Gender and Health Research Unit

Current projects

Developing an understanding of Intimate Femicide in South Africa
The results from the National Female Homicide alerted us to the magnitude of intimate femicide (a women killed by an intimate partner) in the country. However, not much is known about why men kill their partners and under which circumstances such killings occur. The aim of this project is to develop an understanding of the context of intimate femicide through the use of qualitative methods. The project is firstly exploring the perceptions and ideas of perpetrators of such crimes. Interviews are being conducted with perpetrators who have been found guilty and currently in a correctional facility. The project aims to also go beyond the victim-perpetrator dyad by exploring ideas held by others in their social network, thereby exploring the social context of both victim and perpetrator which may help our understanding of the vulnerability. Data is currently being analysed. E-mail: shanaaz.mathews@mrc.ac.za

Stigma of HIV and sexual violence
The overall aim of this study is to explore the role of stigma among two groups of participants: those who experienced a sexual assault and those who are HIV positive. We wish to understand the social experiences of these two groups, how they view themselves after a sexual assault and a HIV diagnosis, to gain an understanding of the contribution of stigma and other influences on changes in self-concept, and how this changes over time. The study will also explore individual’s pathways to seeking healthcare after a sexual assault, and a HIV diagnosis. This qualitative study is being done at two sites i.e. Cape Town and Mthatha. E-mail: naeemah.abrahams@mrc.ac.za

Intervention study to improve PEP adherence following a sexual assault
The aim of this study is to test and evaluate an intervention to improve post exposure prophylaxis (PEP) adherence after a sexual assault to prevent HIV transmission. Previous studies done by the Unit and other researchers have shown the poor level of adherence to the PEP treatment. An intervention was developed to improve compliance to PEP after a sexual assault. This was based on research conducted with women that attended sexual assault services. The intervention developed will use a combination of information and support through follow-up telephonic contact during the 28 day period. The support will be provided by trained nurses/counselors to motivate and facilitate the taking of PEP medication. The study will be conducted at two sites: Cape Town and Mthatha. E-mail: naeemah.abrahams@mrc.ac.za

Curriculum development and training manuals for sexual assault care practitioners in South Africa
The Gender and Health Research Unit have embarked on an initiative to provide technical support to the Department of Health’s Directorate of Mother, Child and Women’s Health (MCWH) in order to improve sexual assault services within South Africa. This initiative aims to develop a national curriculum and training manual for sexual assault care practitioners in South Africa and provide support for its implementation in all provinces. The proposed training curriculum will be piloted in four provinces before being finalised. The pilot will be evaluated to determine the impact of the training on clinical skills, service provision and patient outcomes. The project will be completed by mid-2008. E-mail: ruxana.jina@mrc.ac.za

Tracking justice
This study aims to describe the circumstances in which rape occurs in Gauteng Province and the factors that influence attrition of rape cases through the criminal justice system. Data has been collected from a randomly selected sample of all rape cases reported to the police in the province during 2003 and from the files of cases that went to court. Data collection is being completed and data entered, and findings are expected to be released towards the end of 2007. This research is being led by the Tshwaranang Legal Advocacy Centre and Centre for the Study of Violence & Reconciliation. E-mail: Lizle.loots@mrc.ac.za

Project publications

• Jewkes RK, Christofides N, Vetten L, Jina R, Fuller R, Loots L Medico-legal findings, case progression and legal outcomes in South African rape cases: a cross-sectional study. The Lancet (currently under review)
• Vetten L,  Jewkes R, Fuller R, Christofides N, Loots L, Dunseith O. (2008) Tracking Justice: The Attrition of Rape Cases Through the Criminal Justice System in Gauteng. Tshwaranang Legal Advocacy Centre. Johannesburg (pdf format, 659 kb).

