Why South African women still lack access to reproductive health services
Image: AI Ron
South Africa's Constitution articulates one of the world's most progressive visions for human rights. But after 30 years into democracy, the daily reality of women's sexual and reproductive health rights (SRHR) boldly contradicts the spirit of that promise.
Section 27(1)(a) of the Constitution of the Republic of South Africa guarantees access to health care services, including reproductive health, to everyone living in the country, regardless of their immigration status.
South Africa's legal architecture around SRHR is extensive. Beyond Section 27, the Constitution affirms the right to bodily and psychological integrity under Section 12(2)(a), explicitly including reproductive decision-making.
The Choice on Termination of Pregnancy Act 92 of 1996 translated these rights into policy, permitting abortion on request within the first 12 weeks of pregnancy and under specific conditions thereafter. No parental or spousal consent is required. This is a rare marker of autonomy on the African continent.
In theory, SRHR includes far more than abortion. It spans contraception, antenatal and postnatal care, treatment for sexually transmitted infections, cancer screening, and comprehensive sex education. These are essential tools not just for health, but for women's autonomy.
Services like antenatal care, family planning, HIV testing, and termination procedures are rights and not privileges in South Africa.
Video Player is loading.
Play Video
Play
Unmute
Current Time
0:00
/
Duration
-:-
Loaded :
0%
Stream Type LIVE
Seek to live, currently behind live
LIVE
Remaining Time
-
0:00
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
Text Color White Black Red Green Blue Yellow Magenta Cyan
Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan
Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan
Transparency Transparent Semi-Transparent Opaque
Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps
Reset
restore all settings to the default values Done
Close Modal Dialog
End of dialog window.
Advertisement
Next
Stay
Close ✕
Although South African law guarantees access to SRHR services, several gaps persist, including:
• Adolescents face judgment from health workers when requesting contraception, even though the Children's Act allows access from age 12.
• Women with disabilities report being denied services due to a lack of trained providers and physical infrastructure.
• Many rural clinics lack midwives, specialist doctors, and even running water, turning basic care into a logistical marathon.• Migrant and undocumented women are being denied health services in certain areas, due to their status in the country.
The result? Women resort to unsafe abortions, suffer undiagnosed infections, and navigate pregnancies without professional support. Rights exist, but implementation remains uneven, inaccessible, and in some cases, non-existent.
Seshni Moodley , admitted attorney , director of Seshni Moodley attorneys incorporated.
Image: Supplied
The statistics speak volumes. According to the research I conducted for my LLM dissertation—a comparative analysis of women's SRHR in South Africa and the Democratic People's Republic of Korea, unsafe abortions account for approximately 52–58% of the 260,000 estimated abortions performed annually in South Africa. Maternal mortality remains disproportionately high in underserved areas. Women with HIV are often denied appropriate fertility treatment or cervical cancer screening, despite being at increased risk.
This research also makes it clear that South African women do not lack rights. They lack access. Rights remain theoretical unless they are realised at the point of need, the clinic, the hospital, the mobile unit.
Based on the findings in that research, the following recommendations offer a pathway forward:
• Implement the National Health Insurance Act: This will equalise access to comprehensive SRHR across socioeconomic lines, including free services at private practitioners for those who need them most.
• Deploy more mobile clinics to remote areas: Rural women should not be penalised for their geography. Mobile clinics offer a direct bridge to primary services such as contraception, antenatal care, and family planning.
• Increase specialist staff and midwives at public facilities: More obstetricians and gynaecologists, not only in urban centres but rural hospitals, are essential to addressing maternal morbidity. Midwives, often the first contact for SRHR, are a critical resource and their numbers should be increased especially in rural health facilities. This will reduce maternal mortality and improve reproductive outcomes.
