Married Men’s Perceptions of Their Wives’ Sexual and Reproductive Health Rights: A Study Conducted in the Rural Area of Waterberg District, Limpopo Province, South Africa

Abstract

Married women often become victims of STIs and HIV due to inability to exercise their sexual and reproductive health rights. The present study was conducted to explore married men’s perceptions and experiences regarding their partners’ sexual and reproductive rights. Semi-structured interviews were conducted with 12 rural, married men in Lephalale villages of Waterberg District in Limpopo Province. The main findings highlight women’s lack of autonomy within their marriage. The findings further suggest that rural married women are at risk due to their socioeconomic status, religion, and sociocultural influences that silence and deny them the opportunity to exercise their sexual and reproductive rights.

Keywords:

• Barriers
• marriage
• married women
• married men
• sexual and reproductive rights

The Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) are among the policies that contain the world’s efforts to achieve Universal Health Coverage (UHC) (Lince-Deroche et al., 2016). Sexual and reproductive health rights (SRHR) are noted as needing fundamental attention if we are going to attain UHC (Ravindran & Govender, 2020). The advocates for SRHR argue that it will not be possible to achieve UHC without paying attention to SRHR (Ravindran & Govender, 2020). Sexual and reproductive health is defined as the state of physical, emotional, mental, and social well-being in relation to sexuality and reproduction (International Planned Parenthood Federation [\IPPF] & United Nations Population Fund [UNFPA], 2017). This is not limited to the absence of disease, but includes information in all matters related to sexuality and the reproductive system’s functions and processes (IPPF & UNFPA, 2017; United Nations, Department of Economic and Social Affairs, Population Division [UN DESA], 2017).

SRHR entails a positive and peaceful approach to sexuality and sexual relationships, including the possibility of pleasurable and safe sexual experiences, free of coercion and violence (IPPF & UNFPA, 2017). Rights, in relation to sexual and reproductive health, include the right to freely control and responsibly decide on matters related to sexuality, including sexual and reproductive decision making and the ability to seek sexual and reproductive health care free of coercion, discrimination, and violence (IPPF, 2015). SRHR includes the freedom to decide if, when, how, and how often to have sex. It also includes the basic right for all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children; the right to have the information and means necessary to make those decisions; and the right to attain the highest standard of SRH and health care (IPPF, 2015).

SRHR have long been advocated in various policies across the world. Many of the policies were based on the outcomes of the International Conference on Population and Development (ICPD) that was held in 1994 in Cairo, Egypt. ICPD was followed by intergovernmental declarations, including the Beijing Platform for Action (1995); the Global Strategy for Women’s, Children’s and Adolescents’ Health; the 48th session of the Commission on the Status of Women (2004); and other international human-rights conventions, declarations, and consensus agreements (International Planned Parenthood Federation [IPPF] & United Nations Population Fund [UNFPA], 2017; World Health Organization, 2016). Amnesty International (2010) declared SRH as an essential component of the universal right to the highest attainable standard of physical and mental health. South Africa adopted the MDGs and SDGs with the intent to promote and protect SRHR, especially for women (Lince-Deroche et al., 2016). That effort is also enshrined in South Africa’s constitution, particularly chapter 2 (the Bill of Rights), which emphasizes gender equality. This includes ensuring that all genders’ SRHR are protected.

At a policy level, it has been argued that it would be beneficial if men were positively involved in their female partners’ SRH. IPPF and UNFPA (2017) noted the following benefits: (1) When men partner with women to encourage and support prenatal and postnatal visits, women’s maternal health outcomes improve greatly; (2) Men’s active involvement has significant benefits for their newborn’s health and throughout the child’s development and into adolescence, in addition to promoting gender-equitable views; (3) When men participate in prenatal visits and receive maternal health education, they can provide life-saving support to their partners, such as noticing danger signs during pregnancy or childbirth and getting their partners the necessary emergency care; (4) Men’s involvement during and after pregnancy provides psychological and emotional support, and is associated with reduced likelihood of postpartum depression; (5) Fathers can improve children’s health by encouraging immunization, seeking care for childhood illnesses, and supporting infants’ nutrition; (6) Positive father involvement is associated with children’s emotional and social development, such as empathy, lower rates of depression and behavioral and psychological problems, cognitive and language development, better academic performance, and protection from risky behaviors.