Study of rape perpetration and its intersections with HIV
This study is being undertaken in collaboration with the School of Education Studies at the University of KwaZulu Natal (Robert Morrell) and Emory University (Kristin Dunkle). The aim of the study is to describe the epidemiology of rape perpetration; factors associated with raping; to describe the associations between rape and HIV sero-status and risk behaviours. In 2008 we implemented the data collection for the study, working in 222 census enumeration areas in three districts in the Eastern Cape and KwaZulu Natal (OR Tambo, Ugu and Ethekwini), where we sought to interview 4440 households. Informants were men aged 18-49. This survey includes a range of questions on aspects of men’s backgrounds, particularly their experiences in childhood, other violent and criminal practices and other aspects of men’s behaviour, such as caring and child rearing practices. Our questionnaire is being shared with collaborators in Brazil, Mexico, Chile and India who have funding for a multi-country study that will replicate large areas of our data collection which will enable us to have access to a multi-country data set for comparative analysis of data on men and masculinities. yandisa.sikweyiya@mrc.ac.za

A new report from the MRC’s Gender and Health Research Unit tries to understand the prevalence of rape perpetration in a random sample community-based adult men as well as understanding factors associated with rape perpetration, and to describe intersections between rape, physical intimate partner violence and HIV. Read (pdf, 30kb) the executive summary of the report.

Men and Gender Equality Policy Project
This is a three year project led by Promundo in Brazil which aims to analyse public policies relating to gender equality and men/boys; to undertake qualitative research on men who adopt non-traditional care giving roles in order to map and understand what influences these; and to develop an international men and gender equality survey. The Gender & Health Research Unit is the South African partner for this initiative with Prof Robert Morrell of the University of KwaZulu Natal. The initiative spans across South Africa, Brazil, Mexico, Chile, UK and India. E-mail: rjewkes@mrc.ac.za

Safe Dates adaptation for South Africa and testing
This three-year project is led by the University of Cape Town, Department of Child and Adolescent Psychiatry (Alan Flisher), Pacific Institute for Research and Evaluation (PIRE), University of Kentucky (Rick Zimmermann/ Pam Cupp). The Unit is collaborating with them, as is Cathy Mathews (MRC, Health Systems). The project is funded by the NIMH. The aim of the project is to develop and pilot/test an intervention to reduce dating violence for use in schools (aimed at Grade 8). The intervention being developed has been inspired by Safe Dates, which was shown to be promising in reducing date violence in North Carolina. The South African intervention is a substantial deviation from the original intervention. In 2008 the questionnaire for the evaluation was developed; the shape of the new intervention was agreed and drafting has commenced. rjewkes@mrc.ac.za

 A RCT evaluation of a brief woman-focused behaviour change intervention that aims to increase knowledge and skills to reduce substance abuse, sexual risk and victimization in VCT settings
The aim of the study is to use a RCT to test the effectiveness of combining voluntary counselling and testing (VCT) with a woman-focused intervention in helping women reduce their substance abuse, sexual risk, and victimization compared to two control groups ( a VCT only group and an equal-attention (nutrition) group) at 3-, 6-, 9-, and 12-month follow-ups. The study is being led by Research Triangle Institute (RTI) (Wendee Wechsberg) and the Alcohol and Drug Research Unit of the MRC (Charles Parry). The Unit is collaborating. It is funded from the NIAAA in the USA via a R01 mechanism.

List of completed projects

Evaluation of Stepping Stones: a gender transformative HIV prevention intervention
Stepping Stones is a gender transformative HIV prevention behaviour intervention (see training tools page). The Unit has been evaluating the intervention since 2002 among youth in the rural Eastern Cape. It is a cluster randomised controlled trial to determine its impact on HIV and HSV2 incidence, and sexual and violent behaviours. The research also included qualitative research. Data collection has been completed and the main findings have been presented for publication. Data analysis for a range of papers that will deepen our understanding of gender and sexual behaviour is ongoing. Partners in the research were Dr Adrian Puren of NICD, Dr Kristin Dunkle of Emory University, Dr Nata Duvvury of ICRW, Prof Mary Koss  of University of Arizona and Dr Kate Wood of the Institute of Education. E-mail: rjewkes@mrc.ac.za

