We need to talk about the “taboo” of women’s health in SA

Women’s healthcare in South Africa is steeped in stigma and misinformation, and Donald Trump’s Global Gag Rule does nothing to clear the misunderstanding. There is a severe lack of education locally surrounding women’s health, particularly surrounding reproductive and family planning services. The problem has little to do with money and more to do with misinformation and strained healthcare workers. It seems that women who visit public clinics face worse stigma than those in private clinics.

The Daily Vox spoke to South African women about their experiences in reproductive health services at public clinics.

Lerato Moko, 20, told The Daily Vox that the healthcare workers were brusque and unfriendly when she requested contraception services. “The first time I went to the clinic, I wasn’t sure which option would be best for me, and I asked if there was counselling of some sort. The receptionist told me I should go Google that and come back when I know what I want and not waste their time,”Moko said.

Gaopalelwe Phalaetsile, 25, who wanted an abortion, did not fare much better. “From how I was looked at and questioned at the public hospital regarding abortion, it seemed the nurses believed I was a promiscuous teenager who was there to waste their time,” said Phalaetsile.

Phalaetsile was three weeks pregnant at the time. She was told to come back when she was 20 weeks into her pregnancy – halfway through the 40-week gestation period – but opted to raise funds to use a private clinic instead.

Abortion is safer when performed in the first 12 weeks of pregnancy. After 12 weeks, there are increased risks of haemorrhage, infection, damage to the uterus or the cervix, abortion failure, and even death.

Dr Tlaleng Mofokeng, medical doctor and chairperson of the Sexual and Reproductive Justice Coalition (SRJC), told The Daily Vox that healthcare workers are often ill-prepared, overburdened and misinformed about women’s reproductive health.

Mofokeng said that with high-priority, competing health issues like trauma care and child immunisation in clinics, “contraception and women’s health become the things that people think are nice to have”.

“I think it’s more of a training issue but also because of the pressure that the health workers are under to try and prioritise different care,” Mofokeng said.

It seems that private clinics are better informed and staffed than public clinics, but this comes with an additional cost and many do not have access to medical aid. Despite the bad treatment women receive at public clinics, they still go back because reproductive health services are free.

“Many women prefer private clinics because there are not much long queues and your rights are respected but the cost that comes with that can be unbearable,” said Phalaetsile. Moko added that private clinics are, “efficient [and have] privacy, and you get the respect and dignity you deserve”.

The reason for the lack of information, especially in public clinics, is rooted in the stigma that permeates women’s healthcare. Andrea Thompson, of Marie Stopes International, told The Daily Vox that stigma dramatically affects South African women seeking reproductive healthcare.

“It can mean having to avoid a certain clinic for fear of being recognised or forgoing a service such as long-acting contraception altogether for fear of mistreatment by clinical staff. Stigma also affects providers who may fear pushback from clinical colleagues, or due to personal beliefs refuse to assist women in need of this healthcare service,” she said.

Marie Stopes is an international non-governmental organisation (NGO) that provides sexual and reproductive healthcare services to women and girls in developing countries.

Moko said that “young girls are judged every time they come for family planning,” and that those who experience unwanted pregnancy are afraid to go to get an abortion for fear of ridicule.

Hikatekile Maringa, 25, also said she feels that there is a stigma against women who take contraceptives and are confident to say that they are on contraceptives. “The people who work [at public clinics] aren’t exactly friendly. There is something uncomfortable about going there and asking for those [family planning or reproductive healthcare] services,” Maringa said.

Information is important for destigmatisation

“You don’t deal with something that’s stigmatised by withholding the treatment or the procedure. You deal with it by educating people,” said Mofokeng.

Sixty-three percent of women don’t know that termination of pregnancy is legal in South Africa. Without that information, it is difficult to target the unsafe abortion and backdoor abortion providers because women cannot be open about abortion, said Mofokeng.

The stigma, misinformation, and backward social norms can also lead to a number of other issues like unwanted pregnancy, women leaving their studies and becoming dependent, child abandonment, child trafficking, and an increased number of children on the streets.

Mofokeng emphasised that we need to spend time educating women about how their bodies work and what they need. “Start with information: telling people that in fact this service is available, this is how we know you’re pregnant, these are the symptoms and things you look out for. When you do think you’re pregnant, where should you go? What should you ask for? What can you expect? Without that type of information available, everything is done in secrecy,” she says.

Medical and nursing students need to be better prepared on how to care for women holistically. Each section of the clinic must have specific plans with trained and dedicated staff, said Mofokeng.

Women’s healthcare in South Africa is varied, with layers of complexity. “You’ll find a woman in the rural area where the clinic is supported by an NGO and those women have access to good healthcare. The Joburg region, the CBD, is one of the poorest societies in the country. But because it’s in an urban setting, it gets ignored because it doesn’t tick the boxes of ‘needs’.”

“It’s not about how much money you have and what job you have. It’s more about the decisions you’re making based on the information that you have,” said Mofokeng.

The Gag Rule only makes a bad situation worse

Whitney Chinogwenya of Marie Stopes International told The Daily Vox that the Gag Rule robs women of information and referrals. “This is a huge step back for women all over the world and will affect the poorest, most disadvantaged women. This will have a negative impact on comprehensive sex education and will affect women seeking all kinds of sexual and reproductive health services, including contraceptive care,” said Chinogwenya.

Mofokeng said South Africa has not fully recovered from the previous time the Gag Rule was reinstated – back when George W. Bush was the president. “A lot of the NGOs were limited by the conditions of having to exclude abortion care as part of the services they offered. People literally died because of that approach to healthcare,” she told The Daily Vox.

“The whole world thinks they have a right to tell women what to do with our vaginas and our uteruses, yet there isn’t that type of demand with anyone else. No one tells lawyers or bankers how to do their thing; everyone takes for granted that those people have professional standards and ethics that they adhere to. Women’s health seems to be a free for all for everyone to have an opinion on,” said Mofokeng.

Featured image via Twitter