There are global policy and practice efforts underway but achieving and protecting SRHR for women remains a challenge. For example, over 60% of the global total population of people living with HIV and AIDS in 2013 were women (UNAIDS, 2006). Ravindran and Govender (2020) showed that about 4.3 billion people of reproductive age worldwide have inadequate SRH services over the course of their lives, and there is relatively poorer access in the low- and middle-income countries (LMICs). In 2016, sub-Saharan Africa and South Asia (regions dominated by LMICs) accounted for approximately 86% of the estimated global maternal deaths (WHO, 2016).

Many of the challenges that lead to poor SRHR and/or unmet health-care needs are due to social, political, economic, and cultural factors that include lack of international and domestic funding, policy and legal barriers, gender-based inequalities, and restrictive gender norms (IPPF & UNFPA, 2017; Ravindran & Govender, 2020). Many women have been reported to have little or no control over SRH decision-making; male partners often control use of contraception and determine the desired number and timing of pregnancies (IPPF & UNFPA, 2017). Furthermore, although the use of contraception among women aged 15–49 doubled from 1990 to 2015, in sub-Saharan Africa a large percentage still had unmet needs for contraception (Lince-Deroche et al., 2016).

In South Africa, the patriarchal system remains prevalent within the country’s societies; it perpetuates gender inequality and plays a role in putting women’s health at risk even after more than 25 years of democracy (Payne & Wermeling, 2009). According to Sonke Gender Justice (2008), HIV infection rates are higher among women due to gender-driven behavior: men who subscribe to problematic, traditional gender norms dictate the terms of sex, including whether or not to use condoms. According to Vetten (2014), domestic violence is widespread in South Africa. Thus, the role played by men in women’s SRH can be understood from cultural beliefs, religious beliefs, and women’s socioeconomic status, which are discussed below.

Cultural Beliefs and Sexual and Reproductive Health Rights

Culture can be understood primarily as the way of doing things in people’s everyday lives (Albertyn, 2009). Culture includes knowledge, belief, art, morals, law, literature, lifestyles, ways of living together, value systems, traditions, customs, and any other capabilities and habits acquired by people as members of a society (Tylor, as cited by Uwah, 2013; UNESCO, 2000). However, culture is also fluid because the way of doing things continues to adjust to different circumstances over time depending on many factors. That is, people’s norms, values, and the material goods they produce and use are not static (Albertyn, 2009). People’s gender practice and relations also continue to adjust over time. Yet, it is paramount to understand that there are traditional, long-lasting cultural beliefs and practices that play a role in people’s lives, and patriarchy is a prime example. In patriarchal cultures, men have power over women’s lives.

To understand the role played by men in women’s SRHR, it is necessary to discuss gender relations as they exist in societies. Gender plays a fundamental role in any research on human sexuality because gender and sexual health are intertwined (Tamale, 2011). Within a society framed by patriarchy, men have problematic power over women’s SRHR. Men’s decisions are central, and they often negatively influence women’s sexual knowledge, beliefs, values, attitudes, behaviors, procreation, sexual orientations, and personal and interpersonal sexual relations (Farre, 2012; Tamale, 2011). Therefore, men are important actors in women’s reproductive health outcomes (Farre, 2012). After marriage in a patriarchal culture, men assume a position of ownership of women as though women are their property (Albertyn, 2009). As a result, wives are expected to obey their husbands by performing household duties, including serving the husbands’ sexual demands as per the husbands’ preference. Therefore, understanding men’s behavior and beliefs about fertility and family planning is crucial for the design of successful reproductive health policies (Farre, 2012).

Cultural beliefs and practices framed by patriarchy have been perceived to have damaging effects on SRHR in many African countries, including South Africa (UNESCO, 2000). Patriarchal cultural practices have resulted in gender inequity, the marginalization of women, stigma, violence, and discrimination. My interest is in the magadi-lobola cultural practice. In South Africa, the custom of magadi-lobola (also referred to as bride price) is widely practiced. According to South African law, particularly Recognition of Customary Marriages, 1998 (Act 120 of 1998), certain requirements must be complied with in order to conclude a valid customary marriage, including the negotiation of the magadi-lobolo (Bakker, 2016). This negotiation is a crucial step toward a valid customary marriage, in law and in culture. A distinction is made between “magadi-lobolo,” the tangible form of asset that constitutes an agreed-upon dowry, and the magadi-lobola negotiations, the set of legal customary processes that constitutes the fundamental dialogues between the two families and is necessary to establish the magadi-lobolo and the conclusion of the negotiation. The latter always precedes the former.