Project Publications

• Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Khuzwayo N, Koss M, Puren A, Wood K, Duvvury N.  A cluster randomised controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Tropical Medicine and International Health 2006; 11:3-16.
• Jewkes R, Dunkle K, Koss MP, Levin J, Nduna M, Jama N, Sikweyiya Y. Rape perpetration by young, rural South African men: prevalence, patterns and risk factors. Social Science and Medicine. 2006; 63: 2949-61
• Dunkle K, Jewkes R Nduna M, Levin J, Jama N, Khuzwayo N, Koss MP, Duvvury N Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape AIDS 2006; 20: 2017-14.
• Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, Koss M, Puren A, Duvvury N. Factors associated with HIV sero-positivity in young, rural South African men, International Journal of Epidemiology 2006; 35: 1455-1460.
• Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, Koss M, Puren A, Duvvury N, Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV International Journal of Epidemiology 2006; 35: 1461-8.
• Dunkle KL, Jewkes RK, Nduna M, Jama N, Levin JB, Sikweyiya Y, Koss MP. Transactional sex and economic exchange with partners among young South African men in the rural Eastern Cape: prevalence, predictors and associations with gender-based violence. Social Science and Medicine (in press),
• Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, Duvvury N (2008) Impact of Stepping Stones on HIV, HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial British Medical Journal 337:a506

Policy brief

• Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Wood K, Koss M, Puren A, Duvvury N.  Evaluation of Stepping Stones: A gender transformative HIV prevention intervention (March 2007)

Fact sheet

• Jewkes R, Jama N, Nduna M, Levin J, Dunkle K, Khuzwayo N, Duvvury N, Koss M. Stepping Stones Study: Fact sheet on young people’s health and sexual practices in villages and townships of the rural Eastern Cape. Medical Research Council, Pretoria. 2005. (PDF link)

National female homicide study
This is a retrospective study of the homicides of women aged 14 and over in South Africa in 1999, which involved data collection from mortuary death registers which were followed up via their police case numbers. The main study finding was that, in South Africa a woman is killed every 6 hours by an intimate partner, which received extensive media attention and has also been used extensively in all advocacy campaigns to raise awareness among policy makers and communities. The study finding on the use of guns in these murders has also been used in the process of developing the new Firearms Control Act in South Africa. Partners in this research were Prof Lorna Martin of the UCT Forensic Pathology Unit and Lisa Vetten from The Centre for the Study of Violence and Reconciliation (CSVR). Publications from the study findings have been presented for publication. E-mail: naeemah.abrahams@mrc.ac.za

Project Publications

• Abrahams N, Martin LJ, Jewkes R, Mathews S, Vetten L,  Lombard C (2008) The epidemiology and the pathology of rape homicide in South Africa. Forensic Science International 178,132-138
• Mathews S, Abrahams N, Jewkes R, Martin LJ, Lombard C, Vetten L,  (2008) Intimate femicide-suicide in South Africa. Bulletin of the World Health Organisation 86:542-58.
• Mathews S, Abrahams N, Jewkes R, Martin LJ, Lombard C Alcohol use and its role in female homicides in the Western Cape, South Africa. Journal of Studies on Alcohol and Drugs (in press)
• Mathews S, Abrahams N, Jewkes R, Martin L, Vetten L, Lombard C. Injury patterns of female homicide victims in South Africa. J Trauma (in press)
• Abrahams N, Jewkes R, Martin LJ, Mathews S, Lombard C, Vetten L Mortality of women from intimate partner violence in South Africa: a national epidemiological study. Journal of Violence and  Victims (in press)

Policy Brief

• Mathews S, Abrahams N, Martin LJ, Vetten L van der Merwe L & Jewkes R.  "Every six hours a woman is killed by her intimate partner": A National Study of Female homicide in South Africa (June 2004)

