Q&A with sexual and reproductive rights activist and woman human rights defender Dr Tlaleng Mofokeng
Dr Tlaleng Mofokeng always knew that she was going to become a doctor. Affectionately known as ‘Dr T’, she trained as a medic at Nelson Mandela School of Medicine, in Durban, in the early 2000s. Her training coincided with an upsurge in campaigns around the prevention and treatment of HIV and AIDS. Inspired by this activism, and by professors dedicated to providing abortion services, she took an interest in sexual and reproductive health.
During her medical training, she set up a youth friendly clinic in rural Matatiele, KwaZulu-Natal (KZN). At the clinic, she observed that adolescent girls required comprehensive reproductive health services, including contraceptive options.
After working in government health systems for seven years, she now runs DISA Health Clinic in Sandton. The clinic provides a range of sexual and reproductive health services.
Dr T has dedicated her medical career to advancing sexual and reproductive health rights (SRHRs) for women and children.
AISA: What do you think is the biggest challenge facing SRHRs in South Africa?
Dr T: The issue around safe and legal abortion access remains simply because we are just not making the right types of health system responses. The National Department of Health (DoH) is still falling short of training and ensuring that there is continuous medical education for postgraduates. The issue of making sure that women have information is a big one. I spend a lot of my time, online, providing people with information firstly that’s accurate, and evidence based, but secondly, that links them to safe abortion services. The other work includes advocacy and clinical training young medical people, not just doctors, but other allied professionals. These include nurses, pharmacists and psychologists.
Even African traditional medicine doctors have been part of the training. I train them to become champions and to advocate for safe and legal abortions within their contexts. This means that if, for example, we also show pharmacists and pharmacy students why it is important for them to assist in terms of procuring medicines, including ensuring there are no stockouts. We also train them on advocating for generics to be registered, and how they can impact and add on to ensuring that more and more people can access services safely.
The training that I’m doing currently is called ‘advocacy in practice’, for safe and legal abortion. We are trying to make sure we have as many people who are involved in service delivery be aware of the human rights of people, be aware of how their work and their profession links to better outcomes at the end of the day.
And of course, the other thing I’m involved in, globally, is the resistance to the Global Gag Rule (GGR). This is something that has been influencing my interest in terms of global health politics: The issue of foreign funding, and how much of that is allowed to influence the NGOs, which receive this funding. But also, in South Africa unfortunately, because of the way our health system is designed, you have a lot of USAID recipients which have partnerships with the Department of Health (DoH). And those relationships are impacting on their ability to give information to ensure services are accessible and available for women.
I went to the United States, and held a briefing at the Senate on Capitol Hill, where I gave a brief on what or the impacts of the GGR, with what happens in South Africa despite our Constitution and the Choice on Termination of Pregnancy Act (CTOPA), but also historical perspective on the experience of South Africa under George W. Bush. And now, with Donald Trump, what does it look like and how does this impact our ability, even as private doctors, to offer services that are safe and ethical? I also
discussed breaking down the relationships between civil society because, people have to choose between providing HIV management and services, or giving comprehensive sexuality services inclusive of abortion information, referrals and procedures. This is unethical but also unconstitutional. So, our work on that global sphere has been around resistance of the GGR and to coming up with ways to end unilateral implementation of restrictions and hopefully one day soon, end the Gag Rule that comes with health aid.
We must all be asking very specific questions around foreign aid, and how much of that should be allowed to influence our national healthcare delivery.
AISA: Do you have a solution to this challenge?
Dr T: It’s difficult for me because I can only do so much as a person who is a private health practitioner. But I think the big opportunities lie in collaborations and partnerships across sectors and across society. That way, we can amplify each other’s work and each other’s message. And I think the issues for me, daily, are not limited and cannot wait for a campaign that happens once a year.
Women’s Month in August tends to allow for issues to be given a bit more attention but it is a fact that these issues are ongoing, and how do we help people take up these causes on a day-to-day basis? And they manifest themselves in terms of women’s healthcare and women’s rights, but these are everyone’s health rights.
It’s more than just about cisgender heterosexual women, it’s about the Black lesbian women in the townships, for example, who are still victims of hate crimes. It’s about transgender women who are trying to access services and hormone therapy. It’s about having proper medical emergency centres that can assist in rape survivors and victims. All these issues, because of the country that we live in, cannot wait for Women’s Month. But there is obviously this vigour around the month. And we need to take advantage of that. For me, it’s about partnerships, collaborations and, obviously, bringing these issues up and sustaining them throughout the year.
AISA: So, there is still a long way to go?
Dr T: I think you’ve got pockets of excellence but, unfortunately, that’s not the standard. And because it’s not the standard, the quality of service that people get is very varied. You cannot say for certain once you’ve referred someone to a different facility, or for a step-up in care, that they will receive comprehensive care. And I think we still, as medics, deal with structural determinants as outsiders looking in and not enough time on advocating for patients’ rights, accountability from NDOH.
[We need to ask] What is their story? Yes, they may also have an STI, but what makes this case different from the next one that walks in, and what makes that one different? We’re not giving tailored healthcare, we’re giving generalized healthcare to people with very specific problems.
And I think again, just in terms of the curriculum and how medicine is taught, it is still very much colonised. This is visible even in the types of patient profiles that we are taught about in medical school. We don’t go deep enough In understanding the history, and the racial and gender bias of medicine. We don’t interrogate how we are perpetuating those same racial and gender biases in how we practice medicine. The photos of genitalia depicting sexually transmitted diseases in the books and lectures are of only black people, the biomedical developments are researched for an average 70kg white male, yet we know the profile of the majority of the patients we help do not fit the mold.
AISA: The fight for SRHRs is not unique to South Africa, but an issue in many countries, Argentina being one of them. What do we, as South Africans, bring to the global fight for SRHRs?
Dr T: I know that for us in South Africa, one of the biggest lessons we’re sharing is: despite a law that is over 20 years old, which is often used as an example worldwide of what good abortion laws look like, the DoH still can’t translate that into integrated, timeous and dignified care for women.
And how do we move beyond legal frameworks, to ensuring that whatever we do results in lives being saved, and in women getting access without delay and stigma. Those were the biggest lessons for me.
Despite all these different legal frameworks, and different contexts, that people work in, all of us are grappling with the issue of stigma and the issue of literal access to service.
Follow Dr T on Twitter @DrTlaleng
You can also stand up for sexual and reproductive health rights! Sign here and support the call to the South African government to increase access to safe abortion services in South Africa. #MyBodyMyChoice #TakingInjusticePersonally