Contraceptives: Public versus private sector

Our constitution recognises that both women and men have the right to know about contraception and to have access to safe, effective, affordable and acceptable methods of birth control of their choice. The right to this service should be safe guarded. Moneybags writer Alina Hardcastle finds out about the types of contraceptive methods offered by the public sector and whether or not they are up to scratch with the private sector.

Public versus private sector

 Dr Heinrich Cyril Volmink, Shadow Deputy Minister of Health for the Democratic Alliance (DA) and a Member of Parliament, says that in the private sector there appears to be a wide range of contraceptive choices. “However, given that only about 18% of the population is covered by medical aid, the high cost of some contraceptives in the private sector may make them difficult to access for the majority of the population. For example, the estimated out-of-pocket costs for Implanon (hormonal implant) and the Intrauterine device in the private sector is R1700 and R2000 respectively.”

He adds that although work has been done on creating a policy framework for the public sector, the challenge is in the implementation. “Issues such as limited human resources for health, poor supply chain processes (potentially impacting on the availability of contraceptives) and barriers to health promotion initiatives with respect to reproductive health services need to be taken into consideration.”

However, Jo-Anne Otto, principal communications officer of Western Cape Government Health, expresses that despite the fewer options, the products used in the private sector are the same as those used in the public sector.

“The service is well-established and possibly even more accessible and efficient than that of the private sector where one is required to see a doctor, get a prescription and pay for not only the service but also the product. In the public sector, the nurse that will counsel you on birth control has received specialised training in managing primary healthcare birth control.”

Clinics offer free contraception to all patients whereas the private industry doesn’t.

Otto adds that there are quite a few options available at specialised facilities, including the insertion of the Mirena (a hormone based IUD) and an Endometrial Ablation which is permanent and essentially stops menstruation. Due to the high cost of these procedures, these options are only available to patients who fit a certain criteria or for whom other forms of birth control are not an option. These procedures can only be done at specialised facilities that have the necessary expertise and equipment, the same applies to the private sector. Health care workers are required to attend training on the insertion and removal of the product before administering it.

“All nurses working in the Women’s Health areas of clinics and CDC’s have received an additional post graduate diploma in Primary Health Care, which includes a section on birth control. Furthermore, nursing education and updates are offered to all clinical staff.”

Contraception offered by the public sector

The public sector has a wide variety of birth control choices for women. The options are discussed with the patient when visiting the clinic.

  • Emergency contraception: This is to prevent pregnancy in the event of unprotected sex. This must be taken within 72 hours of the sexual encounter to be effective.
  • Mini-pill: This is for females who are breast-feeding and can remember to take the pill every day at the same time.
  • Oral contraceptives: The pill is taken daily. There are a few different options to suit different people.
  • Injectable contraceptive: Both the bi-monthly and tri-monthly options are available. One of the advantages of this form of contraception is that for many women it stops menstruation, making it ideal for women at school or those who participate in active sporting activities.  The other advantage is that one only needs to visit the clinic every second or third month.
  • The intra-uterine device (IUD): The device used to be known as the Loop or the Copper-T. This is a good form of birth control for women who are in a mutually monogamous relationship. It is non-hormonal and offers protection from pregnancy for 10 years. It can be removed at any time, should the patient wish to start a family. It needs to be inserted and removed at the clinic by a trained nurse. This is a non-hormonal form of birth control which means that women menstruate as normal.
  • Implanon: The Implanon is sub-dermal implant, meaning that it placed under the skin. It is inserted under the skin of the inner upper arm and releases hormones that prevent pregnancy. It offers protection for three years. This contraception is growing in popularity as, although some women still have a light menstruation monthly, many have reported their periods have disappeared completely. You can return back to fertility immediately once the Implanon is removed.
  • Sterilisation: This is a permanent form of birth control and is available to women who feel that their families are complete.

The following contraceptives are offered to men:

  • Condom use: If used correctly offers not only birth control, but also offer protection from STI’s and HIV.
  • Vasectomy: This is a permanent form of birth control available to men who have decided their families are complete or you don’t want children.

Male and female condoms are offered free of charge at all clinics. It’s important that dual protection is used i.e. a barrier method such as condom for protection against STIs and the pill or IUD for unwanted pregnancy. All of the above services are offered free of charge and are available at all local primary healthcare facilities (Clinics) and Community Day Care Centres (CDCs).

The importance of contraceptives for young females

Otto expresses that the Department wants to appeal especially to young girls attending school to access birth control and condoms from their local clinic. “There are so many complications that arise in one’s life when one has a baby at a young age; rather focus on completing your school career so that you can live a full life and have a baby when you are ready and able to provide a safe, loving and secure home for them,” says Otto.

Learn about contraceptives in the private sector that will suit your wallets and needs, click here.