Modern Desires: Family Formation Patterns in the Context of HIV/AIDS in Post-Apartheid Rural South Africa

This dissertation examines family formation patterns in rural, post-apartheid South Africa, focusing on changes in the timing and union context of first births, and shifts in young women's fertility preferences and future projects. I use longitudinal data from households in the Agincourt Health and Demographic Surveillance System from 1993-2010. I also use qualitative data collected from women aged 18-79 in Agincourt via in-depth interviews, focus group discussions, observations, and conversations with key informants from January-June 2010. My findings demonstrate that South Africa's unique context of low fertility and high AIDS mortality has contributed to changes in the timing and union context of first births. Overall very few women enter unions by age 35 (10%). The majority of first births remain nonmarital, yet women today more often postpone first births beyond the teenage years and have their first births while married. Women with nonmarital births face several disadvantages as they move through early adulthood including being: less likely to marry; more likely to enter unstable unions; more likely to get divorced or separated; and more likely to die than women without nonmarital births. Qualitatively, I identify an empirical puzzle: Why do young women who desire children fail to consider the risk of contracting HIV, despite extremely high HIV prevalence in Agincourt? I draw on sociological theories of hope, aspirations, and future projects, to argue that uncertainty about one's current and future HIV status alongside new access to antiretroviral treatment allows women to construct idealized futures free from HIV. Even though HIV serves as the backdrop to life for young South African women, they maintain hope in their ability to obtain the modern life trajectories and goals they have constructed drawing on discourses provided by the new democratic government. My findings also document generational shifts in fertility preferences. For older women, having a large family produced status and respect. Conversely, young women desire to limit their family size and instead gain status by educating their children and acquiring modern consumer goods. I draw on the Theory of Conjunctural Action to document factors at multiple levels of society that have facilitated these changes

Premarital Births and Union Formation in Rural South Africa.

CONTEXT: In rural South Africa, women often delay union formation until they are in their late 20s, though premarital first births are common. METHODS: Longitudinal data from the Agincourt Health and Socio-Demographic Surveillance System in rural South Africa were used to examine the relationship between premarital birth and union entry among 55,158 nonmigrant women aged 10-35 who took part in at least one annual census from 1993 to 2012. Discrete-time event history models were used to determine whether the likelihood of union formation differed between women who had had a premarital first birth and those who had not. Associations between single motherhood and union type (marriages or nonmarital partnerships) were identified using logistic regression. RESULTS: Forty-five percent of women had had a premarital first birth and 25% had entered a first union. Women who had had a premarital first birth were less likely than other women to have entered a first union (odds ratio, 0.6). Women who had had a premarital birth in the past year were more likely than those without a premarital birth to have entered a union (1.5), but women had reduced odds of union formation if they had had a birth 1-2 years earlier (0.9) or at least five years earlier (0.8). Unions formed within two years of a premarital birth had an elevated likelihood of being nonmarital partnerships (1.2-1.4). CONCLUSIONS: Single motherhood is common in the Agincourt HDSS, and women with a premarital first birth face challenges in establishing committed unions with partners

Strategic Silence: College Men and Hegemonic Masculinity in Contraceptive Decision Making

Condom use among college men in the United States is notoriously erratic, yet we know little about these men’s approaches to other contraceptives. In this paper, accounts from 44 men attending a university in the western United States reveal men’s reliance on culturally situated ideas about gender, social class, race, and age in assessing the risk of pregnancy and STI acquisition in sexual encounters with women. Men reason that race- and class- privileged college women are STI-free, responsible for contraception, and will pursue abortion services if necessary. Since men expect women will take responsibility, they often stay silent about condoms and other contraceptives in sexual encounters—a process we term “strategic silence.” Men’s strategic silence helps uphold local constructions of hegemonic masculinity that prioritize men’s sexual desires and protects these constructions by subtly shifting contraceptive and sexual health responsibility onto women. Our analysis demonstrates the importance of men’s expectations of women for upholding constructions of hegemonic masculinity, which legitimate gender inequality in intimacy and are related to men’s underestimation of the risks associated with condom-free sex

Conflicting Contraceptive Norms for Men: Equal Responsibility versus Women’s Bodily Autonomy

