Conflict and care in sexual and reproductive health services for young mothers in urban South Africa

'Foreign body': a social history of Implanon in South Africa's Eastern Cape

This article explores the reception of the contraceptive implant, Implanon, by healthcare workers and patients in family planning units in South Africa's public health sector. Based on observations conducted at public health facilities in the Eastern Cape Province, and on interviews with nurses and patients in the same province, the study explored real-world experiences of the implant. This article examines the strategies used by nurses to promote use of the device, and explores how patients themselves responded to a widescale, national rollout of the implant within government family planning services. The study examines the reception of Implanon in the context of the post-Apartheid era in South Africa, in which the vestiges of Apartheid-era healthcare provision, and lack thereof, continue to animate personal experiences of contraception.

Shifting Social Norms and Adolescent Girls' Access to Sexual and Reproductive Health Services and Information in a South African Township

Despite policy on adolescent sexual and reproductive health (SRH) services and education, teen pregnancies remain common in South Africa. Social norms and cultural resistance are a well-documented challenge for SRH program implementation in South Africa, and beyond. To gain insight on the complex picture of adolescents' access to SRH information and services in a peri-urban township, we explored this topic from a diversity of perspectives, carrying out 86 interviews to capture perceptions of adolescents, their parents, community members, and health professionals. Our research shows that despite the taboo nature of the issue of adolescent SRH, individual positions on adolescent access to SRH services and information are shifting and diverse, and are influenced by factors other than cultural norms. This research serves as a reminder to avoid simplistic reference to "culture" as a way of explaining health-related behaviors and people's responses to health challenges.

'There is no more future for me? Like really, are you kidding?': agency and decision-making in early motherhood in an urban area in Johannesburg, South Africa

Background: The South African development goals for young women aged 15 to 24 are to reduce HIV incidence, teenage pregnancy and gender-based violence, and to increase school completion and economic security. Early, unintended pregnancy undermines these goals, creating discourses of early motherhood that position young women as powerless. There has been scant attention on the agency of young women in their structural context.Objective: This study explored how young women exercise agency after an unintended pregnancy and make decisions concerning their future, including sexual and reproductive health, school completion and/or income generation, and caregiving for their babies.Methods: I used narrative analysis to explore the lived experiences of young mothers, paying attention to decision-making during pregnancy and motherhood. Domains of analysis included health care, education, and caregiving. I conducted in-depth interviews with 30 young mothers: 30 were interviewed once, nine were interviewed twice, and six were interviewed three times. I interviewed four significant people in the lives of young mothers and six health care providers at a health centre.Results: Progressive policy facilitates increased access to services for young pregnant and parenting women. However, education and health care providers continue to discriminate against them, formally through denying them access to services and informally through discourses of shame which pervade their structural context. Kinship capital in urban and rural contexts and the Child Support Grant mitigate some struggles in early motherhood and help young mothers navigate decision-making.Conclusion: Young mothers exercise agency along a continuum to realise their aspirations. Social and structural support mediate their agency. Policy needs to expand the focus from prevention to include issues of care and support after an early, unintended pregnancy to ensure the health and wellbeing of young mothers and their children.

The effects of a cash transfer intervention on sexual partnerships and HIV in the HPTN 068 study in South Africa

Evidence on cash transfer interventions for HIV prevention in adolescent girls and young women is unclear and indicates that they may not work uniformly in all settings. Qualitative interviews were conducted with 22 girls and young women post-intervention to determine how a cash transfer study (HPTN 068) in South Africa was perceived to influence sexual behaviours and to explore mechanisms for these changes. Participants described how the intervention motivated them to increase condom use, have fewer partners, end risky relationships and access HIV testing services at local primary health clinics. Changes were attributed to receipt of the cash transfer, in addition to HIV testing and sexual health information. Processes of change included improved communication with partners and increased negotiation power in sexual decision-making. Economic empowerment interventions increase confidence in negotiating behaviours with sexual partners and are complementary to sexual health information and health services that provide young women with a foundation on which to make informed decisions about how to protect themselves.