The long road to care: accessing reproductive health in rural South Africa
By: Palesa Chidi, Celene Coleman, and Hanifa Mahlangu
“When the weather was bad, it was impossible to go to the clinic. Even when I made it there, essential contraceptives like Depo shots were often out of stock. They’d just give me condoms instead,” says Kamogelo Mohale*, a 24-year-old young woman living in a rural village in the Free State.
Mohale’s unmet need for reproductive health care services in South Africa remains a scary statistic.
According to the SA Medical Research Council 31% of adolescent girls (15-19) and 28% of young women (20-24) do not get the reproductive healthcare services they require from the South African government.
Their research brief looked at Access, use, and perceptions of contraception services among adolescent girls and young women in South Africa
In 2024 RHAP also launched a contraceptives factsheet highlighting how reproductive health remains a critical yet often neglected aspect of healthcare in rural areas. It showed that there are serious shortages of doctors, nurses and basic resources.
For young women, this translates into a dire situation as they face significant challenges in accessing essential services, from long distances to clinics and cultural stigma to inadequate medical supplies.
As we mark Reproductive Health Month, RHAP spoke to young women in rural areas to hear their experiences and what they think needs to change. We wanted to hear from them about their struggles firsthand. Their experiences detail how they must navigate long trips to clinics, face stigma, and struggle to access contraceptives and other essential services.
Their stories reflect both resilience and frustration as they navigate a system that frequently overlooks their needs.
The struggle to reach care
Rural communities have significantly less access to healthcare based on physical access, affordability, and acceptability of services. Like many other rural women, Mohale struggles to access reproductive healthcare due to obstructed roads during bad weather and frequent stockouts, leaving her with limited options and often forcing the discontinuation of contraceptive use.
Zimbini Madikiza, RHAP’s Outreach and Training Coordinator, and rural health advocate, points out the barriers women face in accessing reproductive healthcare. “Many women in rural areas struggle with long distances to clinics, stockouts of contraceptives, and judgment from healthcare providers,” she explains.
Madikiza’s passion for this work is personal. Growing up in a rural community, she experienced these challenges firsthand. “We had to walk through dusty roads and cross rivers to get to a clinic in town,” she recalls. “There was no transport available, and sometimes stockouts meant I had to go to another clinic even farther away.”
Unable to access contraception, Madikiza became pregnant in her final year of high school, an experience that shaped her commitment to advocating for better healthcare solutions.
Even when transport is available, affordability remains an issue. Nozipho Zulu* 30, from KwaGingindlovu, KwaZulu-Natal, who relies on taxis to get to a nearby clinic, explains: “We wake up early to catch taxis that only operate at specific times. The cost is manageable for me, but for many women, it’s a big burden.”
Another young woman from Ga-Mphahlele, Limpopo, Hunadi Kgoale echoes this sentiment: “Many women can’t afford transport. If there were smaller clinics closer to our communities, it would help so much.” Women who can’t afford transport may delay or miss essential health services, like getting contraception. This forces them to choose between healthcare and other basic needs, trapping them in a cycle of continued poverty.
Cultural stigma
Beyond logistical barriers, cultural beliefs also restrict access to reproductive healthcare.
According to Nurses’ and patients’ experiences of family planning services in a rural district, South Africa, a qualitative study in a rural area of the Western Cape found that stigma around contraception is due to the perception that it means a person is sexually active or promiscuous.
Twenty-seven-year-old Gontse Gcaba* from rural KwaZulu-Natal lives through this reality: “In my community, young people are judged for seeking contraceptives. It’s considered a taboo because it’s seen as going against the laws of nature.” As a result, many women seek care in secrecy or avoid it altogether.
And for Thobile Koko, there is a similar challenge. The 36-year-old mother who didn’t wish to reveal where in South Africa she lives, adds that unmarried young women are particularly vulnerable to social stigma. “It’s not accepted for young women to be pregnant if they aren’t married. People hide their pregnancies because they’re afraid of being ostracised,” she explains.
Healthcare workers: a mixed experience
Another issue for young women in South Africa’s rural areas is how healthcare workers treat them.
Research has shown that overburdened healthcare providers often find it challenging to deliver patient-centred care.
As a result for some women, clinic visits are distressing rather than helpful, which may lead to discontinuing services.
“Instead of supporting young women,” Gcaba says, “some healthcare workers judge us, calling us names if we’re pregnant or have STDs. It makes you not want to go back.”
What needs to change?
The women we spoke to proposed several solutions to improve reproductive healthcare access in rural areas.
Zulu, for example, spoke about community outreach and education. “Healthcare providers should visit schools and communities to educate young women about reproductive health,” suggests Zulu.
Madikiza refers to introducing mobile clinics and creating youth-friendly services. “Staff need training to create a safe, non-judgmental environment,” she says.
Their responses show that while the fight for accessible adolescent sexual and reproductive healthcare remains an important issue that requires policy change, for young women it’s a matter of dignity.
RHAP’s policy brief highlighted several potential solutions, including:
- making sexual and reproductive healthcare services accessible by listening to young people and training healthcare providers to be supportive and non-judgmental.
- Breaking down stigma to allow adolescents to seek care.
- Developing awareness campaigns, and educational materials.
At the centre of these changes are a shared responsibility between the government and civil society must be at the core of our approach. If we fail to act, we fail an entire generation.
*Some names have been changed to protect the identities of those interviewed. *