The process of lobolo negotiations can be culturally varied, long, and complex, and involves many members from both the bride’s and the groom’s extended families; normally, this would just be the uncles of the marrying parties, as well as the fathers where custom allows. The groom is not allowed to participate directly in the actual negotiations. In some cultures women may be present in the negotiations, but some households hold on to a tradition of not allowing women to take an active part in the negotiations. Often, the payment of magadi-lobola by men leads to various negative influences on women’s SRHR, which tend to be violated within their marriage by their husbands.

Magadi-lobola is an important part of African culture (Nkosi, 2011), which embraces collectivist values. It is an age-long tradition among Africans that is aimed at bringing two families together through marriage, developing mutual respect, and showing that a woman's future husband is capable of financially supporting his wife (Olisa, 2016). The primary concern regarding the magadi-lobola system is that it creates an overall African identity, which does not allow (or encourage) interpretation and conceptualization by individuals. Thus, cultural attributions are usually accepted as the social order even if they are detrimental to some individuals within the culture. In this understanding, mogadi-lobola is often followed by patriarchal connotations of social relations where men are regarded as powerful because they are the ones who pay magadi-lobola and women are, therefore, subjected to their husbands’ control (Klugman & Weiner, 1992).

Religious Beliefs and Sexual and Reproductive Health Rights

Grounded in the history of colonialism, religion has become one of the important social institutions with pervasive effects on various aspects of African people’s lives, attitudes, and behaviors (Kessi & Boonzaier, 2018; Tamale, 2011). Christianity, in particular, has been used as a form of social control, and it continues to play a significant role in influencing the various aspects of South Africans’ daily lives and health (Agadjanian, 2005; Chitando, 2007). For example, rural churches are a center for informal social interaction, as well as formal teaching and regulation, all of which shape attitudes toward health-seeking behaviors (Agadjanian & Menjivar, 2008; Mpofu et al., 2011). Although the influence of religious organizations has been recognized as important in the HIV/AIDS epidemic (Dilger et al., 2010), few studies have examined how religious affiliation might affect SRHR.

South Africa, Zimbabwe, and Ghana are known as the most religious countries in Africa; however, religion affects women’s SRHR in many countries at least to some extent (Kelly-Hanku et al., 2014). For example, Fadeyi and Oduwole (2016) found that women in Nigeria are often the custodians of family norms and honor, and religion is used to control them directly and indirectly. As a result, their bodies and sexuality, as well as their freedom of movement, reproduction, and manner of dress, are sites of religious control. Extreme interpretations of religion have also impacted people’s choice of sexual partners and practices.

Some religious institutions in South Africa deny women the right to use contraceptives and to abort pregnancies, which forces women to become voiceless. Contraceptive use has assumed particular importance, especially in Christian sub-Saharan Africa, in communities with high HIV/AIDS prevalence. However, despite the importance accorded to contraceptive use (e.g., condoms) by public health specialists, the Catholic Church has officially spoken against condom distribution (UNFPA, 2016). Furthermore, Christian views on abortion vary among, and sometimes within, denominations. The strongest opposition to abortion comes from the Roman Catholic Church, the Maronite and Eastern Orthodox Churches, and some Evangelical and Pentecostal denominations (Zion, 2012). In South Africa, the Roman Catholic Church and other indigenous churches, such as the Zion Christian Church, strongly oppose the use of contraceptives and abortion (Ndinda et al., 2017).

Religion greatly affects access to reproductive health services, especially for women. Many conservative individuals and religious groups believe that providing comprehensive information about reproductive health and sexuality will result in women becoming more sexually active (Fadeyi & Oduwole, 2016). As a result, men may believe that they have the right to prevent women from accessing this information; by doing so, they subject women to men’s authority.

Women’s Socioeconomic Status

The economic inequality that exists in many African societies, mostly due to the history of the continent’s colonialism, has left many married women vulnerable within their marriages. In many cases, men are the providers or breadwinners in the marriage, and women are forced by the socioeconomic and political structures to be financially dependent on their husbands. Given women’s dependency on men and limited opportunities to provide for themselves, women tend to remain in marriages even if they are vulnerable and have had their SRHR violated (Liang et al., 2005). This dependence makes some women afraid to ask for safer sex because they could be divorced. Even though divorce would reduce their risk of HIV infection, it has debilitating financial implications for women and their children (Liang et al., 2005). Economic dependence has been associated with less power to negotiate for safer sex in studies that have investigated women’s vulnerability to HIV in southern Africa (e.g., Posel et al., 2011).

