Dr Thabile Ketye

Despite South Africa’s progressive sexual and reproductive health (SRH) policies, a new doctoral study from the University of the Western Cape found that adolescents continue to face serious obstacles when trying to access contraception. From school governing bodies (SGBs) denying permission to distribute condoms, to public clinics with limited hours and seasonal contraceptive stock-outs, the research exposes how structural shortcomings undermine young people's health rights.

Dr Thabile Ketye’s thesis, which explores a decade of policy and practice in adolescent sexual and reproductive health (ASRH), highlights a profound disconnect between national intentions and local realities. Her interviews with healthcare providers, teachers, and care assistants reveal that while policies exist on paper, implementation is patchy, uneven, and often shaped by moral gatekeeping or resource constraints.

While South Africa is often lauded for having some of the most progressive sexual and reproductive health (SRH) policies on the continent, Dr Ketye’s study found that systemic challenges, poor infrastructure, and cultural taboos mar real-world implementation.

Interviews with healthcare professionals and school staff in the Western Cape highlighted “seasonal stock-outs” of contraceptive methods, particularly during the COVID-19 pandemic. Others described how clinic hours, typically on weekdays, clash with school schedules, making it difficult for learners to access services discreetly and consistently.

Moreover, many clinics in rural areas lack the resources to provide private, youth-friendly services. “Lack of privacy was cited as a major deterrent for adolescents,” Dr Ketye wrote, noting that embarrassment and fear of stigma remain significant barriers.

South Africa’s policy frameworks, such as the Integrated School Health Policy and National Adolescent and Youth Health Policy, advocate for youth-friendly, holistic SRH services. But Ketye found that, in practice, these services are inconsistently applied and often focus disproportionately on adolescent girls.

Photo by Reproductive Health Supplies Coalition on Unsplash

“Many policies place the burden of contraception on girls and women, inadvertently reinforcing gendered expectations,” the study noted. This singular focus undermines efforts to engage boys and young men in conversations about responsibility and prevention.

Additionally, the study found that school governing bodies (SGBs) can act as gatekeepers to contraception services in schools, with some denying learners access to methods like condoms based on moral or cultural objections. This discretion undermines national efforts and reinforces inequality in service provision across different districts.

The thesis placed considerable emphasis on the perspectives of nurses and school health practitioners, including teachers and care and support assistants working at schools. Often caught between educational mandates and community expectations, these individuals struggle to navigate a complex emotional and ethical terrain. Practitioners expressed a need for clearer guidelines, better training, and more support from the Department of Health and the Department of Basic Education.

“We are expected to do everything, but we don’t have the tools,” one school nurse says.

Teachers, in particular, noted that comprehensive sexuality education (CSE) curricula are often inconsistently delivered and lack resources to engage students effectively. 

“We’re not always sure what we’re allowed to say,” a Life Orientation educator shared.

Dr Ketye’s thesis offers a compelling call to action: greater collaboration between policymakers, implementers and the young people they serve. Among her recommendations are:

• Adopting a multisectoral approach and developing innovative ways to bring SRH services to young people.
• Increasing the number of adolescent and youth-friendly clinics with extended operating hours.
• Ensuring consistent supply chains for contraceptives, especially in rural areas.
• Expanding SRH education to include male adolescents more deliberately.
• Establishing clearer, cross-cutting guidelines for school-based service delivery.
• Strengthening training for school health practitioners and nurses on youth engagement and confidentiality.

Notably, the study calls for a cultural shift - one that destigmatises adolescent sexual health and recognises young people as active agents in their reproductive choices.

Photo by Reproductive Health Supplies Coalition on Unsplash

Dr Ketye argues that the disconnect between policy and practice reflects a deeper tension within South Africa’s health and education systems: a lack of meaningful youth involvement in shaping the services they use.

“Adolescents need more than just access - they need autonomy, information and respect,” the study concluded. Only then, Dr Ketye suggested, can South Africa move beyond rhetoric and create a health system that truly supports its youth.

Her findings serve as a clarion call for government departments, educators and health practitioners alike to reimagine service delivery as a technical challenge and a human rights imperative.