Governing pregnancy in South Africa: political and health debate, policy and procedures
- Authors: Du Plessis, Ulandi
- Date: 2019
- Subjects: South Africa. Department of Health (1994- ) , Maternal health services -- South Africa , Mothers -- Mortality -- South Africa , Prenatal care -- South Africa , African mothers -- Mortality -- South Africa
- Language: English
- Type: text , Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10962/76552 , vital:30600
- Description: South Africa democratised in 1994. However, due to the discriminatory and segregationist character of the preceding regime, vast swathes of the country’s spaces and people entered the democratic period heavily deprived of essential government services. This was the case with health care in general, including maternal health care. There were also little to no national data available on maternal deaths, especially among the black population. One of the first tasks of the new National Department of Health (NDoH) was to target the high maternal mortality rate. The NDoH made maternal deaths notifiable by law and instituted auditing and information gathering systems in the health sector; health infrastructure was expanded exponentially, and maternal health care was made free. Despite this, the last 24 years have seen the maternal mortality escalate. The latest statistics show that between 1200 and 1300 women die in the South African public health sector each year during pregnancy and the puerperium. This puts the current institutional maternal mortality rate (MMR) at around 154/100 000 live births. The international target for ‘developing’ countries was to reduce the MMR rate by three quarters by 2015, which would have meant a reduction to 38/100 000 live births. The aim of this dissertation is to examine how the democratic South African government (influenced heavily by global health thinking) has laboured to reduce that statistic. I analyse, using Foucauldian discourse analysis, all relevant health and maternal health policies, procedural documents and reports produced by and for the NDoH in the last 24 years. I draw on Foucauldian concepts, specifically those related to Foucault’s work on governmentality. In this dissertation I introduce a new perspective towards the maternal health practices implemented in South Africa, practices that have generally remained unquestioned, been perceived as self-evident, and thus often escaping critical analysis. Through an analysis of the intended operation of the public antenatal clinic (within the larger institutional system) I show how ‘development’ has come to operate as a truth regime in South Africa – facilitating the introduction of liberal governmentality (including some advanced liberal practices) into public health service provision.
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Narrated experiences of the pre-termination of pregnancy counselling healthcare encounter in the Eastern Cape public health sector
- Authors: Mavuso, Jabulile Mary-Jane Jace
- Date: 2018
- Subjects: Abortion counseling -- South Africa -- Eastern Cape , Abortion -- Psychological aspects , Abortion -- Social aspects , Pro-choice movement -- South Africa -- Eastern Cape , Reproductive rights -- South Africa -- Eastern Cape , Women -- Sexual behavior -- South Africa -- Eastern Cape , Women -- South Africa -- Social conditions
- Language: English
- Type: text , Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10962/62928 , vital:28311
- Description: Research that has been conducted about experiences of pre-abortion counselling tends to investigate either womxn's1 or healthcare providers' experiences separately, with research on womxn's experiences of abortion and abortion counselling dominating this area of research. Although some of the studies on womxn's abortion experiences have explored womxn's experiences of interactions between themselves and healthcare providers, these aspects have been underreported. To my knowledge, research that also explores womxn's interactions among themselves in the waiting room has not been done. Furthermore, research that explores the pre-termination of pregnancy healthcare encounter, where womxn's and healthcare providers' experiences of waiting room interactions and of pre-abortion counselling practices are seen as interrelated, has not been conducted. Research that has been conducted among womxn's experiences show that womxn have varying experiences of pre-abortion counselling, with some finding it useful while other womxn have found it to be lacking in relevance to their specific situation or needs. Research conducted among healthcare providers also points to varying experiences, with some healthcare providers stratifying womxn's reasons for abortion according to the acceptability of the request. This study explores health service providers’ and womxn’s narrated experiences of the pre-termination of pregnancy healthcare encounter (waiting room interactions and pre-abortion counselling) in the Eastern Cape public health sector. An African feminist post-structural approach, which enables analysis of how discursive structures and power relations may underpin African womxn's experiences of oppression and resistance, was used. Fusing this approach with a narrative-discursive analysis, enabled an exploration of the discursive resources drawn upon and the power relations referred to by participants when constructing micro-narratives and accounts of their experiences of waiting room interactions and pre-abortion counselling practices. This fusion enabled an understanding of the micro (individual) and macro (social) and how they interact and come to bear on experiences of the pre-abortion counselling healthcare encounter. Womxn's micro-narratives and healthcare providers' accounts were compared for convergences and divergences in the pre-abortion counselling practices they described. The implications of these convergences and divergences and of the power relations referred to by participants for pre-abortion counselling service provision are discussed. The research referred to in this study were conducted in contexts where abortion is legal, although the conditions under which it may be accessed differ across and within contexts. This present study is contextualised by the Choice on Termination of Pregnancy Act