Women whose husbands have affairs often do not leave their husband because they are not financially independent and cannot support themselves and their children (Swan & O’Connell, 2012); a husband may be the only way for women to access their economic needs. The relationship between poverty and ability to negotiate for safer sex is very complex. Women who depend on their husbands financially often find themselves having to risk their health because they may not find it easy (or possible) to negotiate safe sex or condom use. Women are likely to believe that asking their partner to use a condom implies that he is unfaithful. Women then become doubly victimized as they fear casting accusations of infidelity on their husbands, but then they become victims of HIV and other infectious diseases.

The Present Study

The implementation of policies based on the ICPD recommendations are meant to ensure that SRHR for women does not focus only on health statistics but that all factors relevant to the rights of women are given needed attention. Policies such as the Programme of Action underscore the mutually reinforcing linkages between population and development (IPPF & UNFPA, 2017; WHO, 2016). In so doing, policies accelerate the momentum for women’s, children’s, and adolescents’ health within the overall framework of the SDGs. Furthermore, they recognize the importance of women’s empowerment in ensuring that women have greater agency over their bodies and choice in reproductive decisions, which are key to improving the quality of life for all (IPPF & UNFPA, 2017; WHO, 2016).

In response to the known barriers to achieving better access to health care and health information and meeting the needs for SRHR, LMICs have worked to reduce the cost of SRHR services and address various gender-related issues to improve access and inclusion of all genders and to address poor leadership and governance (Ravindran & Govender, 2020). The aim of the present study was to explore rural men’s understanding of the importance of respecting women’s SRHR and to address the barriers to women’s ability to exercise their SRHR. The main research question was: What are rural married men’s perceptions and experiences concerning their partners’ exercise of their sexual and reproductive health rights?

The study was qualitative in nature. Qualitative approaches depend strongly on people who are articulate and introspective enough to provide rich descriptions of their individual experiences (Padgett, 2016). In order to gain a holistic picture of the participants’ experiences, I engaged participants in a meaningful manner and bore in mind that qualitative research concedes that there is no single truth (Moule & Goodman, 2014).

The study was grounded in feminist theory. The patriarchal system is evident in nearly every society. The extent to which this system is practiced differs from society to society and is still very strong in the third world, especially in poor areas such as rural African communities (De Janvry & Sadoulet, 2000). African Black feminisms in particular were chosen from a number of existing feminisms due to their relevance to the study. The main impetus for this research was to understand and dialogue with married men and to probe wider discourses of African women’s SRHR within marriage because these rights are tied to broader aspects of gender oppression and the construction of ‘African womanhood’ (Gatwiri & McLaren, 2016). I hope that this study will contribute to feminist understandings of lived experience and how these insights are needed to inform future practice and knowledge related to women’s SRHR. By consulting directly with perpetrators of oppression, I give a voice to issues experienced by women who have been marginalized (Hesse-Biber, 2006).

Method

Population and Sampling

The sample consisted of married men from the Waterberg District of Limpopo Province, in particular, Shongoane Village within Lephalale Municipality, South Africa. The participants had to have had at least 5 years’ experience of married life. The reason for this is that the participants who had gained more experience in marriage would be better able to share in-depth information based on a variety of experiences. The participants were also expected to have a clear understanding of the issue at hand and be able to express themselves in Sepedi, TshiVenda, XiTsonga, or English, as the semi-structured interview guide was only compiled in these four languages. The study area is predominantly populated by speakers of the aforementioned languages because there are migrant workers in the area. As the researcher, I was conversant with the said languages. I preferred not to enlist the services of an interpreter, as that could have affected the meaning of what the participants shared and issues related to the freedom or comfort of the participants to share their personal information in the presence of an interpreter. The final sample consisted of 12 men who are described in Table 1.

Table 1. Biographic information of participants (N = 12).

