/ 30 September 2008

A hard pill to swallow?

On World Contraceptive Day Errol Nkonko Mutamba looks at why women are not using birth control

More than 30% of South African women do not use contraception, despite being well informed about contraceptives services.

As we celebrate World Contraceptive Day on Friday September 26, it is worth looking at how accessible contraception and related services are in South Africa.

So to what do experts attribute the low uptake? History could play a role: contraception was introduced by the apartheid government as a form of population control.

Studies show that family planning introduced in the 1960s by the apartheid government, which evolved into the establishment of the National Family Planning Programme in 1974, generated scepticism about contraceptive services.

The 1998 South Africa Demographic Health Survey established that the prevalence rate of modern contraceptive methods was 61,2%. Five years later, in 2003, the Health System Trust found the prevalence rate was just more than 64%.

Yet the South Africa Demographic Health Survey found that women in South Africa are actually well informed about contraceptive services. Their sources of information vary from print media, radio and TV to educational material at health facilities.

There are many possible reasons for the low uptake and for the high numbers of pregnancies among young women. It is possible that younger women have less access to information about contraception.

Understanding and ability to get hold of contraception could be influenced by many other factors outside a woman’s control, such as her socio-economic environment and education.

Cultural beliefs and norms also influence whether contraceptives are used. More education of men is needed, since male partners can influence a woman’s decisions and opportunities regarding contraception.

The Constitution guarantees women’s rights to access to information on sexual and reproductive health and services. An integral part of these is access to contraception.

Contemporary international and regional declarations, such as the Maputo Plan of Action, which South Africa has signed or ratified also confirm these fundamental women’s rights.

However, nationally, ensuring a better quality of healthcare in the public health sector is still a challenge.

Public health services are undergoing transformation in an attempt to redress past inequities and to improve overall quality of care. As far back as August 2001 national contraceptive policy guidelines were developed to improve these services. However, there are still gaps in the implementation of these guidelines, even though information is more readily available.

But other areas still need attention. The state remains the main provider of contraceptive services in South Africa. In the public sector contraceptive services and commodities are provided free, but choice can be limited. In the private sector contraceptive services and methods are widely available but can be expensive.

To increase access, attention should be paid to providing contraceptive methods that suit women’s lives.

In particular there also needs to be an adequate supply of contraceptive commodities in rural areas.

Sexual health and reproductive services should be integrated within the healthcare system.

There needs to be an improvement in the collection and analysis of data on fertility and contraception in South Africa to monitor whether women’s needs are being met.

The National Contraception Policy Guidelines and research findings need to be implemented fully to ensure wider usage, access and acceptability of contraception in South Africa before we will achieve the United Nations Millennium Development Goal pertaining to reproductive health by 2015.

Abortion campaign bombs
After nearly a year of soliciting signatures as part of a campaign for global “safe abortion,” Marie Stopes International says fewer than 500 people have signed an online petition that calls for “full access to legal, voluntary, safe and affordable abortions”.

The campaign was launched at the International Global Safe Abortion Conference in London in October last year.

The campaign criticises government programmes that focus on Millennium Development Goal 5 to improve maternal health but “neglect the 13% of maternal deaths caused by unsafe abortions globally and fail to support the full range of preventive actions required”.

Pro-choice proponents often link unsafe abortion and maternal mortality to push for legal abortion. Critics challenge the assertion that legal abortion would result in fewer maternal deaths.

In Poland, after abortion was severely restricted in 1993, the country showed a sharp decline in both the abortion rate and in maternal deaths. Ireland, where abortion remains illegal, reports one of the lowest maternal mortality rates in the world. — Mail & Guardian reporter

Errol Nkonko Mutamba is research, monitoring and evaluation coordinator at Ipas South Africa, an international NGO promoting women’s sexual and reproductive health rights