Reproductive Healthcare

"For most women, including women who want to have children, contraception is not an option; it is a basic health care necessity."

-Louise Slaughter

Access to health care is a complex concept. It includes physical accessibility, financial affordability, and acceptability. Universal access implies that individuals can get quality care when needed, without financial risk. The reproductive health care is essential to people’s overall health and well-being. This includes preventing and treating sexually transmitted infections, including HIV/AIDS. In addition, reproductive health care can bring patients into the health care system, encouraging diagnosis and treatment of other diseases and conditions. South Africa still has high rates of HIV and unintended pregnancy, and young women face particular challenges to protecting their health and exercising their rights: One in three women aged 15-24 experiences an unintended pregnancy before the age of 20 and among females aged 15 to 24, HIV incidence is more than four times higher than the incidence of males in the same group (Ibis Reproductive Health care. w/d)

South African law guarantees access to sexual and reproductive health (SRH) services and also the death rates from unsafe abortion has declined by more than 90% since the Choice on Termination of Pregnancy Act that was created in 1996 (Ibis Reproductive Health care. w/d). However, the country’s maternal mortality rate remains unacceptably high, and many women face obstacles to getting a safe, legal abortion. In South Africa, which is home to 20% of all people with HIV worldwide, all health care services are currently offered through two parallel systems: public and private. The public system is financed through public taxation and serves roughly 80% of the population (JSTOR, 1998). Primary health care services are offered freely to individuals who do not have private health insurance; services are also free for all pregnant and lactating women and children under age six.

The private health system is financed through payments from individuals or via privately purchased health insurance, which often requires users to co-pay for services. In response to access problems in the public sector and equity concerns, South Africa’s national government has announced plans to merge the public and private systems into a National Health Insurance (NHI) scheme and planning and piloting for the new system are currently underway. As South Africa and other countries grapple with increasing access to SRH services under the rubric of universal access, it is important to remember that individuals incur costs despite free care at the point of service. Policies that address geographic proximity and service quality would be important for reducing costs and ensuring full access to SRH services.

"The truth is women use contraception not only as a way to prevent unintended pregnancies, but also to improve their health and the health of their families. Increased access to contraception is directly linked to declines in maternal and infant mortality."

-Felicity Huffman