said there were “golden opportunities to enhance integration of care” when it came to contraceptive options, TB and anti-retroviral treatment, as well as consultations over sexual and gender-based violence or safe abortion care.

O’Connell noted there had been a longstanding problem with supply, training and willingness to offer abortion services in the country, despite it being legal. She said this denied women their reproductive health rights as guaranteed in the Constitution. 

Civil society organisations and partners had been filling the gap through sexual and reproductive healthcare programmes, but when these stopped, it left a space that was government’s responsibility to fill, O’Connell said.

SECTION27 health lawyer Baone Twala pointed to a disconnect between what the law and health policy said, compared with what was implemented on the ground. Twala said the Constitution expressly provided for the right to reproductive health.

She said the government was failing in its obligation to provide reproductive healthcare and in the process was violating other rights such as dignity, equality and the freedom to choose whether you wanted children and how you wanted to proceed with a pregnancy. 

This could also result in women and girls having illegal abortions and unplanned children, which in turn placed additional pressure on women to seek government assistance.

Commenting on the report, director of the Rural Health Advocacy Project Russell Rensburg said: “One has to ask, if we can’t deliver sexual and reproductive healthcare compehensively, what does that mean for the fight against HIV? 

“Part of the conversation is not just supplying contraceptives, but also responsive services to young women, and we should use this report as a capstone for a much stronger campaign around the strengthening of the responsiveness of primary healthcare — not just at provincial, but district level, to ensure that when we meet again next year, we see some progress.”

The report said that “although there are challenges to ensuring an adequate supply of contraceptives, government has an obligation to provide access to reproductive healthcare services. Progressive laws and policies that recognise women and girls’ right to reproductive healthcare are not enough.

“Government must address the shortcomings that prevent contraceptives from reaching women’s hands.” DM/MC