Most research investigating how men and women in heterosexual relationships negotiate contraceptive use focuses on the women’s point of view. Using a sample of 44 interviews with men attending a western US university, this study examines norms governing men’s participation in contraceptive use and pregnancy prevention and their responses to those norms. We demonstrate how competing norms around sexual health decision-making and women’s bodily autonomy contribute to unintended outcomes that undermine young people’s quest for egalitarian sexual relationships. While men largely agree that responsibility for sexual health decision-making should be shared with women, they also believe that women should have power over their own bodies and sexual health. However, the coexistence of these two competing norms—which call for both equal responsibility in decision-making and women’s bodily autonomy—results in a disconnect between men saying that sexual health decision-making should be equal, but not always participating equally. Thus, men largely give contraceptive decision-making power over to women, putting the burden of pregnancy prevention on women and letting men off the hook. We conclude that men’s negotiation of these competing norms reinforces unequal power and inequality in sexual relationships

Norms, Trust, and Backup Plans: U.S. College Women's Use of Withdrawal with Casual and Committed Romantic Partners.

This study integrates research on contraceptive prevalence with research on contraceptive dynamics in hookup culture to examine college women's use of withdrawal with sexual partners. Drawing on in-depth interviews with 57 women at a midwestern U.S. university, we analyzed women's explanations for using withdrawal for pregnancy prevention and framed our study within the research on gender norms, sexual scripts, and power dynamics. Findings showed withdrawal was normalized within collegiate hookup culture, and that women frequently relied on withdrawal as a secondary or backup method or when switching between methods. Women often followed up with emergency contraceptives if using withdrawal alone. With casual partners, women advocated for their own preferences, including for partners to withdraw. In committed relationships, women prioritized their partner's desires for condomless sex, but also linked withdrawal with trust and love. Thus, women in relationships may be disadvantaged by hookup culture norms suggesting sex is freely available, putting pressure on them to acquiesce to withdrawal. Many women used withdrawal despite acknowledging it was not the most desirable or effective method, emphasizing the need for a sexual health approach that acknowledges these tensions and strives to help women and their partners safely meet their sexual and contraceptive preferences

Low-Income Women’s Navigation of Childbearing Norms Throughout the Reproductive Life Course

Shifts in family structure have affected age norms about both teenage childbearing and reproductive sterilization, but we lack research examining how childbearing norms are connected across the reproductive life course. Drawing on interviews from 40 low-income women in Colorado, we explored linkages between early childbearing and the desire for early sterilization. Specifically, we examined two narratives women use to negotiate competing norms throughout the reproductive life course. The low-income women in our study characterized their teenage childbearing experiences negatively and justified them using a “young and dumb” narrative. Women also asserted that reversible contraceptives do not work for them, using a “hyper-fertility” narrative to explain both their early childbearing and their desire for early sterilization. Our results illustrate the influence of mainstream social norms about childbearing timing on low-income women’s lives and provide evidence of how women use narratives to explain and justify their violation of childbearing norms

Working with teams of "insiders": Qualitative approaches to data collection in the Global South

Background: The convergence of two qualitative methodological strategies - working in "teams" and with "insiders" - can facilitate access, efficiency, and insights into research questions of interest to demographers. Even though this approach is becoming more common among population researchers in the Global South to address a range of research questions, little has been published that describes the method and critically assesses its strengths and weaknesses. Objective: We draw on three projects embedded in the Agincourt Health and Socio-Demographic Surveillance System site in rural South Africa that integrate both approaches to demonstrate the benefits and limitations of this strategy. Methods: We document, through in-depth description, how these three projects achieve access, efficiency, and insights into issues of population concern (HIV/AIDS, aging, and child wellbeing) utilizing a "team-insider" approach by working with groups of local research assistants. Conclusions: The projects vary in their use of "teams" and "insiders" but collectively deepen our understanding of pressing population concerns in the Global South. In particular, by using teams of insiders, these projects gain insights into local ideas about HIV, uncover ways that HIV affects older women's lives, and provide in-depth understanding of children's social connections. The approach also presents a number of challenges, however, such as grappling with the responsibilities and burdens that are placed on local insider team members