The lack of access to essential healthcare services in rural areas worsens the challenges women face, particularly when it comes to early pregnancy and gender-based violence. Celene Coleman and Hanifa Mahlangu argue for strategies that prioritise the empowerment of rural women through improved access to contraception and mental health services.
The severe consequences of early pregnancy include increased maternal mortality, educational disruption, economic hardship, and social stigma. Similarly, the mental health impact of gender-based violence (GBV) has devastating effects on women survivors.
Early pregnancy has far-reaching implications for the mother, her child, their family, and society at large. Teenage pregnancy has for example been shown to result in girls on average dropping out of school earlier. With adolescent pregnancy and birth rates increasing in South Africa, the situation seems to be getting worse.
Poorer access to sexual and reproductive health services in rural areas means women who live in these areas are at higher risk of early pregnancy and related negative outcomes. The negative socio-cultural factors prevalent in rural areas, such as the lack of access to contraceptives, limited financial means and social stigma surrounding pregnancy and contraceptive usage, exacerbates women's lack of access to sexual and reproductive health care services. We discussed these and other factors in more detail in a recent policy brief.
To see things in context, early pregnancy should be considered alongside other realities that many young women face, particularly GBV and its mental health consequences. GBV has a strong association to patriarchal ideologies which are fertile in rural areas due to the ingrained cultural norms of male dominance.
In the past few years, South Africa has reported over 50 000 sexual assaults. Data from an analysis of 3 national surveys shows that largely rural provinces such as Eastern Cape, KwaZulu-Natal and North West have the highest number of cases of femicide - the murder of women, based on their gender. This underscores the significant challenges the country encounters in tackling GBV. Even more concerning is that many of these GBV cases against women are at the hands of their partners.
Women survivors of GBV are at high risk of mental illness such as depression and post-traumatic stress disorder. The negative impact on the mental health of GBV women survivors is exacerbated by the reality that the necessary mental healthcare services are often not available or accessible, particularly for women in rural areas, leaving them to deal with the impact of GBV on their mental health on their own.
The issues of early pregnancy and GBV are deeply intertwined. For example, when young girls in rural areas are not able to access contraceptives, their risk of early pregnancy increases, and with that their risk of dropping out of school. This coupled with the lack of employment opportunities for women severely limits women's life choices and increases their vulnerability to GBV and its mental health consequences.
So what can be done?
To start with, we need to establish adolescent-friendly healthcare services, with a focus on understanding adolescent needs and providing youth-oriented counselling and support. Beyond generally improving access to healthcare services, we need specific interventions such as the provision of a consistent supply of contraceptives in schools. To increase uptake, it is necessary to provide education on these issues, and hold campaigns to decrease stigma and increase awareness.
Empowering women through free childcare and equal access to jobs will also help. Free childcare services would enable women with children to continue their education or join the workforce, thus experiencing opportunities equal to those of men. The increased access to employment will also promote a reduction in GBV, as women will have greater financial independence.
The backbone of community well-being is good healthcare, especially in rural areas where access can be limited. Good healthcare means early detection, timely treatment, and improved overall well-being. Let's continue to advocate for equitable access to healthcare in #Ruralareas. pic.twitter.com/MmLblCsPFx
-- RHAP (@RHAPnews) September 4, 2024
When it comes to mental health service provision, one solution is simply to recruit more mental healthcare professionals to work in rural areas. Another promising solution is task shifting, in which healthcare providers who are not specialised in mental healthcare are equipped to provide basic counselling services. This is however challenging in places where healthcare facilities are already understaffed and over-burdened.
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Women in rural areas, who often bear the brunt of healthcare disparities, deserve more than just promises - they deserve tangible change. It's time we empower rural women, not just with words, but with the resources, infrastructure, and sustained support they need to lead healthy, fulfilling lives. This empowerment begins with ensuring consistent access to contraception so that women can have control over their reproductive health and their futures.
*Coleman and Mahlangu work in the research department of the Rural Health Advocacy Project, a division of the Wits Health Consortium.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
