Sex work is a crime in South Africa. With the prevalence and deleterious social and economic effects of HIV, in health literature sex work has often been understood in relation to the way that it intersects with the transmission of the epidemic. This positioning of sex work then inadvertently stigmatises sex workers who are often cast outside the rights-based discourses that characterise South Africa’s post-apartheid democracy. In order to address this problem, this study explored the perceived barriers and facilitators to sex workers’ accessing sexual and reproductive healthcare (SRHC), gaps in the current service offerings relating to sex worker’s sexual and reproductive health (SRH) and the general experiences of SRHC amongst 11 female sex workers in Johannesburg, South Africa. Semi-structured in-depth interviews were conducted with these sex workers, who were based in Johannesburg City Deep. The resultant data were transcribed and subjected to a thematic analysis. The study shows that various structural and individual level barriers are perceived to prevent access to SRH. In particular, the analysis suggests that the disease-specific focus on sex worker-specific projects poses a barrier to sex workers’ accessing a complete range of SRHC services. Violence enacted by healthcare professionals, police and clients fuelled a lack of trust in the healthcare sector and displaced the participants from their basic human rights. It is also worrying that religion posed a threat to effective SRHC because some religious discourses label sex workers as sinners who are perceived to be excluded from forgiveness and healing. Finally, motherhood proved to be a point at which the participants actively managed their health and engaged with and in broad-based SRHC. Participants frequently only sought SRHC at the point at which an ailment affected their livelihood and ability to provide for a family. Taken together, these findings seem to show a range of formidable challenges to sex workers’ understanding of themselves in a human rights discourse. This study’s findings are of particular importance to rethinking the legislation that criminalises sex work, as well as healthcare initiatives geared both towards sex workers and women in general.

Context: The Women’s Health Initiative (WHI) study, published in July 2002, had a significant impact on the prescribing of hormone replacement therapy (HRT). The controversy surrounding the findings, however, has led to much uncertainty regarding the prescription of HRT. Aims and Objectives: The aim of this study is to determine both the initial and the continued impact of the WHI study on the prescribing of HRT in a defined South African population and to determine whether HRT was appropriately individualised based on recommendations published subsequent to the WHI study. Setting: Claims data from a Managed Healthcare Organisation (MHO) that administers for a number of medical aid schemes in South Africa. Method: A retrospective drug utilisation review (DUR) was conducted to identify HRT-related prescribing patterns in the defined populations. The time-frame of the dataset included January 2002, to assess prescribing patterns prior to the publication of the WHI study, January 2003 to determine the initial impact of the WHI study, and January 2005 to assess the continued impact. An extensive, additional dataset of all the HRT users in the defined populations was utilised to conduct a sub-group analysis and determine whether HRT had been appropriately individualised. Key Findings: The percentage of patients in the dataset using HRT decreased from 30.05 percent in January 2002 to 28.30 percent in January 2003 and to 23.24 percent in January 2005, with the latter decrease reaching statistical significance. Although sex hormones and modulators (G03) of the genital system were the most frequently prescribed drug class in all three years of the study period, the prescribing frequency decreased significantly from 10.40 percent in January 2002 to 9.32 percent in January 2003 and 7.44 percent in January 2005. The most noteworthy change in the prescribing of HRT was a 3.95 percent decrease in the prescribing of conjugated equine estrogen (CEE), with a corresponding 2.53 percent increase in the prescribing of estradiol between January 2002 and January 2003. However, less pronounced changes were observed in the prescribing frequencies of other types of HRT, including medroxyprogesterone and estrogen (the HRT type investigated in the estrogen plus progestin phase of the WHI study). Patients initiating HRT post-WHI publication were generally found to be in the younger menopausal age categories (40 to 49 years). These patients were more likely to have been initiated on HRT types other than those investigated in the WHI study and were at a higher risk for disease states for which HRT use is beneficial, such as osteoporosis. Patients discontinuing HRT post-WHI publication were generally found to be in the older menopausal age categories (60 to 69 years), were more likely to have been combined HRT users (although not necessarily the type investigated in the WHI study) and were at a higher risk for disease states for which HRT use is considered harmful or has an uncertain effect, such as diseases affecting the cardiovascular system. Conclusion: It can be concluded that the WHI study did have an impact on the prescribing of HRT in the defined South African population of this study, but that the impact was considerably less than the impact reported in global studies. It was also determined that HRT was appropriately individualised according to recommendations made subsequent to publication of the WHI study.