Name of participant (pseudonyms)	Age	Number of years married	Village of origin
Isaac	35	5	Shongoane 1
Kenneth	52	20	Shongoane 1
Muleya	40	10	Mushi
Themba	35	8	Abbotspoort
Thuba	28	6	Seleka
Aron	48	15	Abbotspoort
Thabani	56	22	Mushi
Thea	43	10	Shongoane 2
Nkosi	43	8	Abbotspoort
Nkululeko	30	6	Abbotspoort
Sparrow	48	12	Seleka
Phineas	30	6	Seleka

The Interview

Semi-structured face-to-face interviews, based on open-ended questions in an interview guide, were used to collect data. An interview guide is a list of questions or a memory aid used to conduct an interview (Hennik, Hutter, & Bailey, 2011). The semi-structured interviews were based on a predefined set of broad questions and themes as suggested by Nicholls (2009). Although semi-structured interviews in a qualitative study share qualities similar to those in clinical interviews (e.g., rapport building, openness, shared understanding), the sole intention of these semi-structured interviews was to gather information and facts (dos Santos et al., 2014). Asking questions in a flexible manner afforded me the opportunity to utilize probes and prompts to explore the themes in detail and to elicit thick descriptions of the participants’ perceptions with regard to their marriage partners and the exercise of sexual and reproductive rights within their marriages. All the participants were asked the same questions in the same order.

Each interview lasted 45–60 minutes. The interviews were conducted in the participants’ natural settings as recommended by Creswell (2016) in order to facilitate rapport with participants and a shared connection to their actual experiences. Upon participants’ consent, the interviews were audio recorded. They were then transcribed in the language that was used in the interview. Most (nine) interviews were conducted in English, therefore, only a few (three) needed translation. Those three interviews were conducted in the following languages: Sepedi, TshiVenda, and XiTsonga. I transcribed the interviews in their original language, translated them, and then asked a peer who was also fluent in English and the three languages to read them and confirm that they were translated accurately. A total of 13 questions were asked in order to gain an in-depth understanding of the phenomenon. The questions are outlined in Table 2.

Table 2. Interview questions.

In your marriage, what is a wife’s duty when it comes to the sexual aspect (sex) within marriage? In your marriage, what is your duty when it comes to the sexual aspect (sex) within marriage? What do you see as your wife’s rights when it comes to sex within marriage? What do you see as your rights when it comes to sex within marriage? Who in your relationship decides when you as a couple have sex? How do you feel when your wife refuses you sex? How do you react? What are your views on the issue of women’s rights? What do you consider to be women’s sexual and reproductive rights? Who in your marriage decides when to start a family? When to expand the family? What is your wife’s responsibility when it comes to the use of contraceptives in your marriage? What is your responsibility as a husband when it comes to the use of contraceptives in your marriage? Who in your marriage is responsible for deciding on safe-sex practices? Tell me your opinion about a woman who may express to her husband that she is not satisfied sexually. Tell me your opinion about a woman who may tell her husband that she does not want to have sex now. Can you tell me what things are important in order for a married couple to be happy? Share with me what you regard as an ideal sexual relationship between men and women in marriage.

Data Analysis

Tesch’s model of qualitative data analysis was used to analyze the perceptions and experiences of rural married men regarding their partners’ exercise of their sexual and reproductive health rights. Thematic data analysis was used to extract themes and subthemes from the raw data, such that the themes and subthemes emerged from the entire process. I followed six steps developed by Clarke et al. (2015). The six steps are outlined in the Table 3, together with explanations of how I applied each step in the present study.

Table 3. Steps and applications of thematic analysis.

Steps	Applicability
1. Familiarization	I transcribed audio-recorded data with the intention of familiarizing myself with it. I further read through the Word document (transcribed data) several times to get familiar with it.
2. Coding	I went through the transcript of every interview and highlighted everything that stood out as relevant or potentially interesting, and I highlighted all the phrases and sentences that matched these codes. I then collated together all the data into groups identified by code. These codes allowed me to gain a condensed overview of the main points and common meanings that recur throughout the data.
3. Generating themes	I looked at codes created, identified patterns among them, and created themes. Some codes were vague and had to fall away. Some codes were combined into a single theme.
4. Reviewing themes	I returned to the data set and compared the identified themes against it.
5. Defining and naming themes	Defining themes involves formulating exactly what we mean by each theme and figuring out how it helps in understanding the data. Naming themes involves coming up with a succinct and easily understandable name for each theme.

