Reproductive Health in the South African public healthcare sector

By: Nadine Dirks for ACTIVATE! Change Drivers

When I turned just 19 years old, I went into the hospital for the hundredth time, something was wrong with me. I knew it, my family knew it, but the healthcare providers in my community didn’t. To them I was next to nothing, everything I said is a lie and there was nothing wrong. I spent years attending the community clinic in Hanover Park, I would need to wake up at the crack of dawn to get ready on appointment days. I had no time to waste, so I had to get into my school uniform so just in case the wait this time around lasted until 4 pm. I went to grab a blanket to wait in the cold and dark, sometimes my dad would stand in line for me, to let me sleep a little bit longer. He would call my uncle to drop me off when he had made it to the second row of sickly and old attendees. Each time we would hope to get some help, but we never did, this time was different. I was experiencing severe pain and needed immediate surgery, slicing me hip to hip before casually telling me I had stage 4 Endometriosis, the most severe stage to boot. It sounds astounding but that is the way it is, when according to The South African Department of Health only 16.1% of South Africans have access to medical aid. Within the 16.1% of South Africans with access to medical aid, the issue of access is further amplified with 77.7% of white people dominating the private healthcare sector. So where does that leave the 83,9% of South Africans?

So what do the experts say?

To better understand the public healthcare system and its flaws, I spoke to renowned sexual and reproductive health and rights activist, affectionally known as The Minister of Menstruation, Candice Chirwa, as well as a young woman of colour, who has been working as a doctor for the past eight years in the public healthcare system, Doctor Qudsiyyah Jabaar. One of the issues I wanted to better understand was simply why the system fails? Doctor Jabaar lends her voice and points out that because of the overburden on the public healthcare system, patients are often not “afforded the time required to adequately manage their conditions.” This makes sense given that there is often no time for patients to adequately ask questions and discuss treatment plans and everything in between. Doctor Jabaar adds that this means that a problem just gets a bandage put on it because some “conditions require a multi-disciplinary approach.” This is also true of my own experiences, due to the extent of my endometriosis being so severe that I required multiple specialists. In the public sector trying to align all of these specialists for a patient’s appointment just isn’t viable, even when it came to my surgeries, I would have to wait for the stars to align for all the necessary specialists to be available.

Barriers to Healthcare

When speaking with Candice Chirwa her perspective on barriers particularly faced by young Black girls and women reliant on the public healthcare sector outside of too few doctors for all the patients is racism and gender discrimination. Candice says “Black women are often subjected to disrespectful treatment, long wait times, and denial of care based on their race and gender.” Unfortunately feeling disempowered in these spaces often means that we do not report healthcare workers because of fear of retaliation. These delays in care often remove or challenge the autonomy of Black women, due to not being listened to, and being fearful to seek care. This is made evident in statistics which estimate that in 2020 South Africa still sees 25,78 deaths per 1000 live births. In addition to a startling 13,9% of the population living with HIV/AIDS.

Why stereotypes are so dangerous

In my experience, whenever I went to the hospital because of my endometriosis symptoms, I was often mocked, laughed at, threatened, physically abused and accused of backdoor abortions and untreated STDs causing my pain and bleeding. The fact is, assumptions made about Black women and girls are dangerous. It is also an enormous reason why we often are fearful of seeking out healthcare services when we need them, which furthers stigma regarding Black women being the hosts for diseases and babymaking. The real question should be why young Black women are not accessing contraceptives, preventative measures, and abortions. It is not because of a lack of trying but rather as Chirwa says “stigma can make people feel ashamed or embarrassed about seeking care for these issues.” Doctor Jabaar goes one step further and says that there is also “poor education about what is available in the state sector”, and honestly, how can we access a service we don’t know exists?

How do we change the system?

So how do we change this? How do we get rid of some of the debilitating barriers to adequate care and treatment? How do we ensure the futures of the most vulnerable? There is no clear-cut answer to this, but Doctor Jabaar who works in the public healthcare sector and finds the job rewarding and not a place to go if money is all you are after shares great understandings. She says it is vital for the public healthcare system to move away from the standard way things have been done to a place “which the patient has more autonomy.” Doctor Jabaar says this helps take some of the burden off the healthcare provider too, which encourages patients to educate themselves and feel empowered regarding their own healthcare. She reiterates that it’s not a one size fits all approach because some patients simply don’t have the privilege to just simply educate themselves for example. Candice weighs in and says the only way to change things is through comprehensive sex education, that way “young people can make informed decisions about their health.” Being able to advocate for yourself is important but how can we confidently do that when we are uncertain or not informed? Candice takes it further than school and says we have to conduct grassroots information to get where we want to go. She says we should conduct “educational campaigns that seek accurate information about reproductive health.” This is vital, we have to make sure that no one slips through the system, no matter how overburdened and often corrupt the healthcare system is. The bottom line is simple: healthcare is a human right. Sometimes the solutions are as small as being kind, compassionate and listening to patients.

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About the Author:
Nadine Dirks is a member of the ACTIVATE! Change Drivers Writers’ hub, she also is a prolific writer, opinion-maker, activist and communications expert. Her work, interests and expertise lie in intersectional feminism, gender, and sexuality and include sexual and reproductive health and rights, particularly of marginalised people. Her work can be found in publications worldwide. She is especially dedicated to women’s health because of her own lived experience. She is an author, public speaker, moderator, and panellist. Her work in civil society spans over a decade. Her hopes are to bring people out from the margins and into the centre of their own narratives. Nadine’s work has been recognised internationally by entities such as the Bill & Melinda Gates Foundation. Nadine is passionate about creating a more equal and sustainable society through awareness, inclusion, and transformation. She is currently pursuing a master’s degree in Women and Gender Studies.