Gender and Health Research Unit

Research highlights

National female homicide study
A national study of the epidemiology of femicide by intimate and non-intimate partners has been undertaken in collaboration with Dr Lorna Martin of the Department of Forensic Medicine of the University of Cape Town (who is a consultant to the Gender & Health Unit) and Lisa Vetten of the Centre for Violence and Reconciliation.

Data was collected on cases that were presented to mortuaries in the year 1999. Interviews were conducted with the relevant investigating officer in order to categorise each case as either intimate or non-intimate femicide.

The study found that in 50.3% of these cases the women were killed by an intimate partner. In the South African population this amounts to a rate of 8,8 out of every 100 000 women, aged 14 years and older, that were killed by an intimate partner in 1999. This is the highest rate that has ever been reported in research in the world.

The findings can be accessed from the policy brief: "Every six hours a woman is killed by her intimate partner": A National Study of Female Homicide in South Africa (June 2004) (pdf format 333 kb)

Associations between gender-based violence and HIV
Rachel Jewkes and Kristin Dunkle have been undertaking research on associations between gender-based violence and HIV infection. That there are such associations is much discussed in advocacy, research and policy circles but there has been very little research directly exploring the associations. Work from South Africa on violence and proximal preventive practices has suggested that gender inequity is more important than intimate partner violence.

The study was undertaken in four Soweto antenatal clinics amongst first time attenders aged 16 or over who had agreed to voluntory counselling and testing, but had not yet received their HIV results and had not been previously tested. Women who were eligible were systematically approached by interviewers. A standard questionnaire was used and 1 395 women were interviewed with a response rate of 95%. The questionnaire asked about intimate partner violence (IPV), child sexual abuse and sexual assault by non-partners as well as a range of factors which could have mediated or confounded the relationship. The HIV results were then collected.

Key findings included a prevalence of past year physical or sexual IPV of 30%; very strong associations between child sexual abuse and adult risk of intimate partner violence; 20% had engaged in transactional sex and this was strongly associated with experiences of IPV and HIV; broader and more frequent IPV and more controlling relationships were associated with an increased risk of HIV infection.

One of the aims of this study was to develop screening guidelines for primary health care or antenatal settings that can be used to identify abused women. Whilst such guidelines were developed from the research, the usefulness of doing this was drawn into question by the observation that, although 30% of women were in currently or recently abusive relationships, an undetectably small number of these made use of a referral facility (to an NGO) which was offered to them as part of the study. The value of such screening clearly requires further research.

Report: Gender-Based Violence and HIV Infection among Pregnant Women in Soweto (pdf format, 168 kb)

An ethnography of sexual health & violence among township youth in South Africa
This work, undertaken as Kate Wood's PhD, was based on 18 months of field work in Ngangelizwe township, Umtata where Kate worked as an ethnographer.

This research focuses on HIV/AIDS and physical and sexual violence within youth sexual relationships. It describes the contexts in which beatings arise, and examines how violent practices produce and sustain a gender hierarchy. These practices are reinforced by notions of control over, as well as discipline and ownership of, female partners.

The study also explores sexual coercion among township youth and analyses the processes by which the (il-)legitimacy and thus classification of particular coercive practices are asserted and contested by young men and women.

HIV/AIDS in this community was examined through an extended case study of an afflicted family and a discussion of young people's interpretations of sexual risk. One of the important conclusions was that levels of denial of HIV in this community were much lower than would appear if the public presentation of cause of youth death is taken at face value.

Sexual assault services
In 2001-2003 SAGBVHI (The South African Gender-based Violence and Health Initiative) conducted a situation analysis of sexual assault services nationally. The aims of the study were to describe how sexual assault services are currently delivered in the public health sector and to explore factors that are associated with a higher quality of care.

Standardized interviews were conducted with 124 nurses and doctors in a stratified sample of hospitals (n = 31) as well as 31 nurses in primary health care clinics nationally. Service providers were interviewed using a standardised questionnaire that consisted of open- and closed-ended questions. The questionnaire contained five sections: demographic characteristics of providers; rape service provision; availability of protocols; rape training undergone; and the knowledge and attitudes of staff.

Since rape case records were not comparable between provinces (in some facilities record-keeping was done systematically while in other facilities it was chaotic and not accessible) we relied on self-reported management of rape patients. A facility checklist was made at the sampled health facilities, which detailed the presence or absence of equipment and drugs as well as structural issues such as the availability of private examination rooms. Analysis of data will include bivariate analysis (Chi2) and a logistic regression model, exploring factors associated with higher quality of care.

See report for details: The state of sexual assault services: Findings from a situation analysis of services in South Africa (pdf format, 220 kb)

Impact on South Africa's abortion policy
Data collected in 1994 on incomplete abortion in South Africa and back street abortion has been presented twice to Parliament during its deliberations over changes to abortion legislation.

This inforrmation was drawn on heavily in the Parliamentary report on legislative changes. In this way, this research contributed to the passing of legislation allowing for abortion on demand up to 12 weeks into pregnancy and abortion up to 20 weeks in a range of circumstances, including socio-economic difficulties. This is now one of the most liberal laws in the world.

Clinical research on the use of 600 micrograms of misoprostol (per vagina) for cervical ripening two hours prior to termination of pregnancy using manual vacuum aspiration under local anaesthesia performed by nurses demonstrated that this resulted in a significantly shorter procedure than placebo and significantly less procedure failure.

Research to evaluate the 1997 Act has demonstrated that the proportion of women presenting to hospitals with severe complications of incomplete abortions has significantly reduced, as has the proportion with definite signs of induction of the abortion. There has been a change towards use of lower technology in incomplete abortion management. However, half of South African women still do not know of the legislative change and many of those who do have insufficient knowledge to be able to access a legal termination of pregnancy.

Sexual harassment and sexual coercion in schools
In January 2001 the Lancet published Rachel Jewkes' paper from the 1998 SA Demographic and Health Survey which found that 33% of rapes of children under the age of 15 were by school teachers.

There was a tremendous amount of local and international media attention given to this issue, despite the fact that the findings had been released in South Africa previously and already had been made known to the Department of Education.

The impact of the publication of the paper in the Lancet was very extensive: Martin Prew, Director of Governance and Safety in the National Department of Education, recently reported that the work priorities of his directorate were completely reorientated for a year afterwards. A new Director of Gender Equity in schools has also been established in the National Department of Education as a result of this work.