Migrant women struggle to access contraceptives 

By Nodumo Makaza,

Johannesburg: Women are finding it difficult to get contraceptive pills that are smuggled from Zimbabwe due to the lockdown regulations.

Some migrant women from Zimbabwe buy Marvelon contraceptive pills and a combination pill, Levonorgestrel and Ethinyl Estradiol with Ferrous Fumarate tablets, from traders who smuggle them into the country. With the borders closed the family planning pills have become scarce.

Nobukhosi Bhebhe says she has been using the Marvelon pill for the past four years and buys it from traders.

“When I was in Zimbabwe I used Marvelon as a contraceptive, and when I moved here I decided to continue using it. The pill is not available in the local clinics, they have a different one and I’m not comfortable with changing. With the Covid-19 lockdown the suppliers say they are running out of the pills,” she said.

The oral contraceptive pills are supplied in Zimbabwean public health facilities for free, then smuggled into the country and sold between R20 and R25 a blister packet. South African public health facilities do not supply the same pill.

Philisiwe Ndlovu, from Hillbrow who usually buys the contraceptive from a smuggler, says she tried getting the pill from a pharmacy in Hillbrow but it is more expensive, compared to getting it from the illegal traders.

“I went to a pharmacy at the Highpoint mall and they sell the pill for R130 a blister packet. I cannot afford to buy it,” she said.

Sihle Ncube says she only started using family planning pills when she moved to South Africa from Zimbabwe, but was advised by her relatives not to use the locally available Oralcon pill, as it is less effective.

“I did not know anything about contraceptives, so when I started using the pill I asked my sister to advise me on the best family planning method, and she introduced me to a lady who sells the pills from back home. I had been buying from her for three years, but now due to the lockdown I am clueless as to where I will get the pills from, because she has not been able to go to Zimbabwe,” she said.

A woman from Yeoville who would not be named says she used to travel every month to Zimbabwe to get the contraceptives.

“I’m not able to travel anymore due to the lockdown; and have run out of the pills. I buy them from Zimbabwean health workers for R5 a blister packet and find ways of bringing them into the country. I then sell the pill for R20 to women from Zimbabwe and Malawi, who do not want to go to the clinic,” she said.

According to a research conducted at the University of Witwatersrand titled Towards a migration-aware health system in South Africa: a strategic opportunity to address health inequity, both non-nationals and nationals face challenges in accessing health care. These access challenges are shaped by documentation, languages spoken, and discrimination by health care providers.

“Lack of documentation, itself a determinant of poor health and persistent daily stressor, has a range of negative health impacts, including challenges in accessing health care and emotional distress,” the report said.

Phiwe Dauwa, a nurse and Champions for Children Club Co-ordinator, says it is not recommended for women to use contraceptive pills without a prescription from a health professional, as women’s bodies react differently to contraceptives.

“It is better to get a full medical history examination done, and an honest conversation with a doctor or nurse to guide on which contraceptive is best for you as an individual. If someone has a blood pressure control, the pill would not be the best solution in terms of how it functions in the body. There is no contraceptive that can be used by everyone. Prescribed pills are tested and trailed,” she says.

Dauwa says there is no clinical difference between the contraceptive pills smuggled into the country and the Oralcon pills supplied by the South African public health facilities for free. “The combination hormone medication is used to prevent pregnancy; it contains two hormones; a progestin and an oestrogen. It works mainly by preventing the release of an egg (ovulation) during a woman’s menstrual cycle. It makes vaginal fluid thicker to help prevent sperm from reaching an egg (fertilisation) and changes the lining of the uterus (womb) to prevent attachment of a fertilised egg,” she says.

Brenda Bamuzo a sexual reproductive health specialist at Lister clinic says the side effects of using a contraceptive pill include an increase in risks of high blood pressure, stroke or heart attack.

“A person taking a contraceptive pill is at risk if they have high blood pressure, diabetes, high cholesterol or if they are overweight. The risk is highest during the first year of taking the birth control pill,” she says.

According to Marie Stopes, a non-profit provider of reproductive and sexual health services www.mariestopes.org.za the contraceptive pill should be taken daily to prevent pregnancy.

“Its ability to prevent pregnancy depends on a person using it correctly, the pill might not work if a person is vomiting or has diarrhoea. When taken correctly it is up to 99, 9 percent effective. The pill does not protect against sexually transmitted diseases including HIV,” said the statement.

The 2019 Regional Voice and Choice Barometer produced by Gender Links, which is an assessment of sexual reproductive health rights (SRHR) by civil society in the Southern African Development Community (SADC) says family planning services must not be limited to accessing contraceptives.

“Family planning services must be expanded to include conditions such as poly cystic ovarian syndrome and fibroids, which are on the rise and affect fertility,” according to the statement.

Yoliswa Biyase, health promoter at Crown Gardens clinic, says there are other family planning options available for free in South African public health facilities.

“We offer Depo-Provera, birth control medication given in the form of a shot. It can last for 12 weeks, and another form of injection is Noristerat, which only lasts up to eight weeks. Women can also choose to insert Implanon; this is when an intrauterine device (IUD); a small device made of plastic, is inserted under the skin of the upper arm. It releases a small amount of progesterone into the body. It lasts between three and five years, and only requires a single visit to the clinic to be fitted. Copper IUD is a T-shaped device inserted into the uterus. Copper wire is wrapped around the stem of the IUD; and can last between five and 10 years. Male and female condoms can also be used in family planning, as they prevent both pregnancy and sexually transmitted infections,” she says.

Nodumo Makaza is a journalist from South Africa. This story is part if the Gender Links News Service Gender and COVID 19 news series.