In 2015, Doctors Without Borders/Médecins Sans Frontières (MSF) surveyed 800 women between the ages of 18 and 49 in Rustenburg and found that one in four women had been raped in her lifetime, yet fewer than 5 percent of those women reported to a health care facility. Since then, MSF has run several sexual and reproductive health programs for the community— including for survivors of sexual violence— across Bojanala district, in partnership with local health authorities. In addition to community outreach and health education in more than 20 schools in the district, MSF supports four Kgomotso Care Centers (KCC) providing sexual violence care. Kgomotso means “place of comfort” in Setswana, one of the official languages of South Africa, and these care centers provide an essential package of medical, social, and psychological care for survivors of sexual and gender-based violence. MSF also supports the sexual and reproductive health units in two community health centers in Boitekong and Phokeng, where individuals from the area and survivors of sexual and intimate partner violence referred from the KCCs can receive a wide range of services including safe abortion care.
Here, Kgaladi Mphahlele, MSF's safe abortion care and family planning activities manager in Rustenburg, talks about the secondary impacts of COVID-19 on access to contraception and safe abortion care—and why sexual and reproductive health services are always essential health care.
Tshireletso*, a 35-year-old woman, came into the clinic today requesting a termination of pregnancy. Unfortunately, I was unable to help her as she was too far along in her pregnancy. She was 27 weeks pregnant. I asked why she had waited so long to see us. She told me the procedure was initially booked for March 27, but that was the first day of the national COVID-19 lockdown, and she couldn’t get to the clinic for her appointment. She came back to the clinic a week later but was turned away by the security guard working for the Department of Health (DoH), who told her that there were no abortions taking place and she needed to come back when the lockdown was over.
So she came back today, the day lockdown restrictions were reduced to level three. It was her third attempt to get the essential care she needed. She pleaded for me to help as she was not currently working and she had children at home to support. But it was too late, I couldn’t help her. We provided her with counseling and connected her with a social worker, but this is just a really sad example of how restrictions implemented as part of the COVID-19 response have affected women’s access to essential health care services.
In the first four days of the lockdown in South Africa the number of complaints of sexual and gender-based violence lodged through the national hotline tripled, but the number of patients coming to seek care at our KCCs decreased.
And it wasn’t just victims of violence who were not seeking care. In April, at the community health centers in Phokeng, 80 percent fewer women came to seek safe abortion care, and women coming to receive family planning services dropped from 2,000 to 800.
Public transport was disrupted and curfews restricted people’s movements. Lockdown restrictions also put many people out of work, so some people could just not afford to travel to a facility. People were calling out for help, but they were not able to leave their houses to get to the clinic.