Reproductive control in South Africa

The controversial state-sponsored family planning program officially began in South Africa in 1974. Although the government did not implement the program on a racial basis, the program was widely believed to be linked with white fears of growing black numbers, and was attacked by detractors as a program of social and political control. In spite of the hostile environment, black women’s use of services steadily increased. Using historical and anthropological evidence, this paper delineates the links between the social and political context of racial domination and individual fertility behavior. It argues that the quantitative ‘success’ of the family planning program is rooted in profound social and economic shifts conditioning reproductive authority and fertility decisionmaking. The analysis traces tensions over reproductive control within and across three different arenas: the evolution of national politics of population; the transformation of gender relations within a racially discriminatory society; and the proscriptions of everyday life for black women. State policies of racial segregation and influx control, ethnic ‘homeland’ politics, and male labor migration transformed opportunities and constraints for black women and men, and altered local and household expectations of childbearing. Women came to manage their own fertility as they increasingly found themselves in precarious social and economic circumstances

How community structures of time and opportunity shape adolescent sexual behavior in South Africa

Recently, South Africa has led the world in rates of HIV/AIDS infection. Particularly among young adults, the prevalence of HIV has soared, now reaching 25 percent. The statistics suggest a high level of unprotected sex and risky sexual behavior even in the midst of high levels of knowledge. Research has focused on the dynamics of individuals’ and partners’ sexual decisionmaking. Little is known, however, about the larger context in which those decisions are made. What are the everyday experiences that influence risk-taking? Are young people with little to do more likely to engage in risky behavior? Do community opportunities of schooling, work, and other activities make a difference? This study employs time-use data and data on education, work, and activities of adolescents collected from a representative sample of 2,992 young people aged 14 to 22 living in KwaZulu-Natal, South Africa, to explore these questions. Analyses of time use indicate that African and Indian girls spend twice as much time engaged in unpaid domestic work as do their male counterparts, whereas white boys spend the most time of those studied in paid positions. Africans, both boys and girls, report studying fewer hours than other racial groups. For girls, levels of education in the community were positively associated with not having had sex in the last 12 months. Levels of wages in communities were positively associated with condom use for both boys and girls. Levels of sports activity in communities had a positive association with risk-taking among boys and a negative one among girls

The spread of primary schooling in sub-Saharan Africa: Implications for fertility change

Caldwell has hypothesized that the onset of the fertility transition would be linked with the achievement of “mass formal schooling.” In sub-Saharan Africa, a region where some countries have begun the fertility transition but many have not, the extent of progress toward mass schooling has not yet been assessed. This paper fills a gap in the literature using newly available Demographic and Health Survey data to assess schooling patterns and trends for 17 sub-Saharan African countries. As background to that assessment, the paper includes a literature review, an overview of the recent history of African education, and an evaluation of alternative sources of data on education. These data are linked to recent markers of fertility change in order to assess the potential importance of mass schooling for the fertility transition in Africa. In most of Africa, the promise embodied in early post-independence education progress whereby the next generation of Africans would be universally exposed to basic levels of formal schooling has yet to be realized. Countries such as Botswana, Ghana, Kenya, Namibia, South Africa, Tanzania, Zambia, and Zimbabwe are the exceptions rather than the rule, and most of these had achieved some form of mass schooling by the early 1980s. Since 1980, growth rates in educational participation and attainment have slowed or halted; in some countries, they have begun to decline. Most of these same countries were in the forefront of the fertility transition in Africa; in Ghana and Tanzania, fertility declines have begun more recently. A systematic empirical analysis of cross-country patterns across all 17 countries supports Caldwell’s hypothesis. Within this group, however, we find a few countries beginning to show signs of fertility transition despite limited progress in mass schooling. Côte d’Ivoire and Senegal are notable examples of this new development. In countries where population growth rates remain high and a growing proportion of the population is of school age, the achievement of mass schooling will be increasingly difficult in the future if high fertility persists. Therefore, if fertility declines are to continue, or in some cases begin, they will have to do so in the absence of mass schooling. Instead, fertility may respond to other vehicles of communication, such as the mass media, which will be increasingly pervasive, providing alternative mechanisms for the spread of cultural change

\u27Bus fare, please\u27: The economics of sex and gifts among adolescents in urban South Africa