Source: Braun and Clarke (2006).

Results

Three main themes were identified in the transcripts. These are described and discussed below.

Payment of Lobola Affords Men Control over Their Wives’ SRHR

Some men interviewed for this study misunderstood the meaning behind the cultural practice of paying magadi-lobola. They believed that paying magadi-lobola gives them power to control the woman to whom they are married; thus, they challenged the idea that their wives should be equal to them in their marriages. This is evident in the following comment:

Some women are able to take care of themselves now. So, I won’t have a problem with us being equal only if women too are able to pay lobola, but if men are still forced to pay lobola, then why should we be equal? (Isaac)

Isaac associated paying magadi-lobola with having more power in the marriage. It would seem that to him, if women could also pay magadi-lobola, then they could attain power in the marriage. A similar connotation is evident in this comment:

I wouldn’t allow my wife to go to work … working is my responsibility as a man … every time when she comes home, she would be tired and as such, she would not be able to do what I paid magadi-lobola for. You know, men, were made in a way that we are hard, we are strong, we are in a way … even in our appearance you can see, we are not as soft as women. (Kenneth)

Similar to Isaac, Kenneth demonstrated patriarchal thinking grounded in control and power; such men think that they are in charge of the women they marry. Furthermore, Kenneth demonstrated his subscription to the traditional patriarchal labor division in the family, where men are expected to be the providers and women to engage in the home chores and other unpaid work. Based on these common patriarchal assumptions, the men in this study believed that women are obliged to give them sex and that their requests are nonnegotiable, as in the comment below:

I will feel bad about my wife if she refuses me sex or even give me a condom especially that I paid the bride price. … I doubt if my wife can refuse me sex while I paid lobola. (Muleya)

In the above quotation, Muleya demonstrated that he would expect to be given sex by his wife and that he would want it the way he chooses, such as without using a condom. His belief is directly linked to the idea that the man would have paid mogadi-lobola, as evident in the comment below:

Traditional or African cultures would say the man is the head of the house, a woman is the body, so the man doesn’t need the woman saying anything, you know, hence I am the one paying magadi-lobola not the woman, she cannot deny or refuse me sex. I will understand if I did not pay magadi-lobola, but now I paid because I needed to have sex with her whenever I wanted. Believe me, if she refuses me sex, then possibility is that she is getting it somewhere. (Themba)

The above comments demonstrate how men in this study misinterpreted the payment of mogadi-lobola as though it means that they own the women they married. Therefore, they thought that they may demand sex as they want, whenever they want, and decide whether to use a condom or not.

Men’s Use of Christian Beliefs to Compromise Their Wives’ SRHR

Religious beliefs play a role in the ways the participants understood and influenced the SRHR of the women they married. Participants reported that they did not use any protection to prevent a pregnancy, nor did they allow abortion, because these acts are considered sinful.

Injections, tablets, and condoms. We do not use anything, and the reason is that we are not murderers. When you use contraceptives while sleeping with your partner means there is no trust in your relationship. You will be making her feel like she is just a person not a wife. (Thuba)

Thuba referred to abortion as murder and use of contraceptives as lack of trust in their partners. Furthermore, Thuba demonstrated that the use of contraceptives may not be expected in a marriage because this does not confirm the woman as a wife. However, in his narrative Thuba seemed to assume a position of control over what happens in the couple’s sexual activities as he said, “When you [referring to himself] use contraceptives…” This seems to mean that he, not his wife, decides either to use them or not. He also made this decision based on his religious beliefs.

That religion plays a role in how men decide on SRHR is also clear in this comment:

The word of God says my body belongs to my wife and my wife’s body belongs to me, therefore, I have to give my wife what is due to her. My wife should be submissive to me and allow me to have authority over her as a man. God says we should replenish and fill the earth, so why should we prevent pregnancy? In my church, even my wife knows that we are not murderers. Using contraceptives is like killing the child before it can be conceived. (Aron)

Aron used Christian beliefs to claim ownership of his wife. He also suggested that he owes his wife sexual duties, but he later contradicted himself by saying that, in fact, his wife has to be submissive to him. Therefore, any of the sexual decisions in the marriage were to satisfy him, not his wife. He went on to claim that it is the expectation of God that people reproduce. This is emphasized in how he claimed a position of control and decided to have unprotected sex with his wife: it is the will of God. None of these decisions seem to include his wife’s preferences.