• Strengthen youth-focused SRHR programming: The National Adolescent SRHR Strategy must be revitalised with consistent sexual education and confidential services in all provinces.• Prioritise reproductive justice for marginalised groups. This includes migrant and undocumented women, women with disabilities, and women living with HIV. All face compounded discrimination in accessing care. Targeted policy shifts and service adaptations are essential.
These are not luxuries. They are constitutional obligations and moral imperatives.
South Africa's National Human Rights Commission must also step up. Monitoring the implementation of SRHR across public hospitals, rural clinics, and community-based services is central to its mandate. Human rights are not realised in courtrooms alone. They are lived in the everyday spaces where women seek care, and where care is often not available.
The bottom line is South African women do not lack rights. They lack access.
Until the state commits to investing not only in legislation but in delivery as well as staffing, infrastructure, outreach, and education, then SRHR will remain a constitutional promise, not a public health reality.
South African women are still waiting.
*Seshni Moodley is an admitted attorney, director of Seshni Moodley attorneys incorporated , with expertise in digital, civil and criminal law. She holds a masters in human rights law and is currently pursuing her PhD in human rights law.
Cape Argus
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
TimesLIVE
2 hours ago
- TimesLIVE
How South Africa's tobacco bill might impact the continent's public health
Could South Africa's proposed smoking regulations have unintended consequences for the rest of Africa? A leading Kenyan doctor believes so. Dr Vivian Manyeki, a public health physician and epidemiologist at Kenyatta National Hospital, the largest referral hospital in East and Central Africa, said the Tobacco Products and Electronic Delivery Systems Control Bill carries major implications for the region and could set a precedent for the rest of Africa. Manyeki, a speaker at the recent Wellness Collective in Johannesburg, a forum aimed at shifting South Africa from selling harm to promoting wellness, said while the bill addresses gaps in youth access control and advertising, it risks placing combustible cigarettes and significantly less harmful nicotine products under the same strict regulations. 'If passed in its current form, the bill may unintentionally discourage smokers from switching to safer alternatives, thereby undermining public health goals and counteracting objectives of harm reduction advocates. This could make it too costly and complicated for smokers to shift to much safer options. A sensible policy would ensure strict regulation on the protection of youth, clearly communicate the risks involved and, most importantly, support, not restrict, nicotine smokers transitioning to safer options,' she said. Manyeki's comments come as parliament continues public hearings on the bill. The next scheduled hearing is on Monday. 'The adoption of tobacco harm reduction policies is lacking on the African continent when compared to high-income regions such as the UK, New Zealand and parts of Europe. 'The UK, for example, integrates harm reduction into national tobacco control policies and has sponsored programmes aimed at moving smokers to less harmful products. 'Afforded the least attention is Africa, with abstinence and cessation viewed as the only viable pathways to nicotine harm reduction. There is also no room for harm reduction products,' she said. Manyeki said the available policies were 'backwards, steered by the burden of precautionary political frameworks stifling creativity and, at times, misinformed narratives about safer nicotine products'. 'The result is that the opportunity to mitigate the growing burden of tobacco-related deaths, which is increasingly emerging from low and middle-income countries, is stifled.' She said there must be a clear understanding of harm reduction. 'The process of minimising the negative impact of health behaviours through focused public policy action is referred to as harm reduction. Unlike more conventional frameworks, this reduces the health, social and economic burdens in public health by not necessarily eliminating the behaviours and focusing more on mitigation.' She listed examples such as seat belts in cars, which do not stop people from driving, but they do make it much less likely someone will die or be hurt in a crash. Helmets allow people to ride a bike or motorcycle but lower the risk of head injury, and water treatment and chlorination allows people to drink water, but treating it lowers the chance of getting sick. 