Contraceptive stockouts are compromising women’s reproductive health

At the close of Women’s Month 2022, the Stop Stockouts Project (SSP) survey results revealed that many women and girls cannot access the contraceptives they need, which places their sexual and reproductive health in jeopardy

This was the findings of the latest survey results on medicine stockouts at public health clinics across South Africa.

These key findings show that while there are generally fewer stockouts at facilities, contraceptives now represent the biggest share of medicine stockouts in the public health system.

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The survey, undertaken in April 2022 in collaboration with the Ritshidze project, indicates that stockouts of contraceptives represented 40% of all medicine stockouts reported.

Adopting a progressive new survey methodology that puts patient experiences alongside data collected from health facility staff and official figures, the survey indicates that while medicine stockouts have declined in comparison to previous SSP surveys conducted in 2013-2015 and 2017, stockouts continue to form a barrier to women’s sexual and reproductive health rights.

15 750 Public healthcare users surveyed

During the period April to June 2022, Ritshidze clinic monitors surveyed 15 750 public healthcare users and public healthcare providers of over 400 facilities. They found that injectable contraceptives and oral birth control pills were most commonly out of stock at 76.3% and 19.4% respectively.

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The research also indicates that other commonly reported medicines stockouts include HIV medication (16% of reported stockouts) and pregnancy tests (10% of reported stockouts). Facilities monitored were located in seven of the country’s nine provinces (excluding the Northern and Western Cape provinces).

The risks of unplanned pregnancy

The impacts of contraceptive stockouts fall exclusively and negatively on women and girls.

“With endemic violence against women in South Africa, failure to meet our reproductive health needs is another stressor as women without access to contraception are forced into a position of negotiating condom use, or risk an unplanned pregnancy. For some of the most vulnerable women in our country, this lack of access can be catastrophic,” says Dr Indira Govender of the Rural Doctors Association of South Africa (RUDASA).

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Healthcare workers do their best

Survey results also indicate that healthcare workers do their best to ensure patients do not leave empty handed. Of the healthcare workers surveyed who saw contraceptive stockouts for their patients, 58.3% recommended switching to an alternative.

However, this is not a sustainable solution and can have detrimental effects on the lives of women and girls, through side effects like hormonal changes, as well as the inconvenience of making such significant, and sometimes risky changes to their lives.

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“Women who take contraception have made a choice not to get pregnant. When supplies are not there, we take away their agency. It’s often risky to change from a long-acting method to a daily method and it can be costly and time consuming to women and girls to ensure future continuous access”, says Lucy O’Connell, a nurse and advisor at the Southern Africa Medical Unit of Doctors without Borders.

A plan that addresses stockouts

SSP has shared the full survey report findings to National and Provincial Departments of health.

Among other things, the entity urged government to develop a plan that addresses stockouts at public healthcare facilities so that women and girls are able to access their preferred contraceptive, and to develop guidelines for managing the impact of contraceptive stockouts for facilities.

“Failure to prioritise access to contraceptives for all who wish to access them is a failure by the government to prioritise the lives of women and girls across the country. The Stop Stockouts Project urges rapid action and response from government to urgently address this issue,” says SECTION27 legal researcher, Baone Twala.

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“Women and girls are bearing the burden of the unavailability of contraceptives in South Africa, despite a clear constitutional right to access to healthcare services, including reproductive healthcare services. Inability to access contraceptives when needed can lead to unwanted pregnancies, which in turn can direct impact their physical and mental health, financial security, and ability to continue education or working,” concludes Twala.

*Info and writeup provided by Doctors Without Borders (MSF) Southern Africa