5 days ago
Why South African women still lack access to reproductive health services
Despite South Africa's progressive Constitution guaranteeing sexual and reproductive health rights, women face significant barriers in accessing these services, says the writer.
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.
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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