No. 92 of 1996 which legalises abortion and stipulates that abortion counselling should be made available to womxn but should be non-mandatory and non-directive. Data were collected at three abortion facilities located in public hospitals in the Eastern Cape. Open-ended, semi-structured interviews were conducted with 30 womxn after they received pre-abortion counselling, and four healthcare providers involved in abortion service provision. Data were analysed using an extended narrative-discursive approach which entailed exploring patterns in and across participants' talk. These patterns took the form of discursive resources (discourses and the subject positions they made available, and canonical narratives), power relations, and micro-narratives and accounts of their experiences of pre-abortion counselling practices and waiting room interactions. Participants described the following pre-abortion counselling practices: information-giving practices, consent practices, administering of LARCs, a waiting period and third-party involvement. In describing these processes, participants drew on an awfulisation of abortion discourse, moralising discourses, pronatalist discourses, and liberal discourses to construct (micro-)narratives in which liberal, pastoral and authoritarian counselling practices and power relations were constructed and referred to. In their micro-narratives, most womxn described the counselling as informative, beneficial and healing whilst also describing shock, hurt, pain and distress at the various kinds of information they received. Healthcare providers drew on discourses and canonical narratives (such as the hero and personal testimony) to justify liberal, pastoral and authoritarian counselling practices which were underpinned by constructing abortion and unintended pregnancy as problematic. The pre-abortion counselling practices that were described were directive in two ways: the coercion of contraceptive uptake post-abortion, and information provision practices which effectively work to delegitimise and persuade womxn against abortion.
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A narrative-discursive analysis of abortion decision-making in Zimbabwe
- Authors: Chiweshe, Malvern Tatenda
- Date: 2016
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10962/496 , vital:19964
- Description: Most research on abortion decision-making has looked at the factors or influences that are seen to affect abortion decision-making and thus take a health determinants approach. However, this approach is rarely able to account for the complex, multi-faceted nature of abortion decision-making, and it is often not located within a framework that can unpick the complex array of power relations that underpins the process of abortion decision-making. Research on abortion decision-making has rarely examined how women who undergo a termination of pregnancy (TOP) construct micro-narratives of the decision to terminate the pregnancy and also how these women are positioned by the service providers who interact with them. Using a Foucauldian postcolonial feminist approach and narrative-discursive analysis, this study explores abortion decision-making narratives in a Zimbabwean context where abortion laws are restrictive. In this study I elicited the narratives of women who had undergone an abortion about how they came to make the decision and proceeded to terminate the pregnancy. I highlight the discourses employed in constructing these narratives and how women position themselves in these narratives and discourses. These are then compared to the subject positions enabled in health service providers’ narratives on the same topic. These narratives are then linked to the social discourses and power relations that work to enable or constrain reproductive justice. The data were collected from three sites in Harare, Zimbabwe. The three sites were Harare Hospital, Epworth and Mufakose. An adapted version of Wengraf’s (2001) narrative interview was used to elicit narratives from 18 women who had terminated pregnancies (six at each site). Semi-structured interviews were conducted with six service providers (two nurses at Harare Hospital, two village health workers in Epworth and two nurses in Mufakose). All the service providers interviewed have experience working with women who have terminated pregnancies. In narrating their stories about their abortions, the women employed discursive resources around shame, stigma, religion, health and culture. These discursive resources were drawn upon in the construction of the women’s micro-narratives. The women spoke in a socially sanctioned manner where stories were enabled and constrained by particular religious, cultural and gendered discursive resources. In these stories, cultural constructions, gendered understandings of motherhood and femininity constrained reproductive justice for women who have terminated pregnancies. Comparisons of the way women positioned themselves and how they were positioned by health service providers point to the existence of social discourses and power relations that work to constrain reproductive justice. While the women saw themselves as having ‘unsupportable pregnancies’, the service providers positioned them as being evil, selfish and irresponsible. The negative positions deployed by the service providers point to the vilification and blaming of women who have undergone a termination of pregnancy. In these positions, the woman is at fault and there is silence on the role of men in abortion decision-making. In the women’s narratives and the health service providers positioning of the women a ‘reproductive rights’ discourse was absent. This was significant as much of the activism around abortion has centred on the woman’s rights to her body. Where rights were mentioned, it was in reference to foetal rights (using cultural, moralistic religious understandings of abortion as killing). The missing ‘reproductive rights’ discourse points to a need to move from a reproductive rights framework to a reproductive justice framework that can be applied through local understandings of hunhu/ubuntu. By doing this, abortion is not seen as a ‘choice’ that a woman makes but rather as involving broader social and environmental circumstances that make a pregnancy ‘unsupportable’.
