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Contraceptives need to be an equally shared responsibility, expert says

Reality is that, in this society at least, contraception is a women’s issue more than a man’s. Picture: Simone van der Koelen/Unsplash

Reality is that, in this society at least, contraception is a women’s issue more than a man’s. Picture: Simone van der Koelen/Unsplash

Published Sep 27, 2023


According to the State of World Population 2022 report, it has been revealed that nearly half of all pregnancies worldwide, approximately 121 million, are unplanned.

Shockingly, South Africa is not exempt from this trend, with a staggering 65% of pregnancies between 2015 and 2019 being unintended.

Worse still, 36% of these unintended pregnancies ended in abortion.

The impact of unintended pregnancies goes beyond the emotional toll it takes on individuals and families. It also comes at a significant financial cost to the country, amounting to billions of rand.

The development of the birth control pill was a game-changer for women’s rights but it didn’t stop there.

Women now have 11 contraceptive options to choose from, including barriers, hormones and long-acting methods. However, a study argues that men have only two options: condoms and vasectomy – neither being hormonal or long-acting.

A recent study published in the AMA Journal of Ethics by Lisa Campo-Engelstein, PhD, titled “Contraceptive Justice: Why we need a male pill”, has shed light on a concerning disparity.

It reveals that while women have a multitude of options, men are limited to only two choices: male condoms and vasectomy.

Not only are these options non-hormonal and non-LARCs but they also place a disproportionate burden on women, leaving them with most of the financial and health-related responsibilities of contraception.

There are two major problems associated with this gender disparity in contraceptive options. The first is that most of the burden of contraception falls on women – financially, physically and otherwise.

The second problem is that it reduces the reproductive autonomy of men by shifting the responsibility from them to their wives.

Although some medical aid schemes in South Africa cover various contraceptives for women, women still carry the primary responsibility for fertility work, including the mental and emotional stress of preventing pregnancy.

Dr Chido Siame, Clinical Care Lead at Kena Health. Picture: Supplied

In a country with high unemployment (particularly among the youth) and persistently high HIV and gender-based violence rates, contraception is a hugely important issue that clearly needs a rethink, said Dr Chido Siame, Clinical Care Lead at Kena Health.

“We need to give serious thought to how to readjust our approach to contraception – and technology could well be the key.

“While the availability of free contraception at public health clinics is a notable achievement, the high pregnancy rate and persistent unmet needs for contraception show that there is still work to be done.”

“Unfortunately, it’s also a reality that, in this society at least, contraception is a women’s issue more than a man’s, so the context of female empowerment has to be taken into account.”

It is clear that women bear most of the responsibility for preventing pregnancy in heterosexual relationships.

This includes not only the physical aspects, but also the mental and emotional burdens. It would be fair for men to share or even take on the primary responsibility for preventing pregnancy, even though most methods currently rely on women’s bodies.

Hormonal contraceptive methods, including birth control pills, patches, shots, hormonal implants and hormonal IUDs, may have potential side effects.

Here are some common side effects:

Hormonal contraceptives can cause changes in the menstrual cycle, such as lighter or heavier periods, irregular bleeding, or spotting between periods.

It can cause nausea or an upset stomach, especially when first starting a new method.

Some people may experience headaches or migraines as a side effect of hormonal contraceptives.

Hormonal fluctuations can occasionally result in changes in mood, including mood swings, irritability, or depression.

Weight gain is often a concern, additionally, some people may experience a decrease in sex drive or changes in sexual desire while using hormonal contraceptives, although this is not the case for everyone.

A study of contraceptive use and sexual behaviour among South African women shows that multiple factors affect the use of contraception.

Important factors are the attitude of male partners, long waiting periods, erratic supply of contraceptives at public health clinics and substandard or biased counselling from nurses.

Further factors would include the stigma attached to contraception in some communities (because it is presumed to indicate promiscuity), how easy various contraceptive methods are to use and side effects, said Siame.

The fact that many women are unaware of how the female reproductive system works as well as the full range of contraceptive alternatives available is a contributing factor, said Siame.

“Education is clearly an important intervention that needs to happen,” she said.

Research also shows a strong link between the attitudes of healthcare providers and the uptake of contraception. Improved patient/provider counselling is essential, along with the need to maintain confidentiality.”

Arguing that given the constraints of the public health system, technology can play an essential role in providing South African women with the private, high-quality and affordable advice and counselling they need to understand their contraceptive options.

A good example is the Kena Health smartphone app, which addresses many issues preventing women’s access to contraception.

Using the app, anyone can chat with a registered doctor, nurse or mental health professional in privacy, something that’s very important given the stigma attached to contraception.

Critically, Kena Health experts can help customers decide on the best contraception method.

Eighty percent of patients are women, and a third of all consultations have been related to women’s health, specifically sexually transmitted diseases and contraception – testimony to the need for such a service in South Africa.

“Because all consultations are done on a cellphone, women are assured of privacy and convenience – no need to waste a whole day standing in a clinic queue. Even more important, the clinicians are professionals able to deliver top-quality advice sympathetically.

“The consultations are also highly affordable at R185 and can be renewed even more cheaply for R120. Prescriptions are sent directly to the customer’s phone, and can then be redeemed at the pharmacy.

“We are developing new ways of making it easier for women to address this pressing issue.”