Morality, austerity and the complexities of sexual and reproductive health services for young people in South Africa

Abstract

Healthcare service provision for young people in South Africa is a complex landscape-balancing youth and human rights, numerous laws, legally and professionally mandated obligations, and a tenuous and resource-strained implementation context, all set against the backdrop of a highly charged and morally contested area of state-based service provision. Sexual and reproductive health services (SRH) are therefore a far-from-settled arena-either for the healthcare workers who provide services, or for the young people who need to access them. In straddling the divide between official policies and client claims, front-line service providers, so-called street-level bureaucrats, often become disdainful of the ‘ungrounded’ directives from lawmakers and politicians who are perceived as out of touch with implementation realities (Maynard-Moody and Musheno 2003). These conflicts are compounded in neo-Liberal environments of limited infrastructure and resources, such as the South African public health system.