Contraception in SA: What you need to know

Although the majority of South African women of childbearing age use contraception, research shows that access to information about contraceptive methods of their choice is still limited – especially for women in rural communities. This restricted access to information has resulted in an alarming increase in young women looking for emergency options like the morning-after pill.

Health-e News takes a look at the current situation and explores the opportunities for young women.

#AskLwanda

Without much access to information, women turn to social media in hopes of finding answers to their many questions about contraception.

A pharmacist and health advisor from the Eastern Cape, Lwanda, Mkhatshane, used his experience as a retail pharmacist to set up a service where everyone can access health and health information online in real time. The hashtag #AskLwanda was featured on social media platforms such as Facebook, Twitter, Instagram. For those who are not in the mood for social media, calls via Skype and messages via Whatsapp are available.

Its website states: “This pre-existing technology enables you to speak to the customer, confidentially and privately, with the pharmacist. The pharmacist is ready to speak to you and provide information on acute or chronic treatments, drug side effects, contraindications and other information. This convenient service costs only R20 per consultation.

Mkhatshane, known as “pharmacist on call,” said it was shocking how many women are looking for the pill and stressed the importance of people choosing contraception as a choice rather than an emergency option.

He shared some of the most common questions people ask him:

• Is there any other way to have safe sex without using a condom mara?
• Is the morning-after pill a contraceptive method?
• How does the contraceptive ring work?
• Why is Implanon so expensive?

Here is the thread on contraception.

I focused on the brand , the price and for whom the method.

1. Enter-use device (IUD)
2. Implant
3rd injection
4. Skin patches
5. vaginal ring
6. Pills

There is no silver bullet.
The choice depends on the patient. pic.twitter.com/DPzG3frVRg

– Online recipes (@AskLwanda) September 5, 2021

Access to SA and contraception

The prevalence rate of contraceptives among all South African women of childbearing age (15–49 years) using modern contraception is 64.6%, according to a study published by BMC in 2019.

Although this percentage is relatively high, it overshadows the problem of quality contraception services, equal access and the ability of women to correctly and consistently use contraceptive methods of their choice. This is especially true for young black women who live in working-class communities and rural areas, according to the study.

The aim of the study was to understand the needs and behaviors of women of childbearing age in South Africa in relation to family planning and contraception. This was achieved through research into women’s biomedical knowledge of the reproductive system and contraception, including the physical and sensory experiences of contraception and how they influence contraception decision-making.

Body mapping explained

In order to examine the physical and sensory experiences of women with contraception methods, body mapping and group discussions were carried out on 57 women of childbearing age during the study.

Body mapping, which can be defined as “the process of creating body maps using drawing, painting, or other art-based techniques to visually represent aspects of people’s lives, their bodies and the world in which they live” – stressed the need to address communication and knowledge gaps related to the female reproductive system.

An example of body mapping and a contraception timeline. (Photo: Reproductive Health Journal)

AYFS – youth and youth-friendly offers

The South African government has developed and implemented various programs through the National Ministry of Health over the years, such as the National Adolescent Friendly Clinic Initiative or NAFCI (2000-2005), the Youth Friendly Services (2006-2011) and the current revised model for youth and youth friendly services (2013-2017).

While there have been remarkable positive results in reducing the prevalence of HIV among young people, this age group continues to face numerous health problems stemming from the lack of widespread systemic change; Lack of in-depth analysis of AYFS programming and implementation; and poor use of health services by adolescents and young people.

As a result, in April 2017, the government and the Ministry of Health, in collaboration with UNICEF and UNFPA, commissioned a Rapid Assessment of Youth and Youth Friendly Services (AYFS) in all nine provinces of the country, with peer educators in some provinces of primary health care facilities in clinics to help young people.

Another BMC research study found the following: The institutions had the essential components for general service delivery, but there were no youth-specific service offers. AYFS is a government priority, but additional facility support is required to meet agreed standards. The fulfillment of these standards could make an important contribution to safeguarding the health of adolescents, in particular to the prevention of unwanted pregnancies and HIV as well as to the improvement of psychosocial management. “

Communication and knowledge gaps

The study concluded that there is an urgent need to address the gaps in communication and knowledge related to female reproductive anatomy, different methods of contraception, and how contraceptives work to prevent pregnancy, thanks to the influence of wider social networks and local language is underlined.