'Sunscreen does not keep you from being in the sun, but it does lower your risk of skin damage and cancer. Using condoms allows you to have sex while lowering your risk of getting HIV, sexually transmitted illnesses and an unwanted pregnancy. Sugar-free or low-fat substitutes mean people continue to consume fatty and sweet foods, but the health effects are lessened. Road bumps and speed limits lessen the frequency and severity of accidents, but do not stop driving. 'In the case of tobacco use, harm reduction refers to the use of e-cigarettes, pouches and heated tobacco products to smoke less dangerous nicotine alternatives to combustible cigarettes. Supporting evidence demonstrates nicotine addiction is the primary reason individuals smoke. Studies have revealed those addicted to smoking tobacco are at a higher risk of conditions such as cancer, heart disease and respiratory illness.' She said harm reduction approaches are effective to save lives due to their flexible frameworks but they face resistance. 'There are several factors that contribute to the limited acceptance of tobacco harm reduction, such as misinformation and risk misperception. Surveys show over and over that a lot of people, even health professionals, think vaping is as bad or worse than smoking. 'There is also regulatory inertia. Policymakers often choose to ban innovative concepts instead of exploring them because they are reluctant to face industry influence or unintended consequences. 'There is also mistrust of the tobacco industry. Given that cigarette companies have done bad things in the past, many people in public health are wary of any new product, no matter how harmful it is. There is also insufficient research in Africa. Most harm reduction evidence comes from high-income countries, which means there isn't enough data from low-income countries, which in turn creates a gap in locally relevant data to guide decision-making.' Manyeki said the key is appropriate regulations. 'These will make sure products are safe and of good quality, curtail young people from using them and educate citizens about the potential hazards. Lives are lost, productivity goes down and healthcare resources are drained when nothing is done. Tobacco harm reduction is not about letting the tobacco industry off the hook; it's about giving smokers a chance to have a healthier future.'
The Citizen
16 hours ago
- The Citizen
Mpumalanga MEC for health leads campaign to encourage healthy lifestyle choices
The MEC for health, Sasekani Manzini, led healthcare professionals in a door-to-door initiative to implement the Cheka Impilo Campaign in Siyatsemba on Tuesday, August 5. According to Manzini, the campaign is part of the department's ongoing efforts to increase testing and screening for HIV/Aids, TB, STIs and non-communicable diseases such as hypertension and diabetes, to initiate more people on HIV treatment and to encourage healthy lifestyle choices. 'The campaign also aims to find and treat missing TB cases and reduce the burden of disease in the province,' said Manzini. Manzini emphasised that the Department of Health in Mpumalanga is committed to improving performance on primary healthcare indicators by ensuring communities use the campaign to detect diseases early and receive appropriate treatment to live healthier lives. ALSO READ: Mbombela beauty queen wish to inspire others through initiative 'The campaign is crucial in ensuring that diseases are detected and treated at an early stage to prevent illness and maintain a strong immune system. We therefore urge communities to prioritise their health and undergo regular check-ups at their nearest health facilities at least every three months,' said Manzini. ALSO READ: Mandela Day Boxing Championship brings thrilling action to KaNyamazane The campaign also visited a local day care centre to encourage women to make use of available healthcare services, such as cervical cancer screening and other primary healthcare offerings. It also ensured that all children at the centre received their immunisations.
