By Sinothando Ndelu

The public health system can be very intimidating. The repeated stories of abuse and obstruction to care make it difficult for adolescent girls and young women to believe it is ready to care for them.  In South Africa, the right to bodily autonomy is enshrined in the constitution. It is a patriotic ideal for every citizen to choose if or when they would like to have a family. Adolescents are being taught to have agency over their sexual and reproductive journey, contraceptives and abortion are a big part of this choice and agency conundrum. The responsibility to use contraceptives is left to young women and girls. Regrettably when it comes to the choice to end an unwanted or unsupportable pregnancy everybody wants to weight in.

Access to contraceptives, in South Africa, has guidelines provided by the National Department of Health. These guidelines are for healthcare workers to give as much information as possible to a person who requires it. However, adolescent girls and young women are giving a different report. According to Section 27 field workers in Sedibeng Municipality, Gauteng- young women complain about nurses who decide which method of contraceptive to administer based on whether the woman has given birth before or not. Those who have children get a three month injectable contraceptive while those who do not have children are given a two month injectable contraceptive. This is done without sharing the different contraceptive options that are available to them.

A quick FYI on contraceptives for perspective. There are short term contraceptives- pills and injectable. The pill is for everyday use and must be taken every day at the same time. The injectable last for two or three months, where on a prescribed date one must return for repeat treatment.  Then there are what we call Long Acting Contraceptives (LAC), which are also available in public health. The implanon is a small rod inserted in one’s forearm, one of these lasts for 3 years and they require one to get them checked every 6 months. Another method is the Intra Uteral Device (IUD). This is a copper device inserted and sits on the mouth of the uterus. IUD lasts for 5 years, it too required check-ups every 6 months. The emergency “morning after” pill is also a contraceptive one can use up to 5 days after having unprotected sex while they are not on any other form of contraception.

Each woman has a different experience of the different contraceptive methods and their side effects.  The most popular contraceptive method in public facilities are the injectables. Women who use injectable generally complain about weight gain and irregular menstrual cycles.  The injectables stop the production of eggs, this means that there will be no menstruation. The hormones in the injectables can cause water retention and therefore weight gain. These two things are simple enough to explain, however women are met with ridicule and push back from nurses when they complain. Myths about the implanon also leads to girls cutting and taking it out by themselves.  Lack of adherence to contraceptives results in pregnancy. Women must be encourage to try out different contraceptive options until they find one that works best for their bodies.

The connexion between contraceptive and access to abortion cannot be stressed enough. Contraceptives do fail! This is a fact.  The causes of this could be a type of medication that is being used by the woman that may decreases the effectiveness of the contraceptives.  Women are fond of detox teas, drinking these without checking how it affects the contraceptive they are using may diminish the effectiveness of contraceptives. A contraceptive method’s effectiveness can also be impacted by body weight which is why comprehensive contraceptive counselling is important. As a result of these many ways in which contraceptives can be rendered ineffective, a woman should be able to end an unwanted pregnancy.

The Choice on Termination of Pregnancy Act provides that without any questions, for any reason up to twelve weeks a woman of any age can request an abortion. This Act offers guidelines of what comprehensive abortion care should be. Adolescent girls and women experience obstruction to care by way of being turned away or being made to wait until the window to access the service ends. Public service also has very few second trimester abortion facilities. Is the health system truly ready to care for women’s Sexual and Reproductive Health?

World over there has had to be a focus on the right of women to choose for themselves when and if they want to get pregnant.  World Contraceptive day on the 26 September and International day for Safe Abortion on the 28 September are days for governments and civil society to reflect on whether there is an environment that encourages choice. The South African public health system needs to work toward changing the narrative of obstruction to care to that of enabling choice. The ability to choose gives agency, CHOICE IMPROVES QUALITY OF LIFE.