September 26 is World Contraception Day (WCD), an event that focuses on preventing unwanted pregnancy and sexually transmitted infections (STIs).
Now four years old, WCD couples outreach and awareness events with an annual survey of youthful attitudes and behaviour. This year’s survey considered more than 5 000 people aged 15 to 24 across 25 countries in Asia, the Pacific, Europe, North America and Latin America.
The results showed that although more than 80% of the respondents acknowledged their responsibility for arranging contraception before having sex with a new partner, 45% had unprotected sex with the new partner, with only half considering themselves well informed about their contraceptive options.
Forty-four percent said personal hygiene, such as applying perfume and waxing, was more important before a first date than arranging contraception. The WCD survey did not include information from any African countries and reproductive health advocates in South Africa express concern about the lack of data on contraceptive use and abortion rates in the country.
A demographic and health survey has not been released by the department of health since 2003, leaving conflicting anecdotal reports that cannot be either confirmed or denied and that offer little feedback on potentially successful family planning interventions.
In the absence of such data, individual opinions and small reports are relied on, says Margaret Hoffman of the University of Cape Town, who has been studying reproductive health in South Africa for decades. “People give their opinions.
This is what they think they’re seeing and it’s not actually based on statistics,” she says. “Unless you’ve got a study or you’ve got accurate statistics, you don’t really know what’s going on.” South African statistics on youth and sex are more current than those for the population at large.
In March this year, the Medical Research Council released a report on risks for youth ill health, which found that only 30.7% of respondents used condoms consistently, in spite of their being the most popular form of birth control. Of the respondents, 17.9% said they used no form of birth control, with one-third of 19-year-old women having had a child.
Sarah Osman of Marie Stopes South Africa notes that although these statistics are alarming, and though youth behaviour is an indicator of adult behaviour, they cannot be extrapolated to the rest of the population. “We need more reliable data,” she says.
In spite of continued attempts to understand why a more recent demographic and health survey has not been released, Osman has not received an answer from the health department. The department also did not respond to the Mail & Guardian‘s questions.
Insufficient data may be indicative of lack of knowledge and education about reproductive health technologies in general. This year’s data from Marie Stopes clinics mirrors that of the 2003 survey, which showed a decline in the use of more reliable and long-acting methods of family planning.
According to Osman, the trend stems from the lack of options and education within the public system. “Women don’t have enough choice in terms of access to contraceptives,” she says.
“In public facilities, you basically have the choice between the pill and injected birth control. If women were more informed and had more access and more choice, they’d be able to make their own decisions and be better protected. They would be able to demand those methods they want to use and reject those which they don’t.”
In spite of South Africa’s progressive abortion laws, more than 30% of the country’s women don’t know that termination of pregnancy is legal, according to Osman. “That is directly linked to the high number of unsafe abortions. Even if women do know that abortion is legal, they’re not exactly welcomed with open arms. A lot of nurses have personal prejudices against women getting an abortion.”
In spite of significant data showing “a tremendous decrease in deaths from abortion and a decrease in morbidity related to abortion” since termination of pregnancy was legalised in 1997, “if you drive into townships, you will see adverts on poles for backstreet abortions,” says Hoffman.
“In general, I don’t think there’s been a huge move to educate women on abortion law. Laws are introduced and they don’t go along with a lot of education, particularly with abortion being such a sensitive subject.
Unless you’ve seen these women who come in with these back-street abortions, and the death and disease that’s related to them, you don’t understand how important this is. “We’ve got to make abortion more available, so that people can use goodquality health services,” she says.
Osman argues that increasing education and access to contraception and abortion within South Africa will help the country reach its development goals.
“If you can decide the number of children you want to have, that always improves your standard of living. If we know that 30% of 19-year-old girls have a child, that means they’re not going to finish school, they’re not going to go on to higher education, it’s unlikely for them to be successful. That’s a huge loss from a social and an economic perspective.”