Gender relations and women's reproductive health in South Sudan

Abstract

BackgroundIn South Sudan, women disproportionately bear the burden of morbidity and mortality related to sexual and reproductive health, with a maternal mortality ratio of 789 deaths per 100,000 live births.DesignA qualitative study was conducted to analyze how gendered social relations among the Fertit people affect women's ability to exercise control over their reproductive lives and thereby their sexual and reproductive health. Transcripts of 5 focus group discussions and 44 semi-structured interviews conducted with purposefully selected community members and health personnel were analyzed using Connell's relational theory of gender.ResultsWomen across all age groups report that they have little choice but to meet the childbearing demands of husbands and their families. Women, both young and old, and also elders, are frustrated about how men and society are letting them down and how they are left to bear the reproductive burden. The poverty and chronic insecurity in South Sudan mean that many men have few sources of pride and achievement; conformity and complicity with the hegemonic practices accord both security and a sense of belonging and privilege to men, often at the expense of women's reproductive health.ConclusionsInequalities in the domestic, social, and economic spheres intersect to create social situations wherein Fertit women's agency in the reproductive realm is constrained. In South Sudan, as long as economic and social opportunities for women remain restricted, and as long as insecurity and uncertainty remain, many women will have little choice but to resort to having many children to safeguard their fragile present and future. Unless structural measures are taken to address these inequalities, there is a risk of both a widening of existing health inequalities and the emergence of new inequalities.

Factors Influencing Contraceptives Use among Women in the Juba City of South Sudan

“…The two decades of civil war disrupted South Sudan health care system and therefore very little efforts were placed on family planning, even after signing of the comprehensive peace agreement in 2005 [6,11]. Family planning services remained underutilized even where the services were made available [10][11][12]. The low uptake of contraceptives in South Sudan is likely to expose women to unplanned pregnancies, inadequate child spacing, and increased risks associated with closed spaced pregnancies and child birth.…”

“…The low contraceptives uptake South Sudan has been a long-standing national issue with little concrete steps taken to address it 2 International Journal of Population Research [10][11][12]. The two decades of civil war disrupted South Sudan health care system and therefore very little efforts were placed on family planning, even after signing of the comprehensive peace agreement in 2005 [6,11]. Family planning services remained underutilized even where the services were made available [10][11][12].…”

“…As of the year 2015, in South Sudan, however, only 6.8% of women of reproductive age use family planning, 2.5% are using the modern methods of family planning, and 4.1% are using the traditional methods of family planning [1,9]. The low contraceptives uptake South Sudan has been a long-standing national issue with little concrete steps taken to address it 2 International Journal of Population Research [10][11][12]. The two decades of civil war disrupted South Sudan health care system and therefore very little efforts were placed on family planning, even after signing of the comprehensive peace agreement in 2005 [6,11].…”

‘You have a child who will call you “mama” ’: understanding adolescent pregnancy in South Sudan

“…The project was implemented between 2012 and 2016 and was geared towards supporting the State Ministries of Health of three states (including WBeG) to improve the quality and responsiveness of the sexual and reproductive health services. Findings from research done amongst adults have been reported earlier [17][18][19][20]. Insights from this research, particularly about how social norms and gender relations shape women's sexual and reproductive health in South Sudan, have also extensively informed this inquiry; it particularly helped us to develop the interview questions and to locate the analysis in the broader social context of the study community.…”

Intersections between gender and other relevant social determinants of health inequalities

“…Examples of these papers include Kosia et al’s study among women living with HIV and AIDS in Tanzania [9], and Dean et al’s exploration of the sexual and reproductive health rights of disabled women in India [10]. Three papers focus on exploring the lived experiences of women (and men) who are in more vulnerable situations, focusing on gender inequality and violence against women: Kane et al’s paper on gender relations and reproductive health in Sudan, Madiba’s paper that brings in narratives from married and cohabiting women in rural south Africa, and Mtega et al’s paper on sex communication among partners in Tanzania [11–13]. Devi Pun’s paper from Nepal explores violence against women, taking the perspective of the community to undercover culturally normalized practices of oppression against women [14].…”