As an historian of fertility and reproductive health in South Africa, I am dismayed to read about the MEC for Health in KZN, Dr Sibongiseni Dhlomo, and the people around him, devising an intervention that ties educational scholarship opportunities for young South African women to their agreement to a specific contraceptive regimen.
Having studied and published research on the history of nursing and medical education in South Africa, and the history of compelled contraception and sterilisation of women under apartheid, this paternalistic approach to fertility control is the opposite of the methodology and politics that our constitutional order seeks to shape.
News that a cohort of women travelling on an educational scholarship must first accept the implanting of a long-term hormonal contraceptive comes with heavy historical baggage. Some historical context is apposite: for centuries women were deemed ineducable because of a supposed inferior capacity for rational thought and compromised moral worth. Menstrual cycles, pregnancy, menopause and related “conditions of the female personality”, such as hysteria, made it impossible, in the view of male-controlled social institutions, for women to learn, think, legislate, conduct scientific and engineering work, conduct business or contract services, own property, create high art, govern, and make public decisions outside the home.
Today we find these assertions absurd. Some of the best run societies have female heads of state – in Germany’s case, the head of state is also a physicist, an expert in several languages, in lawmaking, and in financial analysis.
In the 1800s and early to mid-1900s women’s entry into education was tied, by male dominated academies and regulatory bodies, to control over women’s sexual expression. Virginity, chastity and other requirements of obedience, subservience and meekness were often requirements for women’s limited and very gradual access to areas of paid or public work such as nursing, teaching, banking, secretarial, retail or factory work.
This was not so for men.
Later on in the higher education sector, when women were finally allowed to take degrees, it was the same pattern. In South Africa these shared global experiences were elaborated under the constrictions of racial domination: an anxiety around the supposed vulnerabilities of white women facing rape and assault in colonial society was twinned with a set of ideologies around the supposed licentiousness of black women. This thicket of ideas and assumptions was fuelled by colonial misunderstandings and fears that have taken people decades to untangle, research, write about, struggle against, and eventually to eradicate from legal and institutional frameworks. Despite this effort some forms of paternalistic and misogynistic thinking persist and go underground, only to surface with a vengeance.
A common thread in these waves of paternalism is the silence around men: their sexuality, fertility, social responsibilities, morality and behaviour. The sexual double standard lingers, festers, and takes on the appearance of “the everyday”, it is so casually expressed and thus, like racism in the apartheid era, so normalised.
From the 1930s to 1960s black South African nurses were expected to stand in their underwear and undergo weekly examination by white male medical superintendents to ensure they were not pregnant and to create an atmosphere of control and fear.
White women who worked for public bodies were fired or given part-time posts on low pay if they married or became pregnant, whereas men who conceived children or were married were better paid.
Women of Indian descent were compelled to enrol in fertility control programmes at factories in Natal. Women of mixed ethnicity were given injectable contraceptives from the backs of vans in farming areas as a requirement for their waged work in agriculture. The list of invasions and subordinations of women’s autonomy is a long one in the South African context. And yet it is striking, and must be stated, that even during the darkest days of apartheid no such efforts were made to control the fertility of heterosexual white or black men.
Let us return to the case of the scholarship fund for young South Africans heading to India for medical education. Should we be concerned that candidates, whose heavy expenses are being met by a consortium of interested parties, conceive while on the programme? Perhaps.
But let us ask a few key questions: are the young men in the Cuban or Indian scholarship programme being instructed to undergo a widely practised safe surgical procedure to render them infertile for their time abroad? I imagine there would be a huge outcry if this were the case.
How many of the men in the programme in Cuba fathered a child while abroad? What were the contexts of relations between students in Cuba that led to four conceptions? Has anyone done any research into this? Women do not conceive alone and young men and women’s sexual decision-making and fertility choices are theirs to make. Our constitution makes this very clear, as do all the guiding principles today of medical ethics in South Africa. These constitutional and ethical rights were won after years of struggle. Perhaps the MEC, and any other people in the programme who support this directive, have forgotten how the medical, state, corporate and educational regimes of the past politicised contraception and fertility control?
We have learnt that reductions in youth pregnancies are tied to effective peer education and guidance about sexual maturity; to women’s sense of purpose and equality; to men’s sense of shared dignity and worth with women; and to more equitable cultures of romantic love.
A key context for planned conception and parenthood is full access to contraceptive and sexual health services – all of these elements are what we would expect as South Africans of our MEC for Health in KZN, if he and his team are concerned about the high rates of conception in this cohort. These interventions are the only proven, legal and ethical methods to reduce fertility.
Instead, KZN appears to be embarking on a return to paternalistic, class-based and racist interventions around women’s fertility and sexuality. It is most disturbing to see that women who do not have the family resources to study abroad are being targeted for this coercive, invasive procedure.
* Burns runs the Medical Humanities programme at the Wits Institute for Social and Economic Research.