Force or coercion are often a part of sexual relationships in South Africa, especially among adolescents. This coercion is also often pinioned by an economic exchange: gifts or favours for sex. Studies have pointed out the negative consequences of the exchanges which are often characterised by large age differences (‘sugar daddies’) or power imbalances. Perhaps more pervasive but largely ignored, gift-giving in same-age relationships also may be associated with sexual leverage, an exchange which somehow entitles one partner physical and sexual rights to the other’s body. The circumstances surrounding gifts and favours may shape young women’s and men’s sexual experiences, their ability to negotiate the circumstances of those encounters, and the possibility of concluding or remoulding a relationship into another form. Using focus group discussions collected in the Durban metropolitan area between September and December of 1999 among adolescents age 14-22, we examine the economic context of gift giving or receiving and its relationship to patterns of risky sexual behaviour such as unsafe sex practices, and reports of sexual coercion or force. We find that gift-giving among same-age adolescents is common and important to shaping sexual relationships. Adolescents associate money or cash with prostitution, but do not consider gifts as such. Types of gifts and their meaning varied considerably by racial group and by gender

Pregnant or positive: Adolescent childbearing and HIV risk in South Africa

In communities where early age of childbearing is common and HIV prevalence is high, adolescent boys and girls may place themselves at risk of HIV to realize their childbearing preferences. In this paper, we analyze survey data from Kwa-Zulu-Natal province that explores whether an association exists between pregnancy preferences and behavioral and perceptual measures of HIV risk among adolescents in South Africa. Our analysis is based on data from 1,426 sexually active respondents aged 14-22 who participated in wave 1 of the “Transitions to Adulthood in the Context of AIDS in South Africa” study. We use logistic regression to model the probability of reporting that pregnancy would be a problem, using measures of HIV risk together with controls for individual and community measures that are also likely to affect pregnancy preferences. We find that educational and employment opportunities affect fertility preferences but also that the HIV pandemic, specifically adults’ perception of HIV risk for the young in the community and peer opinions about HIV risk, affect fertility preferences. Some significant differences by sex emerge concerning the influence of the perceptions of HIV risk. The analysis suggests that although individual and structural factors remain important, for some adolescents-and for girls more than for boys-the danger of HIV infection is becoming part of their calculus of the desirability of pregnancy. For both boys and girls, the unprotected sex required for conception puts them at danger of HIV transmission. For girls, the environment of risk may be particularly influential because the double threat of pregnancy and HIV infection carries an additional risk of HIV transmission to the infant, as well as the possibility of learning one’s serostatus at an antenatal clinic during pregnancy

Adolescent pregnancy and parenthood in South Africa

South Africa’s total fertility rate is estimated to be one of the lowest in sub-Saharan Africa, less than 3.0 births per woman nationally and declining. At the same time, adolescent childbearing levels remain high more than 30 percent of 19-year-old girls are reported to have given birth at least once. Using evidence from focus groups conducted in urban and rural areas in South Africa with young black women and men, and with the parents of teenage mothers, we consider the experience of early parenthood. Specifically, the analysis explores four aspects of teenage childbearing as it relates to key transitions into adulthood: the advent of a pregnancy and the decision to terminate or carry the pregnancy to term; the conditions under which “damages” (a fine for the boy’s behavior that also effectively assigns paternity even if no marriage follows) are denied, paid, or refused; the impact of early childbearing on school, work, and marriage; and consequences of premarital childbearing on future relationships, including subsequent fertility. We find that in South Africa, in contrast to many other settings, teenage mothers may return to school once they have given birth and that this opportunity is strongly related to a long delay before the birth of a second child. Education is also strongly associated with the valuation of brideprice: girls who are better educated bring a higher price, which may encourage parents to support their daughters’ schooling, and perhaps also their return to school following early pregnancy and childbirth. Babies born to teenage parents are extremely vulnerable. Because the baby is usually born premaritally and subsequent marriage between mother and father is uncommon, the support and maintenance of the child are subject to paternal recognition and commitment. The presence of a baby also generally means a lower brideprice for a future marriage; first-born children are sometimes kept secret from prospective grooms to maintain higher brideprice

Addressing the Health Needs of Rural Native Veterans: Assessment and Recommendations