Associations between gender-based violence and HIV
Rachel Jewkes and Kristin Dunkle worked together on this research on associations between gender-based violence and HIV infection. The study was undertaken in four Soweto antenatal clinics amongst first time attendees aged 16 or over who had agreed to VCT but had not yet received their HIV results and who had not been previously tested. Women who were eligible were systematically approached by interviewers. A standard questionnaire was used and 1395 women were interviewed with a response rate of 95%. The questionnaire asked questions about intimate partner violence (IPV), child sexual abuse, sexual assault by non-partners as well as a range of factors which could have mediated or confounded the relationship. The HIV results were collected. The data has been analysed by Kristin Dunkle for her PhD. e-mail: rjewkes@mrc.ac.za

Project Publications

• Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. (2004) Gender-Based Violence, Relationship Power and Risk of Prevalent HIV Infection among Women Attending Antenatal Clinics in Soweto, South Africa. The Lancet 363: 1415-1421.
• Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntyre JA, Harlow SD. (2004) Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection.  Social Science & Medicine 59, 1581-1592.
• Dunkle KL, Jewkes RK, Brown HC, et al. 2004 Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa. American Journal of Epidemiology  160, 230-9.
• K Dunkle, R Jewkes, H Brown, J McIntyre, G Gray, S Harlow. Gender-Based Violence and HIV Infection among Pregnant Women in Soweto. A Technical Report to the Australian Agency for International Development. Medical Research Council, Pretoria, 2003.

National situation analysis of sexual assault services
This project aimed to describe the facilities in a randomly-selected national sample of South African hospitals and facilities which provided sexual assault care to determine the factors associated with providing higher quality care. The study was a project of the South African Gender-based Violence and Health Initiative (SAGBVHI). E-mail: nicola.chris@mrc.ac.za

Project Publications

• Christofides N, Muirhead D, Jewkes R, Penn-Kekana L, Conco ND Patient experiences of post-sexual assault services and their preferences for how services should be delivered in South Africa.  British Medical Journal 2006; 332(7535):209-23.
• How to Conduct a Situation Analysis of Health Services for Sexual Violence Survivors: The guide can be downloaded from: http://www.svri.org/analysis.htm
  Christofides N, Webster N, Jewkes R, Penn-Kekana L, Martin L, Abrahams N, Kim J. The state of sexual assault services: findings from a situation analysis of services in South Africa. Technical report published by the South African Gender-based Violence & Health Initiative. Medical Research Council, Pretoria.2004

Safety in school toilets
This study was undertaken in collaboration with the CSIR to develop a methodology for exploring sexual abuse of school-going girls, the risks associated with use of school toilets, and school-based strategies for reducing risks. Rapid participatory research methods were used in three schools. Focus group discussions and visualisation techniques (mapping and photography) were used. The key findings are as follows: toilets varied greatly between schools, with some being sites with a risk of sexual violence; stopping smoking in toilets was at times prioritised over basic access and safety; many cases of sexual harassment by teachers were reported in the schools. Strategies for supporting and protecting girls who reported male educators, as well as strategies for raising such cases with the Department of Education, were developed. The research team is involved in redesigning one of the school toilets and a follow-up project is planned in the Johannesburg area to ensure that future architectural designs of schools and public toilets are done from a gendered perspective. E-mail: naeemah.abrahams@mrc.ac.za

Project publications

• Abrahams N, Mathews S, Ramela P. Intersections of ‘sanitation, sexual coercion and girls’ safety in schools’. Tropical Medicine and International Health 2006; 11(5): 751-756.

An ethnography of sexual health & violence among township youth in South Africa
This work was undertaken as Kate Wood's PhD. It was based on eighteen months of field work in Ngangelizwe Township, Umtata, where Kate worked as an ethnographer. The thesis focuses on HIV/AIDS and physical and sexual violence within youth sexual relationships. The work describes patterns of youth sexual relationships: giving an account of multiple partnering, patterns of early sexual experiences, the mediation of relationships by money (or its lack), and the gendering of sexual reputations. E-mail: k.wood@ioe.ac.uk

