Women and contraceptive use : a case study of a South African urban informal settlement.
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This study adopted a case study design to understand women and contraceptive use in the Diepsloot community, an impoverished urban informal settlement, north of Johannesburg. It was guided by feminist and critical theory, and made use of the qualitative research paradigm. The history of the provision of reproductive health services in South Africa has been discussed as a process that has both marginalised the participation of previously disadvantaged communities and also limited the opportunities for effective contraceptive use in the post-apartheid era. The main objectives were to understand reproductive health experiences of women and their knowledge of modern contraception in relation to the ecological environment in which they are embedded. I used the non-probability purposive and theoretical sampling methods. The sample size was theory driven and largely determined by the type of data acquired after a series of interviews with twenty women over a five month period. Data collection ceased when data saturation was reached. Individual interviews and focus group discussions were conducted with twenty primary respondents. For triangulation purposes, primary health care service providers from the two local clinics were interviewed. Also one focus group discussion was done with a group of eight men; two traditional healers and the manager at the local Marie Stopes clinic were also interviewed for the same purpose. I used thematic analysis as the method of analysing the data. Thematic analysis moves beyond merely describing the data but identifies both the unspoken and obvious ideas within data. It was the intersectionality of contraceptive use and the unique lived experiences of disadvantaged women that had inspired the study and all methods employed were aimed at a deeper understanding of the effects of the cultural, social and economic environment on the reproductive health choices of the women. The data were analysed according to the seven themes that emerged from the study and these were: empowerment and reproductive health decision making, level of education as a determining factor in contraceptive use, contraceptive knowledge, contraceptive dialogue as a contributing factor to contraceptive use and choice, opinions on the prevention of pregnancy, spacing versus limiting the number of births and the availability and accessibility of modern contraceptive methods. The inextricable link between education, poverty and gender inequality highlighted the need to empower women in marginalised communities. Due to poverty and lack of education, most women were powerless and not independent to make favourable reproductive health decisions. Knowledge of modern contraceptive methods was limited and the most popularly used method was the contraceptive injection. The circumstances of the women in this study and those of the Diepsloot community speak to the broader economic issues of the country and reflect the need to prioritise women’s education; to create economic opportunities for women and to enhance the participation of the poor and marginalised communities.