Two research methods, a correlational survey and a case study method were used to explore the impact of health focused and economic focused women's organizations on community development and health. Through the study the following questions were answered: (i) Is there a difference in the health and development indicators of the households of Elim Care Group Project members, Akanani members and members of the community who do not belong to any of the organizations? (ii) What contribution have these organizations made to individuals' and/or communities' way of life? (iii) What aspects of these organizations' structure and/or function strengthen or weaken the organization? For the correlational survey, quantitative data were collected from three categories of thirty households each that belonged to Care Group members, Akanani members and community members who did not belong to any organization. The analysis of the data showed that both the health focused and economic focused organizations kept their focus even though their functioning tended to overlap. The health focused group had a greater impact on health indicators e.g. number of diarrhoea episodes, respiratory tract infection episodes, nutritional state, while the economic focused group had greater impact on development indicators e.g. housing, income and education. The improvement in the development indicators did not influence the health indicators directly. The qualitative data collected for the case study provided an indepth information about the case studied. The health focused organization demonstrated stability in its management. This was composed of health personnel under the employment of the Department of Health Managing the Care Group was a paid job for them. The organization was established and supported by the community and therefore expressed the community's concerns. The economic focused organization provided opportunities for the rural people to establish money making enterprises. Some of the problems shown in this study in this regard relate to poor managerial and business skills that resulted in the production of products that were not readily marketable in the locality. This caused a lot of anxiety amongst members as earnings were irregular. The differences in the structure and functioning of the groups were analysed. These influenced the effectiveness and continued viability of the organizations. / Thesis (Ph.D.)-University of Natal, Durban, 1996.

Puberty rites are practised in many countries including South Africa. In South Africa the puberty rites have different names and different practices. This study focused on vukhomba among the Manchangana/Vatsonga. Vukhomba is conducted exclusively for girls who have reached menarche. The purpose of this study was to explore the possibility of utilising vukhomba for the improvement of the health status of women. The study design is a qualitative, exploratory, descriptive contextual research study conducted in the Northern region of the Northern Province among Vatsonga\Manchangana in four selected areas. The ethnographic strategy was used to gain access to the vukhomba to view and describe the rite from an emic perspective. The sample included all girls who were initiates during January 1998 and December 1999 in the four selected areas, as well as Vadzabi, varileri, initiated girls, initiated women and vukhomba elders who attended the initaitions. The techniques for data collection included participant observation, semi-structured interviews, focus group discussions, key informant interviews and feedback workshops. The findings indicate that vukhomba is conducted during the school holidays in order to cater for girls who are still attending school. The sexuality education in this rite is mainly about encouraging initiates to maintain their virginity for their future husbands. Vukhomba therefore teaches girls attending the initiation the facts of life. It was however, found that girls often attend the initiation for material gain and respect for elders. The content of sexuality education information given to girls during the rite is inadequate. Initiated women and girls wanted to gain more knowledge about their bodies, their health, menstruation, child bearing and pregnancy, contraceptives and pregnancy. After reviewing the findings of the research an intervention programme was developed and discussed with the initiated women and initiated girls. Vukhomba elders accepted the intervention programme, however, certain topics were not approved e.g. contraception. The intervention programme is expected to form part of the initiation programme in the future. Initiated community members will be trained to facilitate the activities of this programme. / Health Studies / D.Litt. et Phil.

This study investigated the health needs of immigrant women from the African Great Lakes living in South Africa in the province of Gauteng, Tshwane Metropolitan city. It described their challenges and related factors compromising their holistic wellness, and identifies their context specific health needs as a gender group. A qualitative approach was utilised concurrently with participatory action research method. Data collection involved triangulation of instruments. A literature study was conducted to select relevant information usable as basis for this study. Data analysis and interpretation revealed factors that make it difficult for immigrant women from the African Great Lakes region to gain access to health care services in South Africa, identifying their specific women’s health needs. Recommendations proposed that policy makers and implementing professionals rendering women’s health care services should consider utilising a holistic and interdisciplinary approach to meet these basic needs. / Health Studies / M.A. (Public health)

Thesis (MBA)--Stellenbosch University, 2012. / An exploratory, cross-sectional, qualitative survey was conducted to describe the market of lower income mothers who had recently given birth to a child in a state hospital in the Western Cape (WC) region of South Africa. These mothers were viewed by the researcher as potential consumers of low cost maternity plans which would provide for maternity care in Active Birthing Units (ABUs) in the private healthcare sector in South Africa. The motivation behind the research stems from various sources. The currently inequitable healthcare system in South Africa, which has been described as a two tier system in the recent Policy Paper on National Health Insurance (Republic of South Africa, 2011: 4-5), is one such source. Reports of poor maternity care in the South African public healthcare system (Vogel, 2011: E1097-E1098), is another source of motivation behind the research report. It was apparent to the researcher that given the low quality of maternity care in state hospitals, a potential market of healthcare consumers – who would be willing to pay a small premium for what they considered to be a more acceptable level of maternity care in the private healthcare sector – could exist. This view was supported by research conducted by Joan Costa and Jaume Garcia (2003: 587-599) in which the “quality gap” was confirmed as a driving force behind the demand for private health care. This focus on the lower socioeconomic groups as a market for private sector goods and services was found to be well described by Prahalad (2005). The researcher conducted interviews amongst mothers who had delivered a child in a public hospital in the previous two years. A convenience sample of 100 mothers was selected in a shopping mall in the Western Cape (WC). The researcher administered a structured questionnaire during a face-to-face interview with each of the 100 respondents. The respondents were rewarded with a shopping voucher to the value of 50 ZAR, which was both a prerequisite specified by the management of the shopping mall and consistent with rewards offered in similar studies (Francis, Battle-Fisher, Liverpool, Hipple, Mosavel, Soogun, & Nokuthula, 2011). Data collected from the questionnaire included both data on willingness to pay (WTP), as well as demographic data, which provided interesting insights into a relatively under-researched market segment. A statistical analysis of the data collected revealed that 31 respondents (31%) reported a positive WTP for private maternity care. A statistically significant relationship was revealed between respondents’ WTP and the birth experience the respondents had had during their most recent pregnancy, whereby mothers who had described their most recent birth experience as “poor” were significantly more likely to exhibit a positive WTP for private maternity care (p=0.00006). Significant relationships between respondents' WTP for private maternity care and their age and household size were also discovered, whereby younger mothers were more likely to be willing to pay than older mothers (p=0.02) and mothers from smaller households were also significantly more likely to be willing to pay than mothers from larger households (p=0.02). Amongst a sub group of 32 respondents deemed to have potential monthly savings, those with a higher monthly household income were more likely to exhibit positive WTP (p=0.02753) than were those with higher levels of monthly expenditure (p=0.04093). The researcher acknowledged that the limitations of the research included the fact that respondents were selected non-randomly, as a small isolated sample, which made the extrapolation of the results to the larger population of South African mothers impossible. The research did, however, serve to describe the demographic characteristics of a new and relatively under researched target market of mothers from the lower socioeconomic segment of the WC. Data gleaned from this survey will serve to inform further research into this target market, so as to complete a more comprehensive feasibility analysis for the establishment of low cost maternity care packages and ABUs in South Africa.