“Overall, women have limited biomedical knowledge of female reproductive anatomy, conception, fertility, and how contraceptives work, which appeared to be exacerbated by a lack of contraceptive advice and support from health care providers. Body map images put existing local perceptions and reproductive health knowledge in the foreground. Most women were where the baby was developing, outside of the womb, in the abdomen, and often relied on the local vernacular when naming the reproductive organs with words like “mouse” and “cake” for the vagina, “so the BMC research.

“Women, including younger women, have identified gaps in their own knowledge of sexual and reproductive health and identified these gaps as important factors that have influenced the acceptance and effective use of contraception. These gaps in knowledge were mainly due to poor or lack of communication and advice from the health services. “

Types of contraception available in SA

There are six different hormonal contraceptive methods available to women in South Africa. All of these forms of contraception are available free of charge in public hospitals, but shortages remain a problem.

Health-e News reported on the contraceptive shortage that hit parts of South Africa, particularly Limpopo, in July. The ongoing COVID-19 pandemic devastated pharmacies and clinics in particular, which were unable to meet the demand for the Depo-Provera contraceptive injection.

Contraception methods available in South Africa:

• Oral contraceptives
• Spirals
• Implants
• Injections
• Patch
• Rings

Oral contraceptives

The pill is a tablet that you take once a day – there are different types of pill. The combined pill contains estrogen and progestin, which prevent the ovaries from releasing eggs. It also thickens the cervical mucus, which prevents the sperm from getting to the egg. The so-called minipill contains only 1 hormone, a progestogen that offers an alternative to those affected by the hormone estrogen.

You should swallow the pill at the same time each day whether you are having sex or not. Ask your doctor whether the combination pill is an appropriate method of contraception for you based on your medical history, and if so, which one is best for you.

Popular options are Yazmin, Levora, Camila, and Jolivette.

Spirals

An intrauterine device, commonly known as an IUD, is a sling device that releases progestin to prevent fertilization for five years. It can be obtained with a prescription and inserted into the uterus by a doctor to help prevent pregnancy. It is an option for women who have never been pregnant and offers immediate protection.

Any hormonal contraception carries a risk of side effects – albeit rare. With IUDs, side effects can include vaginitis (inflammation, discharge), headache, back pain, mood swings, and depression.

Implants and injections

The contraceptive implant is a small rod-shaped plastic object that is placed under the skin on the upper arm. It is available free of charge, accessible in public clinics, and lasts for three years. Mkhatshane said it should be implanted during the first five days of menstruation and it works immediately. Enlarged breasts, weight gain, and an irregular period are some of the side effects that can occur.

Depo-Provera and Nuristerate injections are available in both private and public health settings. Depo affects glucose intolerance and can be associated with grimacing. While Nuristerate is considered the milder of the two injectable contraceptives available. Depo-Provera slowly diffuses over a period of three months after injection. It offers instant protection when injected within the first week of menstruation and can be used by all women, including those with epilepsy and those unable to take estrogen. It can prevent pregnancy for nine to 18 months after a single injection. The side effects are similar to those of the implant.

Mkhatshane noted that women with the nuristerate injection would still get their periods but would not experience spotting or prolonged bleeding. This is the preferred injection for women with diabetes, but Mkhatshane warned that women with hyperpigmentation (chloasma) should avoid the injection as it could make their condition worse.

Patches and Rings

The skin patch releases hormones through the skin and into the blood and works to prevent ovulation, thicken vaginal fluid to prevent sperm survival, and alter the lining of the uterus to make it harder for a fertilized egg to attach. Mkhatshane suggested that women with a history of active breast cancer, liver disease, and diabetes with high blood pressure should avoid this method.

The vaginal ring is a small plastic ring that is inserted into the vagina. It releases a steady dose of hormones into the bloodstream to prevent pregnancy. According to Mkhatshane, the vaginal ring is just as effective as contraceptive pills but should not be used by women who smoke and are older than 35 years. Side effects include nausea, vaginal discharge, and decreased sexual appetite.

What do SA women prefer?

Injectable birth control was by far the most common method, used by 25% of women, according to a 2017 study by the South African Medical Journal (SAMJ). Other methods were less common and only a negligible proportion used an IUD (1.6%), while 8.6% used a birth control pill. – Health-e news

source https://www.bisayanews.com/2021/09/27/contraception-in-sa-what-you-need-to-know/