Stratified and violent: Young women’s experiences of access to reproductive health in southern Africa

Healthcare systems in many southern African countries have historically failed to meet public demands, leading to a system stratified along class, gender and racial lines. The poor, often bearing the brunt of mass unemployment, not only rely on a failing system, but resort to parallel systems. Building on theoretical and political standpoints that emerge as feminist scholars interrogate and engage with the body, this chapter explores notions of reproductive violence and stratified access to reproductive health. It argues that southern African countries domesticate international policies governing reproductive health in a way that perpetuates reproductive violence, defined here as the institutional or structural, physical, and emotional violence that women suffer in attempting to access pregnancy termination services. Through domestication, the international policies emerge as ‘soft law’, not binding on governments. The way poor migrant and South African women are lured by illegal adverts to put themselves at risk of maternal death or longstanding reproductive health complications – in a country celebrated for its progressive constitutional position on termination – opens space for conceptual and empirical interrogations. The chapter argues that illegal services illuminate the realities of institutional reproductive violence that stem from limited and inaccessible public healthcare services. It further exposes the realities of transnational care evident in the huge influx of regional migrants to South Africa in search of reproductive justice. It concludes with a discussion calling for decolonised and reformed healthcare systems that speak to contextual specificities and necessities in southern Africa.