Project publication

• Wood K (2005). Contexualising group rape in post apartheid South Africa. Culture Health and Sexuality. 2005; 7(4): 303-317
• Wood K, Lambert H, Jewkes R  ‘Showing roughness in a beautiful way’: talk about love,  coercion and rape in South African youth culture. Medical Anthropology Quarterly 2007; 21(3): 277-300
• Wood K, Lambert H, Jewkes R, ‘Injuries are beyond love’: young South Africans’ understandings of limit and legitimacy in relation to physical violence in their sexual relationships. Medical Anthropology (in press) 2008; 27(1):

The study of the prevalence of emotional, physical and sexual abuse of women in three South African provinces
The Three Province study was the first large-scale violence against women community-based study in South Africa. It had a more specific objective than the SADHS: to describe the epidemiology of violence against women in specific areas and to further validate the findings of the national survey (SADHS). A similar sampling frame as the SADHS was used to allow for comparison and 1 306 women aged 18-49 years in Mpumalanga, Eastern Cape and Northern Province were interviewed. The first South African Demographic and Health Survey (SADHS) were conducted in 1998 and included questions on violence against women. E-mail: rjewkes@mrc.ac.za

Project publications

• Jewkes R, Penn-Kekana L, Levin J. Risk factors for domestic violence: findings from a South African cross-sectional study. Social Science and Medicine 2002; 55, 1603-1618
• Jewkes R, Penn-Kekana L, Levin J, Ratsaka M, Schrieber M. Prevalence of emotional, physical and sexual abuse of women in three South African Provinces. South African Medical Journal 2001; 91(5):421-428
• Jewkes R, Abrahams N The epidemiology of rape and sexual coercion in South Africa: an overview. Social Science & Medicine 2002; 55:153-166.
• Jewkes R, Levin J, Penn-Kekana L. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Social Science & Medicine. 2003, 56(1), 125-34

Men's use of violence against intimate partners: a study of working men in Cape Town
Interviews were conducted with a random sample of 1 400 men employed by three municipalities in the Cape Town area. All were administered a standard questionnaire on their use of physical and sexual violence against their intimate partners of the previous ten years. The data has been further analysed to explore adult violent behaviours associated with having witnessed domestic violence against their mother in childhood. Key findings: 15% of the men reported sexual violence and 42.3% reported physical violence against a partner. Men who were sexually violent were more likely to have other partners, making them multiple sources of risk for their partners. Use of violence against intimate partners was associated with having witnessed it at home in childhood, as was involvement in crime and the use of violence at work and in the community. E-mail: naeemah.abrahams@mrc.ac.za

 Publications

• N Abrahams, R. Jewkes, M. Hoffman, R. Laubscher (2004) Sexual violence against intimate partners in Cape Town: prevalence and risk factors reported by men. Bulletin of the World Health Organisation 82: 330-337.
• Abrahams N, Jewkes R. What is the impact of witnessing mother abuse during childhood on South African men’s violence as adults? American Journal of Public Health 2005;95:1811-1816.
• Abrahams N, Jewkes R, Laubscher R, Hoffman M. (2006) Intimate partner violence: prevalence and risk factors for men in Cape Town, South Africa. Violence and Victims  21(2),247-264.

Integrating gender-based violence into health care in primary care and VCT
The Unit has been working on addressing gender-based violence in health services since 1998. The initial work led to the development of materials for training in primary health care. The programme was called Vezimfihlo and lasted for three days. It was developed by Tanya Jacobs and Rachel Jewkes with Shereen Usdin of Soul City and tested with nurses in the Western and Eastern Cape in 2000. Subsequently the materials were adapted for use in VCT settings and a two day training programme for VCT counselors is available from the Unit. This has been piloted in the Esselen Street Clinic and was developed by Rachel Jewkes with Nicola Christofides, Claire Mooideen and Rowena Ngubeni. E-mail: rjewkes@mrc.ac.za

Publications

• Jewkes R, Christofides N, Mooideen C, Ngubeni R (2007) Vezimfihlo. A training manual for addressing gender-based violence in VCT. Medical Research Council, Pretoria.
• Jacobs T, Jewkes R (2001) Health sector response to gender violence: a model for the development, implementation and evaluation of training for health care workers. Gender & Health Group Report. Medical Research Council, Pretoria.
• Jacobs T, Jewkes R Vezimfihlo: a model for health sector response to gender violence in South Africa. International Journal of Obstetrics and Gynaecology 2002; Sep;78 Suppl 1:S51-6.

