Nokuzola* is a 15 year old school girl who had an unwanted pregnancy from an older man or "sugar daddy". Following advice from her school peers, she cooked strong herbal bush tea in hot boiling water and drank the lethal drink. When that did not work she used a coat hanger to induce a miscarriage. This damaged her womb. Medical care had to be sourced and her parents brought into the equation.
In South Africa, the Choice on Termination of Pregnancy Act No. 92 of 1996 gives all women the right to a free abortion at selected government hospital or clinics during the first three months of pregnancy.
Termination of Pregnancy (TOP) is legal and free and services are provided at some public health institutions. But stigma hinders women from accessing this service. Those who access the services often report negative attitudes by health care professionals who personally disagree with TOP.
Research conducted by the Women's Health Research Unit at the University of Cape Town found that personal politics of many healthcare workers are at odds with the legal commitment and the public health imperative to provide comprehensive reproductive healthcare, including abortion. The research found that women in the public sector were sometimes denied patience assistance during abortion as a way of punishing patients for having abortions.
Sexual health is defined by the World Health Organisation (WHO) as a state of physical, mental and social wellbeing in relation to sexuality. Reproductive health addresses the reproductive processes, functions and system at all stages of life.
The 2015 Southern African Development Community (SADC) Gender Barometer reveals that contraceptive usage in the region ranges from 76% among women in Mauritius, to 5% and 6% in Angola and the DRC. The Barometer reports that only South Africa, and to a limited extent Zambia and Mozambique, give women the choice to terminate pregnancy. Unsafe abortion contributes to high rates of maternal mortality across the region.
While maternal mortality ratios are declining in other regions, in SADC they increased between 1990 and 2010 mainly as a result of HIV. Improved access to HIV and AIDS treatment is beginning to reverse this trend, but the region is still far from attaining the target of reducing maternal mortality by three quarters in each country by 2015.
Women's lack of voice, choice and control in matters relating to their SRHR reflects in the high rates of GBV and HIV in the region. Violence Against Women Baseline studies in six SADC countries show lifetime prevalence rates ranging from 25% in Mauritius to 86% in Lesotho.
Sexual violence against women and girls remains one of the major causes of HIV infection. Marital rape is pervasive and contributes to the HIV and AIDS pandemic. For every two people enrolled in HIV treatment, five become newly infected. Women account for 58% of those living with HIV in the sub-Saharan region and bear the greatest burden of care.
The Protocol calls on Member States to develop, adopt and implement legislative frameworks, policies, programmes and services to enhance gender sensitive, appropriate and affordable SRHR services; to halve GBV, eradicate new HIV and AIDS infections by 2015.
According to the SADC Gender Protocol Barometer 2015, included within the several definitions of Sexual Reproductive Health Rights (SRHR) is the elimination of unsafe abortions, unwanted pregnancies, eliminating sexual violence and GBV as well as coerced sterilisation and inadequate access to family planning services.
Post-2015 goals include developing and implementing policies and programmes addressing the mental, sexual and reproductive health needs of women and men.
At least six SADC counties have a reproductive health policy, namely DRC, Lesotho, Malawi, Mauritius, South Africa and Zambia. Key challenges to implementation of these polices and family planning polices provided on other countries is gender inequality, gender based violence and lack of choice impact significantly especially for women and girls.
Gender based violence is a prime barrier to SRHR. A study carried out in South Africa in 2009, showed that "relationship power inequality and intimate partner violence increases the risk of HIV infections in young South African women". Young women who have been abused by a partner are 10 times more likely to be infected with sexually transmitted diseases than women whom have not been abused.
Sexual violence in the form of forced marital sex which can also be unprotected and within a multi partner relationship has lead women to contracting STI infections. While men can choose when, which whom and with what protection if any to have sex, women often are not able to exercise these same rights.
The Southern African Gender Protocol Alliance needs a strong Post-2015 SRHR sector to gather evidence, lobby and advocate on sensitive areas such as unsafe abortion and LGBTI. Innovation to measure GBV and track SRHR laws is critical.
- Sehlaphi Sibanda is a human rights activist based in Johannesburg. This article is written as part of a special series for the Sixteen Days of Activism being produced by the Gender Links New Service