SA clinics’ shortage of injection contraceptive putting girls, women at risk of unwanted pregnancy

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Injectable contraception represents the most commonly used contraceptive method by women in SA, according to UWC's Prof Diane Cooper.
Injectable contraception represents the most commonly used contraceptive method by women in SA, according to UWC's Prof Diane Cooper.
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Today, the risk of maternal deaths and disability, newborn mortality and morbidity, and other unintended pregnancy risks is lower than it was just over two generations ago, thanks to The Pill.

When the contraceptive pill was invented 60 years ago, it changed the lives of many women and people of child-bearing age for the better.

“It liberated women sexually and socially and finally gave women the freedom to choose control,” says Nicole Jennings of Pharma Dynamics.

“For the first time, women were free to pursue tertiary education and a career – no longer stymied by untimely motherhood.”

“The pill gave women the freedom to choose when they wanted to have children, which changed the course of their lives forever,” says the spokeswoman for the pharmaceutical company specialising in women’s health.

Yet, while the use of contraception among South African women is high (64%), quality contraceptive service delivery, equitable access and women’s ability to correctly and consistently use contraceptive methods of their choice are huge hurdles – especially among young and rural women.  

There has been a shortage of contraceptives at public health clinics in South Africa with contraceptives now representing the biggest share of medicine stockouts recently, the University of the Western Cape’s Diane Cooper warned recently.

“This is a bad situation for women in the country – a country that has women’s reproductive rights written into our constitution,” says the Extraordinary Professor at the UWC’s School of Public Health.

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The shortage of contraceptives, particularly hormonal injectable contraception, could be due to the insufficient devolution of powers to managers and providers at primary healthcare level.

“It could be that they have little control over when medication stocks or methods of contraception are due to be delivered, or don’t get informed in time when stocks are low,” says Prof Cooper.

Since injectable contraception represents the most commonly used contraceptive method by women in South Africa, stockouts could lead to a dire situation with unintended pregnancy potentially becoming exacerbated as a problem in South Africa, she warns.

It is not easy for users to easily to another contraception method, explains Prof Cooper, because it takes time to get used to a new method. 

“This is a challenge, especially when the new method has not taken effect, causing an increased risk of pregnancy.”

“Usually providers recommend condoms during this period, but women may not use them,” Prof Cooper adds. 

“A second scenario is when women may be reluctant to make a change and stop using contraception altogether, while those still considering using contraception may be discouraged by the news of stockouts at clinics and hospitals. With both scenarios there is a likely increase in the rate of unintended pregnancies.”

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There is also a need to address the knowledge gaps that exist around female reproductive anatomy, conception, fertility and how contraceptives work in order to improve uptake,” says Nicole.

“Some women mistakenly believe that long-term use of the pill can lead to infertility. To the contrary, the pill is designed to temporarily delay fertility. Once off the pill, normal fertility levels return. 

“Taking contraceptives also don't increase your risk developing endometrial and ovarian cancer. It does, however, slightly increase the risk of cervical and breast cancer. 

“Another misconception is that taking a morning after pill is like having an abortion. These pills work by temporarily stopping the ovary from releasing an egg – almost like pulling the brake on ovulating.”

Contraception options

There are many different types of contraception available to women, which are offered free at public health clinics in South Africa, says Nicole. These include:  

HORMONAL CONTRACEPTIVES 

These are available in tablet form (more commonly referred to as “The Pill”), a patch or vaginal ring. The pill works by inhibiting the body’s natural cycle by preventing ovulation, changing the cervical mucous which makes it difficult for the sperm to move through the cervix and changing the lining of the uterus to prevent the egg from implanting. 

LONG-ACTING REVERSIBLE CONTRACEPTION 

Also known as LARC, these include intra-uterine devices (IUDs), hormonal implants and hormonal injections. This form of contraception works in a similar way to hormonal contraceptives and can remain effective for several years. 

NON-HORMONAL CONTRACEPTIVES 

These include barrier methods, such as the male or female condom, diaphragm (saucer-shaped silicone cup placed inside the vagina to block sperm from entering the womb), cervical cap (a hat-shaped piece of silicone placed over your cervix to keep sperm out.

Both the diaphragm and cap must be fitted by a doctor and should be used with spermicide. The sponge works in a similar way to the diaphragm and cap, but already contains spermicide. 

“To determine which contraception will work best for you depends on your lifestyle, personal preferences and any medical conditions you may have,” says Nicole.

“Taking contraception reduces unintended pregnancies and the need for unsafe abortions. Talking to your doctor about the different types of birth control, listing the pros and cons of each, is a good place to start.”

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