Monitoring the impact of Domestic Violence legislation
Naeema Abrahams collaborated with Shanaaz Mathews when she worked for the Gender Advocacy Project in Cape Town on an evaluation of the impact of the Domestic Violence Act on the lives of women. The Act, no.116 of 1998, was implemented in December 1999. The study collected data from magistrate court records of applications for protection orders and undertook in-depth interviews with 25 women six weeks after they had applied for the protection orders. A total of 1 172 cases were randomly selected from two courts from their case roll for 1999 and 2000. The study found that the 40% increase in protection orders after the new legislation was enacted could be accounted for by those taken against non-intimate partners or by men against women. The study concluded that there was little evidence to support a positive benefit for women from the new legislation because the process was not adequately resourced. E-mail: shanaaz.mathews@mrc.ac.za

Publication

• Mathews S, Abrahams N. (2001). Combining stories and numbers. An Analysis of the Impact of the Domestic Violence Act (No.116 of 1998) on Women. Gender Advocacy Programme & Medical Research Council.

Research on infertility
Naeema Abrahams has been working for several years with the Department of Obstetrics and Gynaecology of the University of Cape Town on aspects of infertility. Her work has included research into women's perceptions, knowledge and experiences of infertility and infertility care as well as the cultural and social barriers to help-seeking. Since 2001 the study has explored psychological distress related to infertility. Key findings of the research have been the perceived need of couples to know more about the cause of their infertility and treatment options before starting treatment. This has led to the development and pilot testing of a service to provide initial infertility management in primary health care by an infertility-trained nurse. The study has highlighted the problems experienced by both services and clients, which result from a lack of management guidelines for infertility at a primary health care level. E-mail: naeemah.abrahams@mrc.ac.za

Publications

• Dyer SJ, Abrahams N, Mokoena NE, Lombard C  & van der Spuy ZM. Psychological distress among women suffering from couple infertility in South Africa – a quantitative assessment. Human Reproduction. 2005 20(7) (pp. 1938-43)
• Dyer SJ, Abrahams N, Mokoena NE & van der Spuy ZM.’You are a man because you have children’: Experiences, reproductive health knowledge and treatment-seeking behaviour among men suffering from couple infertility. Human Reproduction 2004. 19 (4) (pp960 -67).
• Dyer SJ, Abrahams N, Hoffman M, van der Spuy ZM. (2002). Men leave me as I cannot have children: Women’s experiences with involuntary childlessness. Human Reproduction. 17(6):1663‑8.
• Dyer SJ, Abrahams N, Hoffman M, van der Spuy ZM. (2002). Infertility in South Africa. Women’s Reproductive health knowledge and treatment-seeking

Associations between child sexual abuse and HIV in South Africa and Namibia
This had three parts: a desk review of Southern Africa literature on child sexual abuse, a study of the social context of child sexual abuse in a district in Mpumalanga and a similar study in Windhoek, Namibia. The primary research was ethnographic with interviews conducted at each site with children, people from the community and a range of key informants. The aim was to gain an understanding of the nature of child sexual abuse at each site, how local people explained its causation, rules governing adult-child relationships, perceptions of victims and perpetrators of child sexual abuse, awareness of and ideas about child sexual abuse prevention, barriers to reporting cases and problems experienced by service providers. E-mail: rjewkes@mrc.ac.za

Publications

• Jewkes R, Penn-Kekana L, Rose-Junius H (2005) “If they rape me, I can’t blame them”: reflections on the social context of child sexual abuse in South Africa and Namibia. Social Science and Medicine 61, 1809-1820.
• Jewkes R, Penn-Kekana L, Rose-Junius H, Malala J (2004) Child sexual abuse and HIV:Study of links in South Africa & Namibia. Medical Research Council, Pretoria.
• Jewkes R, Rose-Junius H, Penn-Kekana L (2007) “In my culture children have no status and if you are a girl child you have even less status”: Reflections on gender in the  social context of child rape in Namibia. In: LaFont S, Hubbard D. (eds) Unraveling taboos: Gender & sexuality in Namibia. Legal Assistance Centre, Windhoek.
• Jewkes R (2004) Child sexual abuse and HIV infection. In: Richter L, Dawes A & Higson-Smith C (eds) The sexual abuse of young children in Southern Africa. HSRC, Cape Town.  p.130-142.

