Struggling for control: The hidden crisis in South Africa's contraceptive supply

Source: Affinity Health.

Previous findings from the SSP revealed that contraceptives were the most prevalent stockouts in the country. This report sought to investigate the relationship between supply chain and contraceptive stockouts.

While medicine stockouts are widespread across South Africa, this report focuses on the Eastern Cape, KwaZulu-Natal and the North West provinces between April 2022 and June 2023.

The report details the experiences of healthcare users in accessing contraceptives and includes interviews with public-health facility managers to establish the causes of poor access and the mitigation measures in place. Between April 2022 and June 2023, SSP together with the Ritshidze project surveyed public-health users to assess their experiences with accessing contraceptives.

In the Eastern Cape and KwaZulu-Natal provinces, almost all women and girls who were surveyed did not receive the contraceptives they requested. The survey also examined the availability of various types of contraceptives. Throughout the monitoring period, injectable contraception was reported as the least accessible followed by external condoms and the implant.

Facility managers were interviewed about the measures implemented to address stockouts. While most managers in the Eastern Cape and KwaZulu-Natal reported having received guidance on how to respond to stockouts, managers in the North-West Province said they had not received such guidance.

However, the survey showed that healthcare providers made efforts to ensure that healthcare users did not leave facilities without medicines. Healthcare providers either offered healthcare users alternative medicines or referred them to facilities that had stock.

The survey also highlighted the unavailability of termination of pregnancy services. In all three provinces, most of the surveyed facility managers reported that they referred healthcare users seeking these services to other facilities.

Our findings are that poor national procurement planning continues to be the main driver of contraceptive shortages and stockouts. At the provincial level, causes of stockouts included budgetary limitations, dependence on manual paper-based systems and poor management of stock controls. The report recommends that the national and provincial departments of health urgently address the use of manual data systems for payment and stock management.

Access to contraceptives is a crucial component of the enjoyment of the right to sexual and reproductive health rights as well as the right to bodily autonomy. Contraceptives enable women and adolescent girls to exercise their right to decide whether to be pregnant, the number and spacing of their children and to have pleasurable and safe sexual experiences without the risk of unintended pregnancies.

Moreover, contraception enhances socioeconomic opportunities for women and opens up more educational opportunities for adolescent girls. Failure to ensure access to contraceptives therefore violates various constitutionally guaranteed rights.