Written by Zena Msutu, as part of the Ukuvula Isango: Women Rise project
South Africa is often lauded for its progressive and inclusive Constitution which provides a broad spectrum of human rights protections, however a widening gap between policy promises and rural healthcare delivery in the Eastern Cape continues to be a challenge for rural communities and women, and their capacity for post-pandemic recovery and reconstruction.
The introduction of sexual and reproductive health rights in South Africa was influenced by the programmes of action produced at two United Nations (UN) conferences: the 1994 International Conference on Population and Development held in Cairo and the 1995 Fourth World Conference on Women held in Beijing. In the wake of these meetings, sexual and reproductive health was widely framed as a rights issue, including in the African Union’s Maputo Protocol of 2005, rather than as a mere aspect of population-control measures, which had historically discriminated against black, African bodies and, in South Africa, had been linked to racist restrictions.
Source: https://www.ippf.org/sites/default/files/2023-01/edited_tanya.jpg
In this context and building upon Constitutional protections, the South African government introduced a Choice on Termination of Pregnancy Act in 1996; a Sterilisation Act in 1998; and a Children’s Act in 2005. These Acts provide the right to choose and access abortion services for all women and girls who are less than 12 weeks pregnant; the right to consent to sterilisation for adults of sound mind; and the right of children aged 12 and over to consent to medical treatment (including testing and treatment for HIV). In addition, the South African government has produced a number of policies and laws on HIV/Aids; sexually transmitted infections (STIs); and breast and cervical cancer. It has also enacted protections for sex workers, and lesbian, gay, bisexual, transexual, queer, intersex, asexual, pansexual, and other (LGBTQIAP+) people.
Sexual and reproductive health rights cover a broad range of services: abortion; contraception (short- and long-acting); screening and treatment for STIs (including HIV); fertility; reproductive tract infections; screening and treatment of cancers (breast and cervical); sterilisation; voluntary male circumcision; and decisions on whether people want children, and on the spacing of their children.
Reproductive and Sexual Health Challenges
Many people in the Eastern Cape have faced difficulties in exercising the rights mentioned above, especially during the Covid-19 pandemic and resulting lockdown, when access to contraception and termination-of-pregnancy services, and the treatment and management of HIV and other STIs, were restricted. As a result, the number of untreated STIs rose in the Eastern Cape during this period.
Generic image. Photo: Reproductive Health Supplies Coalition, Unsplash
Another main concern has been the forced sterilisation of women, especially women living with HIV and poor women. In the Eastern Cape, this issue may be placed in the context of a 20% unmet need for contraception and an HIV-prevalence rate of 15.5%. In this regard, several factors have impeded access to sexual and reproductive health advice and services, including the prohibitive cost of transport over poor roads to reach the nearest clinic or hospital; and the physical and/or verbal abuse meted out by some of the healthcare professionals at these places, who may also perpetuate the stigma attached to several diseases.
Residents of rural areas of the province have said that, during the pandemic, they did not visit healthcare facilities either for fear of contracting the virus or because these clinics and hospitals were closed due to high cases of Covid-19 infection. However, even amid such unfavourable conditions, there have been instances of innovation and persistence to meet the healthcare needs of individuals. Community pick-up points (PUPs) such as the Bulungula Incubator have been established to facilitate the delivery of chronic medication to people who live far from clinics.
As a result, many of those who are living with HIV/Aids have not been forced to skip their medication as they may otherwise have done. There has also been greater use of new technologies to deliver healthcare services and information. For example, as part of efforts to minimise human contact during the pandemic, healthcare workers increasingly used SMSs and WhatsApp to remind patients to attend check-ups and appointments or to fetch their medication.
Despite these recent policy innovations, ethnographic evidence from the Women RISE field sites across the Eastern Cape province suggests that poor rural women continue to experience enormous difficulties in gaining access to basic health services, including those related to sexual and reproductive health. Following the reopening of many healthcare facilities after the pandemic, clinics and hospitals continued to experience critical staff shortages, the absence of adequate medication as well as long waits in queues, and the termination of many vital mobile clinic services in remote areas.
References:
National Department of Health. 2019. National Integrated Sexual and Reproductive Health and Rights Policy Edition 1.
Partners in Sexual Health. 2022. Common Good Youth SRHR Project. Available: https://www.psh.org.za/common-good-youth-srhr-project [2023, July 7].
Silver, Laura., & Johnson, Courtney. 2018. Majorities in sub-saharan Africa own mobile phones, but smartphone adoption is modest. PEW Research Centre. Available: https://www.pewresearch.org/global/2018/10/09/majorities-in-sub-saharan-africa-own-mobile-phones-but-smartphone-adoption-is-modest/#:~:text=The%20exception%20is%20in%20South,lowest%20in%20Tanzania%20(13%25). [2023, July 7].
Siyakwazi Youth Network. n.d. Available: https://www.psh.org.za/siyakwazi-youth [2023, July 7].
This piece was written for, and first appeared on the Ukuvula Isango blog.
