Introduction

“PTP”: three letters scrawled in the tattered notebook that served as her medical record. What did it mean? For me, it explained why my previous patient was crying inconsolably onto a nurse's shoulder. For her it signified far more: another mouth to feed, another nervous wait for an HIV test, a shortage of blankets, an unwanted shift in her world. Clinic over, I went outside and gazed at the zig-zag skyline of the mountains. Pregnancy test positive: one of those deceptively simple acronyms that tames the complexity of our patients' lives into something writeable, something understandable, something medical.

I was on my elective in Lesotho, a country about the size of Wales and entirely surrounded by South Africa. It was late June, winter in Lesotho, a season of glaringly bright days and densely cold nights. That day I was working at an ‘outreach clinic’ run by Maluti Adventist Hospital: each Tuesday an assortment of nurses, doctors and students crammed into a minibus and drove 2 hours from the main hospital to run a rural primary care clinic that offered contraception services. Dozens of people would be sitting on the ground waiting for us to arrive, wrapped in their traditional blankets and exchanging village gossip.

The woman who was now so upset had attended for a repeat dose of injectable contraceptive. Unfortunately one of her children had been unwell and so she had been unable to travel to the clinic for several weeks. Access to abortion in Lesotho is very restricted, so all we could offer was antenatal care.

This essay explores the general challenges facing contraception services in Lesotho before discussing specific problems encountered with current contraceptive methods and how the situation might be improved for Lesotho's women.