Eyewitness News
17 hours ago
- Eyewitness News
Inside SA's multi-million rand plan to fill US funding void
Health minister Aaron Motsoaledi recently announced that National Treasury had released roughly R753-million to help plug the gap left by US funding cuts to South Africa's health system. Another R268-million is also being released in the following two years for researchers that lost their US grants. But this may only constitute the first round of emergency funds from government, according to sources we spoke to. The health department is planning to submit a bid for an additional allocation later on, which will be considered by Treasury. But this will likely only be approved if the first tranche of funding is appropriately used. So how is the money supposed to be used? To find out, we spoke with officials from the National Treasury, the National Department of Health and the South African Medical Research Council (SAMRC). MONEY FOR PROVINCES IS FOR SAVING JOBS AT GOVERNMENT CLINICS The current tranche of money comes from Treasury's contingency reserve, which exists partially to deal with unforeseen funding shortfalls. It was released in terms of Section 16 of the Public Finance Management Act. Of the R753-million that's been announced for this year, Motsoaledi stated that R590-million would be going to provincial health departments via the District Health Programme Grant - a conditional grant for funding the country's public health efforts, particularly HIV, TB, and other communicable diseases. Such conditional grants typically give the National Health Department more say over how provincial departments spend money than is the case with most other health funding in provinces.. To explain how government officials arrived at this figure, it's worth recapping what services the US previously supported within provinces. Prior to Donald Trump becoming US president on 20 January, the US Agency for International Development (USAID) had financed health programmes in specific districts with high rates of HIV. These districts were scattered across all South Africa's provinces, save for the Northern Cape. The funds were typically channelled by USAID to non-governmental organisations (NGOs), which used the money to assist the districts in two ways. The first is that NGOs would hire and deploy health workers at government clinics. The second is that the NGOs would run independent mobile clinics and drop-in centres, which assisted so-called key populations, such as men who have sex with men, sex workers, transgender people, and people who inject drugs. Following the US funding cuts, thousands of NGO-funded health workers lost their jobs at government clinics, while many of the health centres catering to key populations were forced to close. In response, the health department began negotiations with Treasury to get emergency funding to restore some of these services. As part of its application, the health department submitted proposals for each province, which specified how much money was needed and how it would be used. (Though this only took place after significant delay and confusion). Since Treasury couldn't afford to plug the entire gap left by the US funding cuts, the provincial-level proposals only requested money for some of the services that had been terminated. For instance, funding was not requested for the key populations health centres. Instead, the priority was to secure the jobs that had been lost at government health facilities. As such, the total amount that was requested from Treasury for each province was largely calculated by taking the total number of health workers that NGOs had hired at clinics and working out how much it would cost to rehire them for 12 months. Rather than paying the NGOs a grant to deploy these workers as was done by USAID, the health department proposed hiring them directly. This meant that they calculated their wages according to standard government pay scales which is less than what these workers would have earned from the NGOs. The total came to just under R1.2 billion for all the provinces combined. Treasury awarded roughly half of this on the basis that the money would be used to finance these wages for six months, rather than 12. This amounts to the R590-million for provinces that was announced by Motsoaledi. If all goes smoothly and this money is used effectively to hire these staff over the next six months, then a new tranche of Section 16 funding could be released in order to continue hiring them. Funds might also be released to fund the key populations health sites. A concern, however, is that the money may just be used by provinces to augment their ordinary budgets. If the funds aren't actually earmarked to respond to the US cuts, then it is much less likely that more emergency funding will be released. At this stage, it is too early to tell how provinces will use the money, particularly given that it appears that at least some of them haven't gotten it yet. Spotlight and GroundUp sent questions to several provincial health departments. Only the Western Cape responded. The province's MEC for Health and Wellness, Mireille Wenger, said that the funds have not yet been received by her department, but that once they were, they would be directed to several key priority areas, including digitisation of health records, and the strengthening of the primary healthcare system. It's thus not clear whether the province will be earmarking any of the funds to employ health staff axed by US-funded NGOs. In response to a question about this, Wenger stated that 'further clarity is still required from the National Department of Health and National Treasury regarding the precise provincial allocations and conditions tied to the additional funding'. WHAT ABOUT