Reproductive health rights of women in South Africa under threat, as supply shortages leave health facilities across the country without supplies of contraceptives.
Public sector supply shortages of contraceptives have been confirmed by the National Department of Health (NDOH) to the Stop Stock Outs Project (SSP).
Despite several suppliers being unable to meet demands—in some cases for months on end—and with shortages expected to persist for several months to come, comprehensive guidance for clinics on how to manage this crisis has not been forthcoming from the NDOH.
“The current shortage of all contraception, coupled with the near absence of access to abortion services in many parts of the country places women at increased risk of unwanted pregnancy and undermines their reproductive and contraceptive health rights,” says Dr Indira Govender, rural doctor, RuDASA member and member of the Stop Stockouts Project (SSP) Steering Committee.
Affected products that are in short supply include various dosages of the oral contraceptive levonorgestrel/ethinyl estradiol triphasic (also known as Trigestrel or Triphasil), and the injectable contraceptive norethisterone enanthate (also known as Nur-Isterate).
Supplies are not expected to return to normal until November 2018 at the earliest. While other contraceptives are available, supplies of these alternatives are also becoming depleted in clinics as their use has widened.
Patients and healthcare workers in contact with the SSP have indicated an increasing problem across the country, and many women are being turned away from clinics without any contraception.
“Most women depend on public health services in South Africa, and can’t afford to purchase contraceptives from private pharmacies,” says Dr. Govender.
“We urge both the National and Provincial Departments of Health to act swiftly to identify where stock-outs are occurring, and direct supplies to where they are most needed."
At the same time, suppliers with production problems must work quickly to resolve these issues—and manufacturers that do have extra stock on hand should make it available to the NDOH at an affordable price.
The SSP is calling for:
- Immediate intervention by the National Department of Health to ensure the uninterrupted availability of contraceptive medicines at facilities. This should include the collection and dissemination of up-to-date information on shortages across all parts of the supply chain, and to the public to avoid a major health crisis.
- Comprehensive guidance from the NDOH to be immediately disseminated to all public health facilities and the public at large, to ensure facilities are clear on which alternatives to provide in the absence of certain contraceptive products, and make the public aware of their rights and contraceptive options;
- Provincial departments of health to ensure that facilities are comfortable offering all contraceptive options (including IUCD insertions and implants), and provide training where needed;
- Rapid approval of any applications to the South African Health Products Regulatory Authority that would facilitate the availability of additional quality-assured contraceptive supplies in South Africa
The SSP has been proactively engaging with patients, health care providers and other partners to identify and address all essential medicine shortages.
“We will continue to work closely with the NDOH and provincial departments of health, to mitigate the impact of these contraceptive shortages and to provide updates on medicine shortages reported through the SSP hotline. Going forward it is critical to improve the ability of health systems to diagnose and solve supply issues as they arise,” Dr. Govender says.
“We are also very concerned about extremely limited access to safe termination of pregnancy services in public health facilities, even though constitutionally, everyone has the right to reproductive health care services and South Africa has one of the most progressive abortion access laws in the world.
To have a complete failure in the contraceptive supply system, but also fail to provide information on or access to safe termination of pregnancy services will likely result in a growing number of unplanned and unwanted pregnancies, and unsafe abortions. The inadequate DOH response has been insufficient and really smacks of a lack of commitment to reproductive and women’s rights,” concluded Dr. Govender.
The SSP is a civil society consortium monitoring and reporting on the availability of essential medicines, childhood vaccines and chronic medicines in South Africa.
The SSP urges anyone who has been affected by medicine shortages or stockouts to send a Please Call Me, SMS or phone the hotline on 084 855 7867 or send an email to firstname.lastname@example.org
Find out more about MSF's work in South Africa.