Insights from a South African Survey**

Authors: Mrs Yashmita Naidoo CEO of HIV SA, Dr Venessa Timmerman (PhD) and Mr Siraaj Adams (MBA, MPH).

HIVSA is an NGO that commissioned the national survey.

Introduction

Studies have reported that students between 18 and 24 years have one of the highest rates of unplanned pregnancies. The lack of effective knowledge concerning contraceptive use results in an increase in unplanned pregnancies (Bryant 2009:12; Trieu et al. 2011:431).

In a study amongst 15 to 24-year-old South African women, it was estimated that only 52.2% of sexually experienced women are using contraceptives (MacPhail et al. 2007:3). Because of the fact that 80% of undergraduate students at higher educational institutions are sexually active, it is vital that they have access to safe, accessible and adequate contraceptive services (Bryant 2009:12). Dreyer (2012:6) suggests that the main reasons for women not utilising or discontinuing the use of contraceptives are side effects, lack of knowledge about different methods available, or lack of interest in utilising it.

In the study amongst students in Durban, South Africa, Roberts, Moodley and Esterhuizen (2004:441) suggested that an increase in the use of emergency contraceptives might reduce the number of unplanned pregnancies.

In our recent survey conducted in South Africa, we embarked on a comprehensive examination of emergency contraception and unplanned pregnancy among 469 female respondents aged between 20 and 35. This survey sought to uncover the prevailing landscape surrounding the use of emergency contraception, experiences with unplanned pregnancies, and the evolving attitudes toward contraceptive accessibility. The data gathered provides crucial insights into the reproductive health dynamics of young women in South Africa.

Understanding Emergency Contraception Practices

Our survey captured the experiences and choices of a diverse group of women,469 respondents from all 9 provinces, offering a comprehensive view of emergency contraception practices. The respondents provided valuable insights into the frequency of morning-after pill usage and the prevalence of unplanned pregnancies.

Key Survey Findings

1. Morning After Pill Usage

A significant 49.3% of respondents reported having used the morning-after pill, highlighting the concerning high utilisation of emergency contraception in managing reproductive health.

2. Repetitive Morning After Pill Usage:

Over 21% of respondents revealed using the morning-after pill more than 2 to 3 times, indicating a recurring reliance on emergency contraception among a notable portion of the surveyed population.

3. Unplanned Pregnancies on Hormonal Contraception

Alarmingly, 18.6% of respondents reported falling pregnant while on some form of hormonal contraception. This finding underscores the need for further exploration into the effectiveness of existing contraceptive methods or whether or not non-compliance by patients is a factor.

4. Incidence of Unplanned Pregnancies

Nearly 45% of respondents disclosed experiencing unplanned pregnancies, verifying the concerningly high prevalence of unexpected reproductive outcomes among young women in South Africa.

5. Termination of Pregnancy

A significant 19% of respondents confirmed having undergone a termination of pregnancy, primarily at public health facilities. This highlights the crucial role these facilities play in addressing reproductive health needs.

6. Preference for Online Morning After Pill Purchase

Almost half of the respondents, approximately 47%, expressed a willingness to purchase the morning-after pill online. This inclination reflects a growing demand for convenient and discreet avenues for accessing emergency contraception.

Implications and Considerations

These survey findings carry substantial implications for reproductive health policies, healthcare providers, and the broader community. The prevalence of unplanned pregnancies, the repetition of morning-after pill usage, and the occurrence of pregnancies while on hormonal contraception warrant careful consideration.

Conclusion

The prevalence of contraceptive use by sexually active students in previous research was high at 79%. However, inconsistent use of contraceptives is a major challenge. Females were aware of the benefits of contraceptives in preventing unplanned pregnancies; however, they used contraceptives inconsistently as a result of being afraid of possible side effects. Overall, there was limited awareness and use of emergency contraceptives. Consistent use of regular contraceptives and condoms should be emphasised to reduce not only unplanned pregnancies but also sexually transmitted diseases (Brunner Huber & Ersek 2009:1069).

In a study among students in Durban, South Africa, Roberts et al. (2004, p. 441), suggested that an increase in the use of emergency contraceptives might reduce the number of unplanned pregnancies. However, due to the lack of knowledge and awareness thereof, the family planning services were underutilised (Roberts et al. 2004, p. 441).

Our survey provides a comprehensive snapshot of the current landscape of emergency contraception and unplanned pregnancy among young South African women. The findings underscore the importance of accessible and effective reproductive health services. Efforts should be directed towards enhancing awareness, ensuring the availability and education around use of reliable contraceptive methods, and exploring innovative solutions, such as online access to emergency contraception. By addressing these needs, we can empower women to make informed choices about their reproductive health, contributing to a healthier and more equitable future. This survey serves as a catalyst for ongoing discussions and actions aimed at fostering reproductive well-being among South African women.

References

Bryant, K.D., 2009, ‘Contraceptive use and attitudes among female college students’, Journal of ABNF 20(1), 12-16. PMID: 19278182.

Dreyer, G., 2012, Contraception: A South African perspective, Van Schaik Publishers, Pretoria.

MacPhail, C., Pettifor, A.E., Pascoe, S. & Rees, H.V., 2007, ‘Contraception use and pregnancy among 15-24-year-old South African women: A nationally representative cross-sectional survey’, BMC Medicine 5, 31. PMID: 17963521, http://dx.doi.org/10.1186/1741-17015/5/31

Roberts, C, Moodley, J & Esterhuizen, T 2004, Emergency contraception: knowledge and practices of tertiary students in Durban, South Africa, Journal of Obstetrics and Gynaecology, vol. 24, no. 4 pp. 441-445, doi:10.1080/0144361040001685619

Failure of the emergency contraceptive levonorgestrel and the risk of adverse effects in pregnancy and on fetal development: an observational cohort study”: https://www.sciencedirect.com/science/article/pii/S0015028205008861