Increasing Access to Reproductive Health Services through Social Business. The Role of Marie Stopes South Africa in Delivering Termination of Pregnancy Services

In 1996 legislation was passed in South Africa that derestricted access to termination of pregnancy (TOP) services, creating huge demand which the public sector was unable to meet. This paper examines the effectiveness of Marie Stopes South Africa's (MSSA) provision of TOP services in order to assess the contribution the not-for-profit social business made in this context. Effective access remained a problem for many women, even after the legislation had been passed. Barriers existed both in terms of internal service delivery issues (such as training health workers and availability of service) and community level factors (such as lack of knowledge and women's status in society). Public sector services were often not safe or not of a high standard of care, as systems were not in place to ensure this. MSSA were able to fill the gap in demand and draw on the expertise of Marie Stopes International (MSI) to develop high quality services with motivated and skilled staff at affordable prices. Between 1997 and 2000 MSSA provided nearly one quarter of all reported legal TOP services (over 40,000) in South Africa. Where government services are severely constrained and affordable collaborations with the private sector are under consideration, contracting out to a well-monitored social business is one strategy that could be adopted in resource-poor, high demand contexts to guarantee access.