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Nascent Desires: Gendered Sexualities in Life Orientation Sexuality Education Programmes and Popular Music
- Authors: Moodley, Dale Dhersen
- Date: 2016
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3274 , http://hdl.handle.net/10962/d1021260
- Description: Formal school-based sexuality education is one medium, amongst others, that recognises young people’s sexuality, but usually as at-risk and/or risk taking subjects, or as innocent subjects. I analyse the gendered sexualities of young people as represented in: Grade 10 Life Orientation sexuality education programmes and popular music, as two mediums of sexual socialisation in Grade 10 learners’ lives, and as engaged with by Grade 10 learners and educators. I collected data from two schools in the Eastern Cape that included: (i) sections on sexuality from two Life Orientation manuals used by educators in classrooms: ‘Oxford Successful Life Orientation’ (2011), and ‘Shuters Top Class Life Orientation’ (2011); (ii) videos and lyrics of three songs voted most popular by learners which were ‘Climax’ by Usher, ‘Beez in the Trap’ by Nicki Minaj, and ‘Where Have You Been’ by Rihanna; (iii) observations of seven sexuality education classes; and, (iv) in-depth semistructured interviews conducted with eight learners and two educators. I draw on an integrated theoretical and methodological approach – Foucauldian, feminist poststructural and psychosocial psychoanalytic perspectives – to conceptualise and analyse gendered sexualities in terms of: (i) the dominant gendered discourses found in sexuality education manuals, and music videos and lyrics; (ii) the reflexive and interactive gendered subject positions taken up and/or resisted by learners and educators during classroom lessons and one-on-one interviews; and, (iii) learners’ and educators’ conscious and unconscious investments in particular gendered subject positions during one-on-one interviews. These three sets of analysis produced four major themes. The first theme centres on responsible sexuality; young women are expected to assume more sexual responsility than young men, thus curbing their sexual agency. The second theme outlines three types of pleasure – sexual, romantic and dating and/or relationship pleasure – that accord young men and women active and passive ways of exercising pleasure. The third theme highlights the heteronormative transitioning adolescent subject that constructs young women as reproductive subjects and young men as sexual subjects. The last theme focuses on gendered power relations and raunch culture, and maintains that young men are powerful and likely to commit acts of sexual violence against young women because they are powerless. The central argument developed when viewing all the themes is that dominant gendered discourse, gendered subject positions, and conscious and unconscious investments in these positions challenge the extent to which the gendered meanings that underpin adolescent learners’ sexuality are stable and fixed. The gendered discourses in the Life Orientation sexuality education programmes showed that gender is expressed rigidly, thus privileging masculine over feminine sexuality. However, the gendered discourses in the popular music contested rigid gender binaries and produced fluid and equitable masculine and feminine sexualities. The classroom practices depicted multiple and more equatable gendered sexualities, highlighting just how contested gender is. Finally, educator and learners’ personal biographies illustrated how conflicting masculine and feminine sexualities present a signficant source of emotional conflict for them. It may benefit policymakers and stakeholders to consider informal mediums of sexual socialisation for learners, such as music, when drafting the Life Orientation sexuality education curriculum, whilst also taking into account learners and educators personal lives.
