South African reproductive rights activist Dr. Tlaleng Mofokeng doesn’t get much downtime. When she’s not running her private reproductive health clinic in Johannesburg, she’s acting as vice chairperson of the Sexual and Reproductive Justice Coalition (SRJC), writing a weekly column for one of South Africa’s leading newspapers, and giving out medical advice on her weekly radio show. She’s started reaching out to people in the country’s LGBTIQ communities through her partnership with mobile health app PASOP GP and, earlier this year, she founded Nalane Associates for Reproductive Justice, an organization that aims to produce comprehensive sexual health education content for all media platforms.
It was Mofokeng’s vocal campaigns against virginity testing in South Africa and rape culture on TV that brought her to the attention of the Bill and Melinda Gates Institute for Population and Reproductive Health. The institute, which recognizes young people inspiring change in reproductive health and contraception, recently named her one of its 120 Under 40 champions.
In South Africa, reproductive health rights are enshrined in law but difficult to access in practice, so many women – especially young women – are unaware of their rights when it comes to essential health services.
Abortion has been legal since 1996, but a lack of understanding of the law and the high cost of traveling to the country’s few legal abortion clinics means many women continue to opt for backstreet procedures, with an estimated 50 percent of abortions taking place outside designated health facilities.
Adolescents trying to get contraception and reproductive health advice often face stigma and judgmental attitudes from health center staff, so many would rather risk pregnancy or HIV infection. In 2014, 7.6 percent of births were to mothers younger than 18. And in the country with the largest number of people living with HIV, the prevalence for women is almost twice as high as it is for the total population.
It’s in this context that Mofokeng pushes for urgent and multifaceted action. “I work to advocate with health departments and communities to make sure they have services that can keep women healthy and that are delivered without prejudice or judgment,” she says.
Women & Girls Hub spoke with her about how improving reproductive healthcare in South Africa requires a shift in political thinking and a lesson in legal literacy.
Women & Girls Hub: Why is it important to focus on reproductive health services for women in South Africa?
Dr. Tlaleng Mofokeng: In South Africa currently, there is poor access to modern contraceptive methods and poor information regarding legal abortion options.
The socioeconomic landscape of this country continues to make young women vulnerable, and results in transactional sex between younger women and older men. These “blessers” or “sugar daddies” continue to abuse and take advantage of black young women’s poverty, with serious sexual and reproductive health consequences, including that girls aged 15 to 19 are more likely to be HIV positive than boys of the same age.
When a health system harms women, for example, in failing to provide nationwide access to abortion or in not addressing the contraceptive needs of women, this is an injustice.
Women & Girls Hub: The right for a woman to make decisions about her reproductive health are enshrined in South Africa’s constitution, which was passed in 1996. Why do you think these challenges still exist?
Mofokeng: These problems arise not because South Africa doesn’t have the programs or budget to protect women’s sexual and reproductive health rights but because of lack of vigor and political will to implement these policies and programs effectively. The Department of Health has not addressed the poor knowledge of health workers in dealing with comprehensive sexual health education and services, or the need to provide comprehensive reproductive healthcare in South Africa. Access to this healthcare continues to reflect historical patterns of economic and gender inequality.
One example is the lack of availability of female condoms, and awareness around them in a context where the department continues to introduce programs to promote men’s sexual and reproductive health, such as circumcision. It’s not that these programs are not equally important, it’s that if a similar amount of energy and funding was put into women’s health, we would be better able to address them.
Women & Girls Hub: The United Nations’ Sustainable Development Goals contain the goal of reducing the maternal mortality rate to less than 70 per 100,000 live births. Is this realistic for South Africa?
Mofokeng: These goals are not unattainable, but it will require a shift in political thinking to achieve them. We’ll need a proper monitoring framework and solutions that address the complexity of the South African situation.
This includes a real need for government departments to work together. You can’t look at women’s sexual and reproductive health without considering their socioeconomic circumstances, the prevalence of sexual violence and rape culture in South Africa, conservative gender norms and the education system.
This also means that the government and civil society need to commit to raising the legal literacy of the average South African. So many women still think that abortion is illegal and face community stigma when accessing their healthcare needs. Legal abortion is also costly. This means that backstreet abortions continue to happen, causing unnecessary health complications, trauma and sometimes death.
Women are not going to demand their rights if they don’t know what their rights are.
Women & Girls Hub: How can the government address these gaps?
Mofokeng: The Department of Health needs to hold itself and other departments more accountable. They need to make the commitment to continuous medical training of healthcare providers and to hosting public awareness campaigns that not only raise awareness of health services but also create positive narratives about reproductive rights for women.
This conversation was edited for length and clarity.