OSSREA Publications

ANALYSIS OF CHANGING
RURAL WOMEN’S REPRODUCTIVE BEHAVIOUR
PATTERNS IN SOUTH AFRICA

Zn Mfono

EXECUTIVE SUMMARY

This report presents a description of the patterns of change in rural women’s reproductive behaviour in South Africa over a period of 17 years extending from 1987–9 to 2004. The analyses were informed by the Programme of Action that was set out at the 1994 International Cairo Conference on Population and Development. The Programme of Action has a 20-year implementation time period, and the year 2004 was halfway through the 20 years. The year 2004 is also 30 years since the introduction of South Africa’s National Family Planning Programme in 1975, which advanced the health rationale for fertility regulation. It is also twenty years after the introduction of the Population Development Programme in 1985, which emphasized the demographic rationale for fertility regulation. It is finally the seventh year after the introduction of the Choice on Termination of Pregnancy Act in 1997, which legalized pregnancy terminations under prescribed conditions, with emphasis on women’s rights to choice.

Guidelines and strategic approaches on provision of reproductive health services that balance women’s rights and health considerations with demographic, developmental and poverty alleviation considerations are provided in the Programme of Action. The ultimate aim is bringing about changes in all societies that contribute to the Millennium Development Goals of poverty alleviation and development.

Secondary data from the 1987–89 and 1998 South African Demographic and Health Surveys was analysed, along with reproductive health service records data for 2004, collected from two rural hospitals in each of the three provinces included in the study.

The focus of this research on black rural women emanates from the fact that they constitute a large proportion of reproductive age women, who, for various reasons, are at the rearguard of the reproductive changes that are afoot nationally.

Five of South Africa’s nine provinces, which have more than 50 per cent of their populations living in tribal areas, were included in the analyses. The focus of the analyses was on the patterns of childbirth, contraception, voluntary surgical sterilizations and pregnancy terminations. The age and marital patterns of childbearing onset and progression, contraception, voluntary surgical sterilizations, pregnancy terminations, as well as changes in number of children born were analysed across the selected provinces. Comparisons with the national trends and between provinces are made. The observed dynamics were also compared with findings of similar analyses done in other African and in Caribbean societies, and finally with those observed in Asian and European societies. Qualitative findings derived from a 2002 study that employed focus group discussions with rural women were used to determine the significance of the changes from the perspective of rural women, as well as the motivations for women’s selective compliance with the various aspects of change.

The findings indicated an upward shift in childbearing ages and a progressive fall in the mean number of births per woman, but both aspects varied according to women’s reported marital status. The median age at onset of childbearing shifted modestly from 19 years in 1987–89 and 1998 to 20 years, with considerable delays in the timing of subsequent childbirths, especially the second childbirth, which had a mean spacing reaching a maximum of seven years in 2004. Child spacing was, however, uneven with the mean years between higher order childbirths progressively narrowing. Provincial variations in ages at childbearing onset were modest.

Lower order births had predominance across the periods considered, and growing proportions of childbearing-age rural women had zero childbirth. The proportions of higher order births reflected a progressive decline during the periods compared. These trends accounted for the decline in the mean number of childbirths per woman during the three time periods compared.

Both contraception and pregnancy terminations during the periods considered had predominant use amongst women in the 20–24 years age cohort. Within their brief history, pregnancy terminations shifted from reflecting neither age nor parity patterns in 1998, to a predominant use by younger age cohorts in 2004. Surgical sterilizations, which appealed to women in their 40s in 1987–89, also changed to a predominance of younger age cohorts during the recent time periods, but the modal parity at which rural women request sterilizations has increased in recent years.
Both contraception and pregnancy terminations appeared to play a significant role in child-spacing than in the postponement of childbearing onset. Surgical sterilizations played a much significant role in limiting the number of childbirths amongst married than amongst single women. Accessibility and use of reproductive health services amongst South African rural women appeared to be good, but sub-provincial variations that require attention appeared to be a problem. The demand for pregnancy terminations was apparently high, and rural women relied heavily on referrals to the health centres that provide this service.

Although the distinction between single and married women is difficult to make because marriage tends to be a long drawn process in the African cultural context, women who identified themselves as currently single reflected an earlier onset of childbirths but a lower number of children ever born than currently married women.  Due to their larger representation in the 1998 and 2004 samples, single women had a stronger pull on the overall directional trends on childbearing. Their large representation in childbearing reflects the high incidence of non-marital childbearing in the subject population, which arises from the high mean marital age, which is estimated at 29–30 years. This high marital age appears to have limited bearing on childbearing onset for many women, but might be the reason behind the narrower spacing of higher order childbirths.

Despite wide criticism of governmental health service provision to rural populations in South Africa in recent years, the findings of this research gave the impression that women’s reproductive health services are accessible enough to provide a variety of choices to rural women of reproductive age. The marginal change in age at onset of childbearing and the apparent decline in contraceptive use between 1998 and 2004 might be indicative of a pervasive normative age of onset of childbearing. The question of the impact of children’s grants on childbearing onset within the rural poverty context is debatable. If the grants provide an incentive to childbearing onset, one has to contend with the fact that they appear to lose their incentive edge after the first birth. Both child spacing and termination of childbearing, when considered appropriate, appear to be within reach for rural women. The downward shift in the normative age for voluntary sterilizations might be indicative of a growing acceptance of sterilization amongst rural women that increasingly frees them from childbearing obligations to meaningful participation in various personal and community developmental initiatives. However, the normative parity for requesting sterilization appears to be rising.
Overall, the reproductive behavioural patterns of rural black women are largely set on the same course as those for their urban counterparts. There are, however, some regional lags, particularly in the former rural Transkei districts of the Eastern Cape Province that have to be addressed. Another challenge is the demand for pregnancy terminations, which presently depends heavily on referrals to a few hospitals that provide the service. This causes delays which in turn result in women requesting the service exceeding the legally prescribed durations for pregnancy terminations.  
The fertility transition that is taking place in rural South Africa, while similar to the postulated African transition in some respects, differs from the latter largely in that the high incidence of non-marital childbearing introduces an accelerative momentum to the transition phenomenon. Both the marital ages and ages at onset of childbearing are also much lower in the societies that were used in the analysis that generated the postulated African transition thesis. Marital prevalence is also high in the polygamous contexts that were considered as basis for the thesis. The South African rural fertility transition context is, however, characterized by considerable postponement of childbearing onset, even more pervasive child spacing and a growing limiting of use of childbearing through surgical sterilization. There is substantial and apparently conscious regulation of childbearing.

The high incidence of non-marital childbearing amongst South African black women has its parallel in both Botswana and Latin American and Caribbean societies, where its dynamics were subjected to more intensive analyses. The backgrounds of the Asian and European women’s reproductive change patterns provide tenuous comparative scenarios because of the cultural distance of childbearing norms.

Focus group discussions conducted with women of different age cohorts indicated that normative patterns of reproductive behaviour have developed, which integrate reproductive health technology into the reproductive traditions. The emerging reproductive patterns are distinctive, and reflect women’s optimal choices, taking into account their perceived economic, health, beauty, social and other realities.

From a policy perspective, the role of men as reproductive partners—an issue that came up strongly in the 1994 Programme of Action—still warrants strategic interventions to place men and women on an equal footing on this important aspect of change in their societies. Adolescent disruption of schooling because of pregnancies, despite accessible family planning services, remains a problem. The decline in childbearing amongst South African rural women requires alternative life options for women, whose time only a few years ago was absorbed by producing and nurturing children. Rural women need alternative developmental challenges that can provide new meaning to their lives and benefit their societies.