Family planning shouldn’t feel like a guessing game, but for many women in Mzansi, it still does. Many are placed on contraceptives without fully understanding what they’re taking or the possible side effects.
They get no clear explanation, no real choice – just weight changes, mood swings, skin issues that follow. They’re told it’s normal.
But when decisions are made for them, not by them, who truly has control?
With limited awareness and few options beyond hormonal contraceptives, many women face these challenges alone.
Left in the dark
It was in 2010 when Athandile Cutshwa from Kuils River, Cape Town, first started her menstrual cycle. That’s also when she was put on contraceptives, despite not being in a relationship or knowing anything about what she was taking.
“Nothing was ever explained to me,” she recalls.
“A family doctor would give me an injection, but no one told me about side effects or what to expect.”
Athandile Cutshwa
Over the years, Athandile says she struggled with heavy bleeding, spotting, and sometimes even having her period for an entire month. This led to frequent doctor visits, but with no clear answers.
“I spent years switching between pills and injections, not because I chose to, but because sometimes the clinic didn’t have what I was used to. Especially when I was moving around a lot,” she says.
Now, she believes all of this has disrupted her menstrual cycle and wishes there was more clarity on whether it’s possible to use family planning and still have a regular period.
“To this day, I’ve never been told the difference between hormonal and non-hormonal contraceptives. No one explains anything. You’re just on your own.”
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‘No one told me why’
Ongezwa Lokwe from the West Coast, Western Cape, says she was never warned about the possible side effects of the contraceptives she was given at a public clinic.
“I gained 10 kilograms in just one month,” she says.
“When I asked why, the only advice I got was, ‘Go to the gym.’ The nurse didn’t ask about my lifestyle or whether I was physically active, she just assumed.”
Ongezwa Lokwe
Lokwe explains that in many public clinics, it’s rare to meet a nurse who takes the time to explain contraceptive options or side effects.
“The only things they asked were whether I had any STIs, TB, or my last period. That was it.”
Now, she’s living with more than just unanswered questions.
“My skin changed, I developed stretch marks, and I started experiencing back pain, fatigue, vaginal dryness, and mood swings,” she adds.
She still doesn’t know if switching to a non-hormonal option would help, or if she’ll even get the support she needs when she asks.
Reliable – if used right
Dr Katlego Lekalakala, who works with Keready, says that in most clinic settings, patients are often given what is most accessible and affordable. Hormonal contraceptives are widely used because they are low-cost, easy to administer, and readily available, she says.
She explains that side effects from hormonal contraceptives can include method failure, especially among those with a history of hormonal use.
Accessibility and affordability play a major role,” she says. “Beliefs and cultural norms are also contributing factors.
When it comes to future family planning, Lekalakala adds, “If a patient wants more children, but not in the near future, I would not suggest tubal ligation. Instead, I would recommend a copper IUD.”
Drawing from Keready’s WhatsApp Healthline, she notes common concerns such as:
- Method failure from prior hormonal contraceptive use
- Limited access to a variety of options
- Affordability
- Cultural and religious beliefs
- Family planning needs for the future
“I’ve had patients refuse sterilisation because their partners believed it would make their womb ‘cold’ and reduce sexual pleasure,” she says.
Lekalakala emphasises that hormonal contraceptives require strict consistency to be effective.
Dr Katlego Lekalakala
“When used as prescribed, they’re reliable. But poor adherence often leads to unplanned pregnancies.”
She points out that these methods can cause side effects like nausea, irregular bleeding, weight gain, headaches, and mood changes. People with a family history of clotting disorders may face added risks with some hormonal options.
Lekalakala says the available contraceptive options include the copper IUD, tubal ligation, and condoms. In primary care clinics, condoms for both males and females are typically provided.
Our bodies are not the same, and what works for one might not work for another. The best thing to do is to speak to a doctor who can examine you and prescribe the contraceptive that is right for you.
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