RESEARCH? Of the R753-million that's been released for this year, R132-million has been allocated to mitigate the funding cuts for research by US federal institutions, primarily the National Institutes for Health (NIH). Unlike USAID, the NIH is not an aid body. It provides grants to researchers who are testing new treatments and medical interventions that ultimately benefit everyone. These grants can be awarded to researchers in the US or abroad as part of a highly competitive application process. Researchers in South Africa are awarded a few billion rands worth of grants from the NIH each year, largely due to their expertise in HIV and TB. But over the last few months, much of this funding has been terminated or left in limbo. (See a detailed explanation of the situation here). The R132-million issued by Treasury is supposed to assist some of these researchers. It will be followed by another R268-million over the following two years. The Gates Foundation and Wellcome Trust are chipping in an additional R100-million each – though in their case, the funds are being provided upfront. All of this money – R600 million in total – is being channelled to the SAMRC, which will release it to researchers via a competitive grant allocation system. According to SAMRC spokesperson Tendani Tsedu, they have already received the R132-million from Treasury, though they are still 'finalizing the processes with the Gates Foundation and Wellcome Trust for receipt of [their donations]'. The SAMRC is also in negotiation with a French research body about securing more funds, though these talks are ongoing. In the meantime, the SAMRC has sent out a request for grant applications from researchers who have lost their US money. The memo states: 'Applicants may apply for funding support for up to 12 months to continue, wind down or complete critical research activities and sustain the projects until U.S. funding is resumed or alternative funds are sourced.' 'The plan,' Tsedu said, 'is to award these grants as soon as possible this year.' Professor Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation, told us that the hope is that the grants could fill some of the gaps. 'This is a bridge and it is certainly going to save some people's jobs, and some research,' she said, but 'it isn't going to completely fill the gap'. Indeed, the SAMRC has made clear that its grants aren't intended to replace the US funding awards entirely. This is unsurprising given that the money that's being made available is a tiny fraction of the total grant funding awarded by the NIH. It's unlikely that research projects will continue to operate as before, and will instead be pared down, said Bekker. 'It's going to be about getting the absolute minimum done so you either save the outcome, or get an outcome rather than no outcome,' she said. In other cases, the funds may simply 'allow you to more ethically close [the research project] down,' Bekker added. For some, this funding may also have come too late. Many researchers have already had to lay off staff. Additionally, patients who had been on experimental treatments may have already been transitioned back into routine care. It's unclear how such projects could be resumed months later. In response, Tsedu stated: 'For projects that have already closed as a result of the funding cuts, the principal investigator will need to motivate whether the study can be appropriately resurrected if new funds are secured.' The SAMRC has established a steering committee which will adjudicate bids. They will be considering a range of criteria, Tsedu said, including how beneficial the research might be for the South African health system, and how heavily the project was impacted by the US funding cuts. They will also consider how an SAMRC grant could 'be leveraged for future sustainability of the project, personnel or unit,' he said. AN ENDLESS BACK AND FORTH The job of the SAMRC steering committee will likely be made a lot more complicated by the erratic policy changes within the NIH. On 25 March, the body sent a memo to staff, – leaked to Nature and Bhekisisa – instructing them to hold all funding awards to researchers in South Africa. After this, numerous researchers in the country said they couldn't renew their grants. However, last month, Science reported that a new memo had been sent to NIH staff which said that while South African researchers still couldn't get new grants, active awards could be resumed. Since then, some funds appear to be trickling back into the country, but certainly not all. For instance, Spotlight and GroundUp spoke to one researcher who had two active NIH awards before the cuts. He stated that one of these was resumed last month, while the other is still paused. Bekker also told us that she had heard of one or two research grants being resumed in the last week, though she said the bulk of active awards to South Africa are still pending. 'Where people are the prime recipients [of an NIH grant] without a subawardee, there seems to be a queue and backlog but some [of those awards] are coming through,' said Bekker. 'But how long this is going to take and when it might come through we're waiting to hear.' She said a strategy might be to apply for the SAMRC bridging funding and 'if by some miracle the [NIH funding is resumed]' then researchers could then presumably retract their SAMRC application. In the meantime, health researchers will have to continue spending their time working out how to respond to the abrupt and increasingly confusing changes to funding guidelines that have dogged them since Trump assumed office. 'It's such a dreadful waste of energy,' said Bekker. 'If we were just getting on with the research, it would be so much better.' Co-published by Spotlight and GroundUp
