A plan by Gauteng Health & Wellness MEC Nomantu Nkomo-Ralehoko to roll out compulsory contraceptive implants for schoolgirls across the province has run into trouble, with critics calling it unlawful and misguided.
The controversial initiative, aimed at reducing teen pregnancies, will be carried out only with parental consent, she said earlier this month when she unveiled the blueprint.
Teenage pregnancy rates, particularly among younger girls, have become a serious concern, with Gauteng having already recorded 31 cases of teenage pregnancy in 2025.
Nkomo-Ralehoko reportedly said the Implanon implant would be mandatory once parental consent was obtained, reports Daily Maverick.
“It will be compulsory for as long as the mother and the father sign a consent form,” she said. Each implant costs R3 000 and a full budget for the initiative will be disclosed in March 2025.
In March last year, the Gauteng Department of Health revealed that at least 150 000 children had fallen pregnant in South Africa during the 2022/2023 financial year. Gauteng, and particularly the Ekurhuleni Region, saw the highest rates in the country, with the highest number of deliveries among girls aged 12 to 19.
‘Violation of bodily autonomy and constitutional rights’
Implanon is a small, flexible rod inserted under the skin of the upper arm. It releases a steady amount of progestin, the hormone that prevents ovulation, and can provide effective contraception for up to three years.
Health experts consider it to be a safe and highly effective form of contraception.
However, an open letter by SECTION27, endorsed by several organisations including the Cancer Alliance, Sexual Reproductive Justice Coalition (SRJC), Soul City Institute, We Mattah, and the Critical Studies in Sexualities and Reproduction at Rhodes University, raises concerns over the proposed approach to curb teenage pregnancy.
The letter called the plan misguided and unlawful, particularly the decision to make Implanon compulsory, based solely on parental consent.
The groups said any attempt to forcefully administer contraceptives to young women and girls would violate their constitutional rights to bodily integrity and autonomy, and amount to gender-based violence and common law assault, echoing the historical trauma of coerced and forced sterilisation practices.
Khuselwa Dyantyi, an attorney in the Health Rights Programme at SECTION27, said the plan contradicted the Children’s Act in several key ways.
“First, the law already allows children over 12 to make their own decisions about their health, including consent for contraception. However, the plan to roll out long-term contraceptives and requiring parental consent goes against the Children’s Act right from the start,” Dyantyi told Daily Maverick.
“Second, under sexual and reproductive healthcare rights, children who are capable of providing consent have the right to choose which contraceptive method they want to use. You cannot impose a specific form of contraception on them, as this violates their rights as outlined in both the Children’s Act and the Constitution.”
She added that while contraceptives could and should be made available, it should be up to the individuals who wished to use them.
Children’s rights ‘before parental approval’
Rotondwa Mashige, programme co-ordinator with the Centre for Human Rights at the University of Pretoria, said when it came to any medical procedure, including reproductive interventions, consent had to come from the individual undergoing the procedure.
Legally, it was essential that the person who was directly affected by the procedure – in this case, the child receiving the implant – gave their consent first, with parental consent as an additional step.
Mashige said the first violation in this approach was the right to privacy. Involving someone else – in this case, the parents – in a decision about a child’s sexual or reproductive health compromised the child’s privacy.
Another violation was the right to bodily integrity, which included the right to make decisions about one’s reproductive health.
Additionally, the right to access information was potentially violated. If parents were the ones receiving information about the procedure, including its benefits, risks and side effects, it deprived the child of the opportunity to make an informed decision.
The child should be directly informed about what would happen, why it was happening, and what their options were, ensuring that consent was truly informed.
Mashige pointed to legal precedents from 1994, establishing that medical practitioners had to obtain consent before any procedure. Informed consent, she said, required ensuring the child understood the procedure, its long-term effects, benefits, and how it would be performed.
Crucially, the child’s ability to comprehend these factors had to be assessed. At 12, the law presumed children were mature enough to make decisions about their healthcare, including consenting to medical interventions.
“It’s unconstitutional. Let me just put it that way. It’s unconstitutional for the MEC to say that they’re going to roll out this programme and just the consent of the parents will be needed, because you need the child’s consent,” she said.
Addressing root causes
Nkomo-Ralehoko acknowledged that some teenage pregnancies resulted from rape, which is why the Implanon implant was proposed to reduce the need for daily contraception.
However, Dyantyi said the focus on curbing teen pregnancy through this approach was misdirected. She believed that while addressing teenage pregnancy was important, the proposed method did not adequately address the root causes of the issue.
“These young girls do not impregnate themselves. Nothing has been said about the perpetrators, the men who are actually impregnating these young girls,” she said.
Many pupils became pregnant because of sexual abuse, often by older men, which constituted statutory rape. She questioned what the MEC for Health and the MEC for Education were doing to address this issue.
Phinah Kodisang, CEO of Soul City, welcomed initiatives aimed at expanding access to contraception and empowering young women to make informed choices about their reproductive health. However, she said contraceptive roll-outs had to be paired with comprehensive sexuality education (CSE) that covered consent, bodily autonomy, and gender power dynamics.
“The consent and bodily autonomy of girls and young women cannot be denied by anyone,” she added.
Instead of focusing solely on contraception, Dyantyi emphasised the need for a more robust approach to tackling sexual violence and supporting survivors, and that the focus should not just be on preventing pregnancies, but also on preventing abuse and ensuring the protection and safety of young girls.
Curbing teenage pregnancy required a more comprehensive approach, with various stakeholders being involved, including the Department of Education, parents and the children themselves. Additionally, she reiterated the need to examine the underlying issues leading to the pregnancies, rather than solely focusing on preventing them.
The Gauteng Department of Health and the Gauteng Department of Education had not replied to questions by the time of publication.
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MEC lashes out at parents over 26 000 teen pregnancies in eight months
36 teen pregnancies, half HIV+, at a single Limpopo school