Evaluation of the 1997 Choice in Termination of Pregnancy Act
In 1999 the National Department of Health commissioned the researchers who had undertaken the 1994 National Abortion Study to repeat the study so that the impact of the new legislation could be evaluated. The research was undertaken in 2000 and completed in 2002. It had three arms: a study of the national epidemiology of incomplete abortion in 2000; a situational analysis of services for termination of pregnancy nationally in 1999 and a study of why women are still aborting outside designated services in areas where these services are available. The preliminary findings were presented to the oversight hearings of the Parliamentary Portfolio Committee on Health on the Choice in Termination of Pregnancy Act in June 2000. This research was undertaken with the Reproductive Health Research Unit of the University of the Witwatersrand. E-mail: rjewkes@mrc.ac.za

Publications

• Jewkes R, Rees H, Dickson K, Brown H, Levin J The impact of age on the epidemiology of incomplete abortions in South Africa after legislative  change. BJOG. 2005 Mar;112(3):355-9.
• Jewkes R , Rees H Dramatic decline in abortion mortality due to the Choice in termination of Pregnancy Act. South African Medical Journal 2005; 95: 250.
• Jewkes R, Gumede T, Westaway M, Levin J, Dickson-Tetteh K,  Brown H, Rees H (2005) Why are women still aborting outside designated facilities in metropolitan South Africa? British Journal of Obstetrics & Gynaecology 112, 1236-42.
• Jewkes R, Brown H, Dickson-Tetteh K,  Levin J, Rees H.Prevalence of morbidity associated with abortion before and after legislation in South Africa. British Medical Journal 2002; 324:1252-3.
• Brown H, Jewkes R, Dickson Tetteh K, Levin J, Rees H. Management of incomplete abortion in South African public hospitals. British Journal of Obstetrics and Gynaecology 2003; 110: 371-7.
• Dickson Tetteh K, Jewkes R, Brown H, Levin J, Rees H, Mavuya L (2003) Implementation of South Africa’s 1996 Choice on Termination of Pregnancy Act: service provision after three years. Studies in Family Planning 34(4), 277-284

Study of what women want from health services after rape and the cost effectiveness of PEP
This project was designed to provide information to inform the health service response to rape. The overall study was divided into three complementary components. First, we developed and conducted a discrete choice exercise aimed to quantify women’s preferences regarding key aspects of post- sexual assault health service delivery. This was informed by qualitative research carried out in five provinces. The second component of the project was the costing of two sites, one rural and one urban, that routinely provide post--rape care. This data was then used to estimate the scale-up costs of providing post--rape services in accordance with the Department of Health’s sexual assault policy. The third component of the study was modelling the cost effectiveness of providing post-exposure prophylaxis to prevent the transmission of HIV after rape. Project partners were Arum Health Care and the Centre for Health Policy of the University of Witwatersrand. E-mail: nicola.chris@mrc.ac.za

Publications

• Christofides N, Muirhead D, Jewkes R, Penn-Kekana L, Conco ND Patient experiences of post-sexual assault services and their preferences for how services should be delivered in South Africa.  British Medical Journal 2006; 332(7535):209-23.
• Christofides N, Muirhead D, Jewkes R, Penn-Kekana L, Conco N Including post--exposure prophylaxis to prevent HIV/AIDS into post- sexual assault health services in South Africa: costs and cost effectiveness of user preferred approaches to provision. Medical Research Council, Pretoria 2006.