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‘Gender’ and constructions of spousal mourning among the AmaXhosa in the Eastern Cape
- Authors: Ngqangweni, Hlonelwa
- Date: 2014
- Subjects: Widowhood -- South Africa -- Eastern Cape , Widows -- South Africa -- Eastern Cape , Xhosa (African people) -- Funeral customs and rites , Xhosa (African people) -- Psychology , Bereavement -- Psychological aspects , Mourning customs -- South Africa -- Eastern Cape , Death -- Social aspects -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3249 , http://hdl.handle.net/10962/d1015647
- Description: Among the AmaXhosa the death of a person is marked by a tradition called ukuzila - the equivalent of the mourning process. As a sign of spousal mourning, and to show respect, the remaining spouse has to put on a marker (be visible). However, it is mostly the woman who is under obligation to show her mourner status by wearing ‘clothes of mourning’. The discriminatory nature of the practice, especially pertaining to visibility and some of the detrimental effects on the widows’ health and safety have been documented by some researchers, but the reasons for the continuity of visibility remain largely unexplored. Taking into account the dynamic nature of ‘culture’, this research explored the discourses deployed in men and women’s constructions of ukuzila specifically focusing on spousal mourning and the continuity of widows’ visibility in spite of their resistance to it. The research used postcolonial feminism drawing on postructuralism as its theoretical lens. This theoretical lens provided useful concepts such as hybridity, visibility, surveillance and power with which to examine spousal mourning and conceptualised people’s subject positions as multiple, fluid and contingent. Furthermore, the research employed thematic and discourse analysis at its methodology. Discourse analysis was employed to identify and analyse the discourses utilised in the constructions of spousal mourning. The research was conducted through focus group discussions held with younger and older urban and rural men and women, as well as interviews held with widows and widowers and key cultural informants. Concerning the question of constructions of spousal mourning for men and women, visibility of the mourner emerged as a central and contentious issue. Some participants were of the view that one could show mourning by engaging in culturally appropriate mourning behaviour, whilst others were of the view that showing one’s mourning had to be visible by publicly displaying mourning through a marker. Another group proposed mourning “by heart”, whereby the mourners’ status could either be inferred from their behaviour, whereas others maintained that behaviour was not mandatory. Various justifications for the continued visibility of widows were advanced. These justifications included showing love and respect to the deceased husband; showing respect to the ancestors; and helping to monitor their own behaviour in order to ensure that it is in line with appropriate mourning behaviour. The continued visibility of widows was also used to regulate the widows’ sexuality. Widows were coerced to put on ‘clothes of mourning’ in order to ‘protect’ them from being approached by men for a relationship during the mourning period. The regulation of the movement of widows was also managed through visibility. Widows’ movements were restricted in order to protect the community from pollution or bad luck. For example, they were not allowed to visit places of entertainment or visit other households. Key discourses identified were the familial-‘ukwenda’, respect-‘hlonipha’, and male sexual drive (MSD) discourse. The familial - ‘ukwenda’ discourse is centred on the idea that one is ‘married to the household’, which includes the nuclear family and wider extended family including ancestors. According to the respect-‘hlonipha’ discourse, respect is due to others on the basis of their age, status, and more especially their gender. Showing respect (hlonipha) necessitates the avoidance of all forms of behaviour and utterances that could be deemed disrespectful. The MSD holds a widespread view of sexuality as a biological drive that resides within each male and it was drawn on to make sense of discontinued visibility among widowers, whilst visibility of widows continued. It is argued that it is these discourses, embedded in the ‘culture’ of the AmaXhosa and upheld by the family that sustain the discriminatory nature of the practice, especially concerning the continued visibility of widows in spite of the resistance that has been voiced.
