On 9 August 1956, about 20 000 women marched to the Union Buildings in Pretoria in protest against legislation aimed at tightening the apartheid government’s control over the movement of black women in urban areas. Women’s Day marks the anniversary of the great women’s march of 1956 and while we celebrate the thousands of women who marched for justice there is much work that still needs to be done, particularly for women who live on the street.
Anita Mwanda, a research assistant at the CSDA recently completed her Masters research under the supervision of CSDA Director Lauren Graham and co-supervision of Associate Professor Kezia Batisai in the Department of Sociology. She researched homeless women’s experiences of accessing their sexual and reproductive health rights in Johannesburg. There is a growing concern about the plight of homeless women because of “extreme forms of social exclusion that extend beyond material hardship” (Watson, Crawley and Kane, 2016: 1). Anita was interested in understanding if homeless women have access to contraception and menstrual hygiene products while living in shelters or on the street.
Their journey into homelessness
In her research Mwanda interviewed ten homeless women aged 20 to 50 years living in a temporary housing arrangement in Johannesburg. The data revealed several themes that indicated the complexities of homeless women living in shelters. The reasons for their homelessness varied, and many of the participants acknowledged having difficulties moving on from this time of their lives. Substance misuse, a breakdown of relationships, and unemployment were the primary reasons for their homelessness. Participants’ lived experiences and realities are changed fundamentally due to homelessness and the reasons for becoming homeless.
Access to contraceptives and family planning
Mwanda focused on participant experiences in shelters and their access to quality family planning, primary health care, maternal health and menstrual hygiene products and management.
She found that many women encounter barriers to contraceptive use including societal norms and influences that influence availability and choice. Similarly, prior studies have found that despite the high demand and supply of modern contraceptives, the contraceptive needs of homeless women are often unmet (Najafi-Sharjabad et al. 2013: 181). In addition, many women have negative experiences with contraceptive methods.
Innocentia explained how the shelter she stays in makes condoms available but the women feel watched when taking freely available condoms, and that shelter staff often then prompted the women to take other forms of contraception too. “They were forcing us to say, no we don’t trust you ladies. We do have a condom container by the door, and so they used to put condoms there. Well, they saw that people are using them because they were getting less and lesser, and then they advised some of us to go and take contraceptives. Well, I was supposed to because I had a new born baby. So, I took it from that time until I realised that it is making me sick” – Innocentia
In contrast, Gloria, 45 years old, was advised by her doctor to stop using contraceptives as she was nearing menopause. Like Gloria, Nomsa, 42 years old, is approaching menopause. However, she has never used any contraceptives before. She explained that she personally never used contraceptives due to misinformation and the lack of awareness. Nomsa said, “You feel like if they [medical practitioners] say it’s family planning, it is for someone who’s got their husband. If you don’t have husband, then you don’t have to do that. So, you don’t understand it 100%”.
One woman commented that many women in the village where she grew up did not reveal whether they used contraception due to the stereotypes associated with contraceptive use and the patriarchal beliefs of the men. “When you grow up in a village, you will hear men, they will only say, no man, that woman she’s using contraceptives. They always condemned them because they think that when women are doing it, they are using it they become open for everybody. So, they always condemn this thing. So, that’s why. So, you grew up thinking that it’s a bad thing because people will be condemning it. Even if you want to use it, you think it’s important for you to use it. It’s hard for me to go and use it because you think that people, they will look at me in another way. But I think because now things are changing, you know, like the age of my child. They are free to use it because things are changing. But during that time, 20 years ago, you will never use contraception.” – Nomsa
Because homeless women cannot afford sanitary products, they rely on potentially harmful alternatives. Letlhogonolo explained how she had to use unhygienic methods to manage her menstruation during this time. These methods include using cloths and rags made out of old clothing and toilet paper in the absence of sanitary products. Letlhogonolo also shared how they would prepare these materials for re-use. She said, “You wash them in the morning, and then when you go to the parks or when you sit next to the park then you put them down, and when they are clean, then you go to the next toilet, and then you make it wet, damp. We used to use that”.
Key findings related to their sexual and reproductive health are that although they can access contraception, they have limited choices in this regard, and some had very negative experiences with the contraception they used. They indicated that they had access to sanitary towels at the shelter but that this was often insufficient, and they did not have choices about what kind of sanitary products they wanted to use, and some related experiences of unhygienic practices of managing menstruation when they were homeless. Overall, the women had access to what they needed regarding their sexual and reproductive health, but their choices were severely restricted.
To ensure that the right to freedom of choice is met in shelters, Anita proposes that shelters give free contraceptives and contraception counselling to women so that they are able to make informed choices about contraception. Further, awareness building amongst staff of shelters regarding rights in relation to contraception could be considered to ensure that women’s choices about contraception are respected. Furthermore, enough information and expertise should be provided to complement contraceptive use increasing the availability and accessibility of contraceptive information to support informed decision-making among homeless women.
 Not her real name