Puberty rites are practised in many countries including South Africa. In South Africa the puberty rites have different names and different practices. This study focused on vukhomba among the Manchangana/Vatsonga. Vukhomba is conducted exclusively for girls who have reached menarche. The purpose of this study was to explore the possibility of utilising vukhomba for the improvement of the health status of women. The study design is a qualitative, exploratory, descriptive contextual research study conducted in the Northern region of the Northern Province among Vatsonga\Manchangana in four selected areas. The ethnographic strategy was used to gain access to the vukhomba to view and describe the rite from an emic perspective. The sample included all girls who were initiates during January 1998 and December 1999 in the four selected areas, as well as Vadzabi, varileri, initiated girls, initiated women and vukhomba elders who attended the initaitions. The techniques for data collection included participant observation, semi-structured interviews, focus group discussions, key informant interviews and feedback workshops. The findings indicate that vukhomba is conducted during the school holidays in order to cater for girls who are still attending school. The sexuality education in this rite is mainly about encouraging initiates to maintain their virginity for their future husbands. Vukhomba therefore teaches girls attending the initiation the facts of life. It was however, found that girls often attend the initiation for material gain and respect for elders. The content of sexuality education information given to girls during the rite is inadequate. Initiated women and girls wanted to gain more knowledge about their bodies, their health, menstruation, child bearing and pregnancy, contraceptives and pregnancy. After reviewing the findings of the research an intervention programme was developed and discussed with the initiated women and initiated girls. Vukhomba elders accepted the intervention programme, however, certain topics were not approved e.g. contraception. The intervention programme is expected to form part of the initiation programme in the future. Initiated community members will be trained to facilitate the activities of this programme. / Health Studies / D.Litt. et Phil.

This study investigated the health needs of immigrant women from the African Great Lakes living in South Africa in the province of Gauteng, Tshwane Metropolitan city. It described their challenges and related factors compromising their holistic wellness, and identifies their context specific health needs as a gender group. A qualitative approach was utilised concurrently with participatory action research method. Data collection involved triangulation of instruments. A literature study was conducted to select relevant information usable as basis for this study. Data analysis and interpretation revealed factors that make it difficult for immigrant women from the African Great Lakes region to gain access to health care services in South Africa, identifying their specific women’s health needs. Recommendations proposed that policy makers and implementing professionals rendering women’s health care services should consider utilising a holistic and interdisciplinary approach to meet these basic needs. / Health Studies / M.A. (Public health)

The registered midwives are engaged in continuous health education lessons In antenatal visits, discouraging antenatal clients from using hannful traditional and cultural practices in an attempt to preserve pregnancy to tenn. Despite the registered midwives' efforts, the clients continue to use hannful cultural methods, which are life-threatening to both the mother and the foetus In utero. The prenatal clients perceive the registered midwives as not being sensitive to their culture. The results of this study revealed that health education in antenatal clinics should be collaborative: that is, the people who have influence over the clients' pregnancy, like me mother-in-law, the traditional practitioners, cUents and their family members, should be involved by the midwives during the preparation of pregnancy lessons and health education lessons on how to preserve pregnancy to term according to· scientifically proven methods. / Health Studies / M.A. (Health Studies)

This study sought to determine if ANC and PMTCT services are utilized within the first trimester of pregnancy by the women in East Ekurhuleni sub-district. Quantitative descriptive research was conducted on 390 eligible pregnant women and data collection was done using structured questionnaires. The results indicated that women start ANC late despite their knowledge of first trimester as the best time to start ANC. Actions that would motivate them to start ANC early were explored and barriers were identified. / Health Studies / MA (Public Health)