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"But what story?": a narrative-discursive analysis of "white" Afrikaners' accounts of male involvement in parenthood decision-making
- Authors: Morison, Tracy
- Date: 2011
- Subjects: Family planning -- South Africa -- Psychological aspects Family size Birth intervals Men -- South Africa -- Attitudes Men -- South Africa -- Psychology Couples -- South Africa -- Psychology Afrikaners -- Attitudes
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3025 , http://hdl.handle.net/10962/d1002534
- Description: Despite the increased focus on men in reproductive research, little is known about male involvement in the initial decision/s regarding parenthood (i.e., to become a parent or not) and the subsequent decision-making that may ensue (e.g., choices about timing or spacing of births). In particular, the parenthood decision-making of “White”, heterosexual men from the middle class has been understudied, as indicated in the existing literature. In South Africa, this oversight has been exacerbated by the tendency for researchers to concentrate on “problematic” men, to the exclusion of the “boring, normal case”. I argue that this silence in the literature is a result of the taken for granted nature of parenthood in the “normal” heterosexual life course. In this study, I have turned the spotlight onto the norm of “Whiteness” and heterosexuality by studying those who have previously been overlooked by researchers. I focus on “White” Afrikaans men’s involvement in parenthood decision-making. My aim was to explore how constructions of gender inform male involvement in decision-making, especially within the South African context where social transformation has challenged traditional conceptions of male selfhood giving rise to new and contested masculine identities and new discourses of manhood and fatherhood. In an effort to ensure that women’s voices are not marginalised in the research, as is often the case in studies of men and masculinity, I conducted in-depth, semi-structured interviews about male involvement in decision-making with both “White” Afrikaans women and men. There were 23 participants in total, who all identified as heterosexual and middle-class. The participants were divided into two age cohorts (21 – 30 years and >40 years), which were then differentiated according to gender, reproductive status, and relationship status. Treating the interviews as jointly produced narratives, I analysed them by means of a performativity/performance lens. This dual analytic lens focuses on how particular narrative performances are simultaneously shaped by the interview setting and the broader discursive context. The lens was fashioned by synthesising Butler’s theory of performativity with Taylor’s narrative-discursive method. This synthesis (1) allows for Butler’s notion of “performativity” to be supplemented with that of “performance”; (2) provides a concrete analytical strategy in the form of positioning analysis; and (3) draws attention to both the micro politics of the interview conversation and the operation of power on the macro level, including the possibility of making “gender trouble”. The findings of the study suggest that the participants experienced difficulty narrating about male involvement in parenthood decision-making, owing to the taken for granted nature of parenthood for heterosexual adults. This was evident in participants’ sidelining of issues of “deciding” and “planning” and their alternate construal of childbearing as a non-choice, which, significantly served to bolster hetero-patriarchal norms. A central rhetorical tool for accomplishing these purposes was found in the construction of the “sacralised” child. In discursively manoeuvring around the central problematic, the participants ultimately produced a “silence” in the data that repeats the one in the research literature.
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(In)visibility and the exercise of power: a genealogy of the politics of drag spectacles in a small city in South Africa
- Authors: Marx, Jacqueline Greer
- Date: 2011
- Subjects: Female impersonators -- Research -- South Africa Male impersonators -- Research -- South Africa Apartheid -- South Africa -- Psychological aspects
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3013 , http://hdl.handle.net/10962/d1002522
- Description: This study investigates the politics of homosexual visibility in dressing-up, cross-dressing and drag performances that take place in a small city in South Africa over a period of sixty years, beginning in the 1950s and the inception of apartheid policy, through the socio-political changes in the 1990s to the 21st century post-apartheid context. The study draws on Butler’s notion of performative resistance and adopts a Foucauldian genealogy to examine the conditions that make visibility possible and through which particular representations of homosexuality are articulated and read, or remain unread or misread. Information about dressing-up, cross-dressing and drag performance was obtained in interviews, from documentary evidence, and from audio-visual recordings of drag shows and gay and lesbian beauty pageant competitions. Semiotics and a Foucauldian approach to analysing discourse were used to interpret the written, spoken, and visual texts. In this study I argue that the state prohibition of homosexuality during apartheid meant that people could not admit to knowing about it, and this ‘not knowing’ provided a cover for homosexual behaviour in public. At this time, the threat of being identified was associated with police raids on private parties. In the 1990s, homosexual visibility was more viable than it had been in the past. However, the strategies that were adopted to negotiate public visibility at this time were tailored to appease normative sentiments rather than challenge them. I argue that, historically, race and gender have played a role in diminishing and exacerbating homosexual visibility and its politics. Addressing the potential for harm that is associated with homosexual visibility in the 21st century post-apartheid context, this study considers the circumstances in which invisibility is desirable.
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