This is according to a national household survey by the SA Medical Journal on contraception coverage and methods used by women in South Africa.
The study suggests the rates of unplanned pregnancies, contraception failure and knowledge gaps demonstrate high levels of a lack of access and choice, especially among black Africans and young women.
Data from a survey on 6,296 women aged 14 to 49 years shows that two-thirds had unplanned pregnancies in the previous five years, a quarter of which were due to contraceptive failure.
In South Africa and throughout sub-Saharan Africa injectable contraceptives are the most popular methods and their use has continued to rise over time. By contrast, in higher-income countries, use of injectable contraceptives is rare, aside from in marginalised groups such as poor African Americans or women of native origin.
The popularity of the injectable method is due to its convenience for providers and women; it is cost- effective and is generally acceptable among women and providers.
Many black women lack knowledge and access to the variety of contraceptives. The study found 92% of women knew about inject-ables, 89.9% about oral contraception, but fewer knew about intrauterine (IUD) devices and only 47.3% about emergency methods.
International policymakers and advocates have placed particular emphasis on increasing access to long-acting reversible methods such as IUD and sub-dermal implants, which they deem the most effective.
The study maintains that low levels of knowledge and frequent misconceptions about contraceptives among women aged 15 to 19 are particularly concerning. This casts doubts on how effectively the national Integrated School Health Policy is being implemented.
The policy recommends that school health services act as a delivery platform for the provision of sexual and reproductive health services, such as contraception and condom distribution.
Access to contraception and the choice of contraceptive methods are key interventions to improve population health, particularly that of women.
Therefore, increased political and economic investment is necessary to decrease disparities in access to contraception between population groups and to raise overall levels of contraception.