REPUBLIC OF SOUTH AFRICA COMBINED SECOND PERIODIC REPORT UNDER THE AFRICAN CHARTER ON HUMAN AND PEOPLE`S RIGHTS and INITIAL REPORT UNDER THE PROTOCOL TO THE AFRICAN CHARTER ON THE RIGHTS OF WOMEN IN AFRICA per woman in 2002 to 2.3 children per woman in 2013. Many factors influence the fertility rate, including urbanisation, female educational levels, infant mortality, costs of raising children, cultural and religious beliefs as well as the use of contraception. In South Africa, estimates show that about two thirds of sexually active 15- to 49-year-old women use a modern contraceptive method. This usage contributes to the decline in the total fertility rate. 138. Access to and use of contraceptives by women is improving. Contraceptive use is an important element in the promotion of sexual and reproductive health. The strategic objective set for improving women’s health was to improve access to sexual and reproductive health services. All public sector health facilities are providing family planning services with a varying mix of contraceptives. A protection rate of 37.8% was recorded, exceeding the 35% national target set for 2012/13. 139. During 2012/13 the updated National Contraception and Fertility Planning Policy and Service Delivery Guidelines were approved by the National Health Council. The National Contraception and Fertility Planning Policy and Service Delivery Guidelines and National Contraception Clinical Guidelines are extremely important documents aimed at reprioritising contraception and fertility planning in South Africa, with an emphasis on dual protection. 140. Contraception is one of the most powerful public health tools for any country. Providing women with access to safe and effective contraception is a critical element of women’s health. Enabling women to make choices about their fertility is empowering and offers women better economic and social opportunities. Birth spacing also improves the opportunities for children to thrive physically and emotionally. Engaging men in sexual and reproductive health encourages shared responsibility in their roles as partners and parents. 141. The adoption of the revised Contraception Policy takes place within the context of renewed international focus. One of the key changes in the policy is to increase the range of contraceptive commodities available in the public sector thereby increasing the contraceptive method mix. The most notable additions are sub-dermal contraceptive implants and a greater variety of intra-uterine devices. These increases to the method mix should give more choice and security of contraceptive protection to women, thus improving family planning.84 142. In 1997, South Africa enacted the Choice on Termination of Pregnancy Act, 1996 85 that allows for the termination of pregnancy. The Act was amended during the period under review, in 2008, through the Choice on Termination of Pregnancy Amendment Act, 200886 84 DoH Annual Report 2012/2013 Act No. 92 of 1996 86 Act No. 1 of 2008 85 43