The Child Care Act states that no medicine may be administered to any child under the age of 14 without a parent’s informed consent. The legal age of consent for sex is 16.
But 12-year-old Lerato* from Kloofwaters Intermediate School near Rustenburg is one of about 10 girls injected with Nur-Isterate, a contraceptive that lasts about two months, without her mother’s prior knowledge.
Tukisang Senne, programmes manager of the Planned Parenthood Association of South Africa (PPASA), says, ‘If it is true that no consent was obtained from parents, then I would say the health officials have committed professional misconduct”.
Lerato says a mobile clinic that provides primary health care services to rural and farming communities arrived at her school in November last year. ‘Our teachers said all girls of my age and upwards should go to the mobile clinic. When we got there the nurses told us they were going to inject us so that we cannot fall pregnant because anything can go wrong during December holidays, like being raped,” she says.
Kloofwaters Intermediate’s principal, Ben Juma, confirms that contraceptive injections were administered in November. Juma says this has been ongoing for years, but cannot say exactly how long. However, Juma says the girls involved were aged 15.
Juma and the school’s teaching staff encourage the girls to have the injection: a number of school-going teenagers have fallen pregnant – two of them have given birth on the school’s premises. Other girls show signs of being sexually abused and Juma is currently involved as a
witness in one such court case. Teachers add that poverty in the area motivates some parents to prostitute their children.
Typical of rural environments, there is a general lack of basic services. The nearest police station, for example, is 38km away.
Juma says that he held meetings with the parents at the school to ‘alert them about this development and I invited them to lodge written objections, if they had any, to file for future reference. However, I do not remember receiving any objection from any one of them. Subsequent to that, I have, admittedly, not bothered to check with them again. It is a mistake we would try to correct in the future.”
But Lerato’s mother says she had no prior knowledge of the plans to administer the injections, and had not been provided with written information or a consent form. ‘I was surprised when my child told me she has been injected with something so that she cannot fall pregnant during the holidays,” she says. ‘At first I could not believe her, until she showed me the [family planning] card. As a parent I feel the school should have consulted me before, however well-intentioned their motive. I mean, what if her body reacted badly and she collapsed?”
Ramphelane Morewane, the regional health manager for Bojanala district, which includes Kloofwaters, says there is a systematic and a coordinated family planning programme carried out by mobile clinics at schools throughout the province.
Morwesi Deswai, a district health manager in Rustenburg, says that this programme has been offered as part of primary health care since 1984.
Morewane says that they are aware of the legal age of consent but that sometimes health workers find themselves ‘in a catch-22 situation” where girls younger than 14 approach them for contraceptives without their parents’ knowledge or consent. ‘Should we refuse to attend to the child because the parent is not there [to give consent] or should we assist the child, as is our responsibility?
‘If a parent has an objection based on religious or traditional grounds, we will certainly respect that view. However, to date I do not remember ever receiving any complaint or objection from parents about our services.”
PPASA’s Senne says that each patient’s medical history must be taken into account before administering contraceptive injections, because health problems such as hypertension, heart conditions and diabetes could have fatal consequences. ‘Whatever the situation, you can’t have a blanket approach where you inject girls of a certain age all at once. You must deal with it on a case-by-case basis. The procedure is that this must be preceded by a thorough check-up, preferably at a clinic”.
Superintendent General of the North West Department of Education Anis Karodia says he is aware that the department of health has a family planning programme running, but is ‘certainly not aware of the details, especially where children under the age of 14 are involved”.
Karodia says that, as far as the department is concerned, schools are ‘no-go areas” for children under the age of 14 to be injected with contraceptives.
He says his department will investigate what happened at Kloofwaters Intermediate School and take appropriate action if
necessary.
Duncan Hindle, deputy director general in the national Department of Education, says he has no knowledge whatsoever of this family planning programme at schools. Commenting on the practice of injecting under-14-year-old girls, Hindle says, ‘I have spoken with Dr Karodia and he has undertaken to investigate the matter. This is all I can say at this stage.”
The national Department of Health’s spokesperson Jo-Anne Collinge says it ‘promotes the awareness of contraceptives among teenagers”. Its programme encourages youths to abstain from sex or to use condoms. But, Collinge says, ‘Informed consent forms the basis of the policy of the Department of Health. Obviously if a child doesn’t have the maturity and intellectual capacity then we will certainly discourage that [receiving a
contraceptive injection].”
Informed consent is a legal imperative in administering any medical treatment, and in this instance applies not only to parents making the decision on behalf of younger children, but also to those over 14. Those involved must fully understand the implications of receiving an intervention, including how it works, what it does and does not prevent, as well as potential health consequences. On the basis of all this information, a request can be made for a medical intervention.
Catriona MacLeod, associate professor and head of the psychology department at the University of Fort Hare, East London, whose doctoral research focused on teenage pregnancy, says, ‘This is not acceptable practice in primary health care. But it happens quite a lot, especially among marginalised women, where contraceptive injections are administered without the women’s informed consent.
‘In many rural areas you will find a lot of parents who want to police girls’ sexuality. Some will resort to virginity testing while others will think that coercing girls into taking contraceptive injections is a good idea.”
* Name has been changed to protect the child’s identity