The Socio-Cultural life of Assisted Reproductive Technologies at the margins in South Africa

Emma Mavodza

Globally, infertility remains in the shadows of sexual and reproductive health (SRH) research, policy and practice. In sub-Saharan Africa, not only fertility rates, but the proportion of people affected with infertility at a given point in time are among the highest in the world (WHO 2023). In post -Apartheid South Africa, competing health priorities including the burden of HIV and AIDs makes it problematic to socially justify public funding for assisted reproductive technologies (ARTs). As a result, both perceived high fertility and infertility are potential reproductive disruptions which disproportionately affect women at the margins. Therefore, despite availability of sophisticated fertility treatments, only a small part of the population benefits from reproductive technologies in South Africa.

Drawing on intersectionality and insights from reproductive justice efforts, this ethnographic project examines the lived realities of black women, specifically their experiences of ARTs in a context where infertility is not only an individual sexual and reproductive problem but also a collective social problem. The historical context within which black people have been compromised means that the treatment and marginalisation (through racial lenses) of black women in South Africa and beyond continue to affect their reproductive choices, decisions and outcomes. Considering this, I examine how black women strategize their reproductive practices within broader socio-economic, moral worlds and competing global ideologies about gender, family, kinship and reproductive futures. This project connects the past, present and future reproductive imaginaries and practices by answering the following questions: How are ARTs imagined, pursued, negotiated and experienced and what do these unique experiences tell us about the reproductive capacities and futures of Black women in South Africa?

Using participant observation, in-depth interviews and focus group discussions with Black women in selected fertility clinics and communities in South Africa, I will engage in open dialogues on perceptions of black women on ARTs, how they describe their cultural encounters with specific reproductive technologies, their level of knowledge, available reproductive choices, forms of agency to choose ARTs, access issues, stigma related to both voluntary and involuntary childlessness, existing ways of reproductive care and addressing infertility.

The overall goal of the project is to show the importance of local contexts in moderating experiences of infertility as well as the multidimensional measures taken to address them. This project opens dialogue and provide a culturally sensitive space to think with ARTs as well as other ways to attain parenthood. In a context where the right to not to have children is not culturally promoted, this project is also a space to discuss the social stigma associated with choosing not to have children. Most importantly, the findings from this project enriches the existing ethnographic pool of evidence on the socio-cultural aspects of reproduction by going beyond childbearing and childlessness as individual biological problems but deeper socio-cultural issues that affect the society as a collective.