Sexual & Reproductive Health

More than 200 million women globally, largely in the least developed countries, want to use modern family planning (FP) methods but cannot access them1. FP methods may not be available in their communities and thus give women very little options in terms of planning pregnancies. In addition to the current unmet need for FP and despite the fact that funding for contraception has been declining over the years, the demand for contraceptives is expected to grow by 40 percent in the next 15 years2.

More than 200 million women globally, largely in the least developed countries, want to use modern family planning (FP) methods but cannot access them1. FP methods may not be available in their communities and thus give women very little options in terms of planning pregnancies. In addition to the current unmet need for FP and despite the fact that funding for contraception has been declining over the years, the demand for contraceptives is expected to grow by 40 percent in the next 15 years2.

A FP Summit held in London in July 2012 has revived and provided guidance to FP activities globally. FP has a crucial role to play if the Millennium Development Goals for maternal health, eradication of poverty, education and gender equality are to be achieved.

Situational Analysis – South Africa (including key figures, relevant policies)

FP is a key issue for government in South Africa. The contraception policy of 2001 and Contraception Service Delivery Guidelines of 2003 guided implementation of the FP programme. These documents have recently been revised. The Policy Guidelines include provision of emergency contraception as an essential component for the reproductive rights and health of women, and reduction of maternal mortality. Emergency contraceptives reduce the prevalence of unintended pregnancies and unsafe terminations of pregnancy (TOP).

The total fertility rate in South Africa has declined from 2.92 children per woman in 2001 to 2.35 children per woman in 20113. This is attributed to wider access to information and services on FP. According to the South Africa Demographic and Health Survey (2003)4, modern contraceptive methods are used by 50.6 per cent of South African women. The contraceptive prevalence rate is therefore estimated at 65 per cent.

Contraception services are adequately funded within the health service budget, and are provided free of charge in most public health facilities. There are also Public Private Partnerships, where pharmacies provide support in dispensing government provided contraceptives. In these facilities, clients are not charged for the commodity, they only pay a dispensing fee.

Key Challenges

  • Despite the high uptake of contraception nationally, and the enabling policy framework, high numbers of unplanned and unwanted pregnancies remain a challenge and indicate unmet need for contraception. This underscores the need for community mobilisation to increase uptake of FP services among youths and in some communities, particularly for very poor and deep rural communities. The challenges may be attributed to lack of easy access and lack of knowledge and awareness on the value of contraception, particularly for adolescents and youth.
  • The provision of contraception services and quality of education and counseling for contraception services is also negatively affected by current human resource shortages in the health sector, and rural health facilities are more affected by this shortage.
  • Nationally, contraception services are provided in health facilities that largely operate during office hours and are therefore not user friendly for working people and school going youths.
  • The Intra Uterine Contraceptive Device (IUCD) is currently not being provided in many facilities and most health care providers are not trained on provision of this method. The re-introduction of this method is required in order to expand the contraception method mix.

Key Opportunities

  • A revision of policy guidelines with regard to contraception and FP started in 2010. The revised policy addresses both contraception and fertility planning, based on the view that, particularly in the era of HIV, FP must be part of the approach to counseling women of childbearing age about their fertility intentions. The new guidelines include some of the following:
  • Expanded scope of the policy to encompass both the prevention of pregnancy (contraception) and the planning of pregnancy (conception).
  • Contraception and fertility planning within the context of HIV in SA – addressing the needs of women at risk of HIV, HIV positive women (both using and not using antiretroviral treatment) and their partners as well as young people who were horizontally infected.
  • Appropriate integration of contraceptive and fertility planning services: with HIV, TB, PMTCT, maternal and child health and adolescent services.
  • Promotion of screening opportunities linked to contraception and fertility planning services: HCT, HIV, STI, TB, cervical and breast cancer.
  • Special service delivery and access considerations for sex workers, LGBTI, migrants, and men.
  • Special service delivery and clinical considerations for adolescents.
  • Establishment of hospital based referral services for use by health care service providers.

UNFPA Responses

  • UNFPA has supported the review of the Contraception Policy Guidelines.
  • UNFPA has been building capacity on comprehensive SRH services provision, with particular emphasis on repositioning the FP agenda. This has already taken place in five provinces, Mpumalanga, Limpopo, Free State, Eastern Cape and KwaZulu Natal. The capacity building programme also emphasises issues of access for adolescents and youth, promoting the use of dual contraception methods and provision of youth friendly contraception services.
  • Supporting re-introduction of IUCDs to the contraceptive method mix, providing theoretical and practical training support (also in the four focal provinces).
  • The UNFPA participated in the development of the Community Mobilisation strategy to increase community awareness and demand for FP services. This strategy will mobilise key relevant sectors of society in the implementation of the revised contraceptive / family planning policy.
  • FP is being prioritized in programme implementation / capacity building as a strategy to reduce maternal mortality.
  • UNFPA has supported the training of close to 400 health care workers on the new fertility and contraception policy and clinical guidelines in KZN and EC provinces including training on the sub dermal implants and IUDs.
  • In 2014 UNFPA, with the Department of Health, is supporting the strengthening of monitoring and evaluation for the FP campaign.

Sexual and Reproductive Health fact Sheet

References

1. Adding It Up: The Costs and Benefits of Investing in Family. Accessed 3/01/2013. Available at:www.guttmacher.org/pubs/AddingItUp2009.pdf

2. UNFPA. Donor Support for Contraceptives and Condoms for Family Planning and STI/HIV Prevention 2010. Accessed 3/01/2013. Available at www.unfpa.org/.../FINAL%20Donor%20Support%202010-2.pdf

3. Statistics South Africa. Mid year population estimates 2011. Accessed 3/01/2013. Available at:http://www.statssa.gov.za/Publications/statsdownload.asp?PPN=P0302

4. South Africa. National Department of Health, Medical Research Council, OrcMacro. 2007. South African Demographic and Health Survey 2003. Accessed 3/01/2013. Available at: http://www.mrc.ac.za/bod/sadhs.htm

5. South Africa. National Department of Health, National Contraception and Fertility Planning Policy and service delivery guidelines 2012.