The pill and the profession: the evolving role of pharmacists in oral contraceptive access for women in South Africa

Abstract

Oral contraceptives (OCs) play a key role in reproductive health and family planning, yet their use and accessibility in South Africa remain shaped by sectoral dynamics, socioeconomic factors, and persistent systemic barriers. Nationally, the prevalence rate of contraceptive use is estimated at around 60% among women of reproductive age. Injectables dominate public-sector provision while OCs are more frequently accessed in the private sector. Within the public sector, free combined oral contraceptive (COCs) and progestin-only pill (POPs) are available, although counselling and patient support are often limited. In contrast, the private sector provides a wider range of formulations, including extended-cycle regimens, but affordability and medical aid coverage remain decisive factors. Certain (emergency contraception) ECs are legally available for non-prescription access in community pharmacies, yet studies indicate poor awareness and low utilisation among adolescents and socioeconomically disadvantaged groups. Pharmacists are strategically positioned as accessible healthcare providers, offering both dispensing and counselling services. However, their role is undermined by limited training recognition, regulatory restrictions, and stigma surrounding EC provision, often reinforced by overly restrictive Good Pharmacy Practice (GPP) requirements. Contraceptive use often comes with complications such as adherence difficulties and side-effects like nausea and breakthrough bleeding, as well as risks such as venous thromboembolism (VTE). Despite these challenges, pharmacists express readiness to expand their role within primary health care, aligning with South Africa’s broader shift toward universal health coverage. This review highlights the importance of strengthening pharmacist-led contraceptive management through policy reform, structured training, and multidisciplinary collaboration to improve reproductive health outcomes for women.