Achieving universal access to sexual and reproductive health services : the potential and pitfalls for contraceptive services in South Africa

Universal access to sexual and reproductive health services was included in the Millennium Development Goals and has been carried forward in the new Sustainable Development Goals (SDGs). Access to contraception is highlighted in the Family Planning 2020 (FP2020) initiative. Given South Africa's ongoing commitment to the SDGs and FP2020, this chapter explores the potential for achieving universal access to contraceptive services in South Africa against the backdrop of the country's domestic policies, current implementation efforts and HIV epidemic. South Africa's laws, policies and guidelines on contraceptive service provision in the public sector are progressive and comprehensive, and promote integrated, rights-based service delivery. The chapter begins with a description of South Africa's enabling policy environment with regard to sexual and reproductive health and rights generally, and contraception specifically. Service delivery norms and approaches for budgeting and expenditure tracking are described, and national and provincial contraceptive statistics are presented. Public sector delivery of contraceptive services nationally faces both similar and unique challenges as compared to other health services. Issues relating to health systems constraints are identified, including scarce resources and the burden of HIV in the country, and their impact on delivery of contraceptive services is discussed. The recent introduction and roll-out of the subdermal contraceptive implant is highlighted as a case study illustrating both successes and challenges. Finally, key recommendations are provided for contraceptive service delivery in the future in light of ongoing research and changes on the horizon - such as National Health Insurance, national-level efforts to integrate HIV and primary care services, and efforts under-way as part of the National Development Plan.