Native Veterans comprise unique populations within the VeteransAdministration (VA) system of care and represent a proud tradition of military service. Limited healthcare data available on rural Native veterans indicate significant disparities in access to care and health status compared with other populations. This article provides an assessment of current challenges, barriers, and issues related to addressing the healthcare needs of rural Native veterans and offers recommendations to improve healthcare for this special population. To meet the needs of rural Native veterans it will be important to: conduct needs assessments to gather important health data about rural Native veterans; develop a clearinghouse of information on and for rural Native veterans and disseminate this information widely; develop strategies to enhance transportation policies and provisions; expand the use of technology and outreach; work toward increasing cultural competence among VA employees; and improve the availability of traditional healing services

Perceived Everyday Racism, Residential Segregation, and HIV Testing Among Patients at a Sexually Transmitted Disease Clinic

Objectives. More than one quarter of HIV-infected people are undiagnosed and therefore unaware of their HIV-positive status. Blacks are disproportionately infected. Although perceived racism influences their attitudes toward HIV prevention, how racism influences their behaviors is unknown. We sought to determine whether perceiving everyday racism and racial segregation influence Black HIV testing behavior

Preferences and priorities for relapsed multiple myeloma treatments among patients and caregivers in the United States

Introduction/Background: This study aimed to describe patient and caregiver preferences for treatments of relapsed or refractory multiple myeloma (MM). Materials and Methods: A survey including discrete-choice experiment (DCE) and best-worst scaling (BWS) exercises was conducted among US patients with relapsed or refractory MM and their caregivers. The DCE included six attributes with varying levels including progression-free survival (PFS), toxicity, and mode and frequency of administration. In addition, the impact of treatment cost was assessed using a fixed-choice question. The BWS exercise included 18 items (modes and frequency of administration, additional treatment convenience, and toxicity items). The survey was administered online to patients recruited from the Multiple Myeloma Research Foundation CoMMpass study (NCT01454297). Results: The final samples consisted of 94 patients and 32 caregivers. Avoiding severe nerve damage was most important to patients, followed by longer PFS. Caregivers considered PFS to be the most important attribute. We estimate that a third or more of patients were cost-sensitive, meaning their treatment preference was altered based on cost implications. Caregivers were not cost-sensitive. The three most bothersome treatment features in the BWS exercise were risk of kidney failure, lowering white blood cell counts, and weakening the immune system. Conclusion: Patients with relapsed or refractory MM and their caregivers consider many factors including efficacy, toxicity, mode/frequency of administration, and cost in their decisions regarding treatment options. The study provides a basis for future Research on patient and caregiver treatment preferences, which could be incorporated into shared decision-making with physicians

Mapping patterns of complementary and alternative medicine use in cancer: An explorative cross-sectional study of individuals with reported positive "exceptional" experiences

<p>Abstract</p> <p>Background</p> <p>While the use of complementary and alternative medicine (CAM) among cancer patients is common and widespread, levels of commitment to CAM vary. "Committed" CAM use is important to investigate, as it may be associated with elevated risks and benefits, and may affect use of biomedically-oriented health care (BHC). Multiple methodological approaches were used to explore and map patterns of CAM use among individuals postulated to be committed users, voluntarily reporting exceptional experiences associated with CAM use after cancer diagnosis.</p> <p>Method</p> <p>The verbatim transcripts of thirty-eight unstructured interviews were analyzed in two steps. First, manifest content analysis was used to elucidate and map participants' use of CAM, based on the National Center for Complementary Medicine (NCCAM)'s classification system. Second, patterns of CAM use were explored statistically using principal component analysis.</p> <p>Findings</p> <p>The 38 participants reported using a total of 274 specific CAM (median = 4) consisting of 148 different therapeutic modalities. Most reported therapies could be categorized using the NCCAM taxonomy (n = 224). However, a significant number of CAM therapies were not consistent with this categorization (n = 50); consequently, we introduced two additional categories: <it>Spiritual/health literature </it>and <it>Treatment centers</it>. The two factors explaining the largest proportion of variation in CAM usage patterns were a) number of CAM modalities used and b) a category preference for <it>Energy therapies </it>over the categories <it>Alternative Medical Systems </it>and <it>Treatment centers </it>or vice versa.</p> <p>Discussion</p> <p>We found considerable heterogeneity in patterns of CAM use. By analyzing users' own descriptions of CAM in relation to the most commonly used predefined professional taxonomy, this study highlights discrepancies between user and professional conceptualizations of CAM not previously addressed. Beyond variations in users' reports of CAM, our findings indicate some patterns in CAM usage related to number of therapies used and preference for different CAM categories.</p