The word of God was further referred to by Thabani, who also claimed control over the sexual decisions of his wife:

The word of God says let everyone be given what is rightfully hers or his. Which means my body belongs to her and so is her body to me. I decide what to do with her body not herself, including whether to prevent or not. (Thabani)

Thabani referred to using or not using condoms when he said,”whether to prevent or not.” He also demonstrated that he claims control over his wife’s sexual and reproductive health through Christian beliefs, as did Thea:

According to the church that I attend, a woman is not allowed to use contraceptives. (Thea)

The Influence of Income on Family Planning

In the previous themes, men used various factors to claim a position of control and made decisions that impacted women’s SRHR. As they claimed control, the men believed that they were the main head of the household; therefore, they thought that they had to be responsible for their wives. This is apparent in the comment below:

It is me as the man, by the way I am the head of the family, therefore I take a decision that now the child has grown up and we must have another one. (Nkosi)

Nkosi thought that it is his responsibility to control his wife’s reproductive decisions. This belief is driven by the idea that men have to be responsible because they are the financial providers for the household. As another participant explained:

I am a man; I have to look at how our income is … whether I am working or not working. You see, I will not be dictated by her to say she wants five or ten children while we are not working, what are they going to eat? (Nkululeko)

Nkululeko assumed that his wife would not be able to understand and assess the financial status of the family, which might lead to her to want a child they could not afford to raise. Participants also perceived that they are the ones who should decide the number of pregnancies, in some cases more than their wives wanted:

My wife does not have such rights. She cannot tell me how many children we should have. I am the one who is working and as such if I can be able to support ten children why should she limit me? When coming to decisions involving the growth of the family, I decide. (Aron)

The assumption of power demonstrated by Aron seems to infringe into his wife’s SRHR, wherein she is not involved in deciding how many children she should birth. A similar approach was reported by Nkululeko, as he stated that “Her rights are limited.” Sparrow’s response below also includes a supposition that women’s SRHR in heterosexual marriages belong to their husbands.

The above findings demonstrate how men in marriages gain power and control over women’s SRHR. However, there were some responses from men who were willing to engage their wives concerning sexual and reproductive health. This approach seemed to be beneficial in protecting women’s SRHR. For example:

We have to do family planning because we are now equal, 50/50. We have to come with ideas then we take a decision so that we do not blame each other … like abortion; the child is still young and she falls pregnant by mistake again … we have to agree that we are opting for abortion so that should anything go wrong we both carry the responsibility. But if she can do abortion without telling me, should any mistake happen then she must carry the responsibility alone. (Sparrow)

Sparrow acknowledged the equality that he had with his wife in all aspects, including sexual and reproductive decisions such as healthy family planning. However, this was grounded in a desire to avoid being wrong, although it was clearly beneficial to his wife’s health and rights. Phineas also demonstrated how he engages his wife in decisions:

We are not using the “head of the family” concept in the correct way. I should say I am the head of the family but must remember that the head has a neck. I should not say I am the head and do not have the neck. This is what causes problems for us. A man should take every decision with his wife. (Phineas)

Phineas demonstrated that it is important to engage with his wife in decision making, again, because he seemed to hold a position that he and his wife are equal in their marriage. This stance is beneficial to his wife’s SRHR.

Discussion

The findings suggest that men in heterosexual relationships compromise the sexual and reproductive health and rights of women to whom they are married. Culture influences men to believe that they have power and control over their wives’ SRHR, which is problematic. The men’s beliefs are mostly inaccurate, but they believe they are correct; hence, they refuse to be challenged by their wives. This should be understood as societal power relations that infiltrate intimate relationships and allow men to assume a position of control over women. This position is grounded fundamentally within a patriarchal society that has a long history in South Africa (Coetzee, 2001). Patriarchy’s long history is entangled within the cultures of South Africa, yet the men in this study demonstrated a lack of understanding of the culture.

Payment of magadi-lobola comes with conditions that deny women their SRHR within marriage. It also pushes women to be dependent on men for economic survival. For some men, magadi-lobola means buying out woman’s SRHR and prioritizing those of men within marriage. A number of participants in this study repeatedly defended their position that women cannot have equal rights by arguing that men pay magadi-lobola.

Misinterpretation of cultural practices such as magadi-lobola may not necessarily be only by men; the bride’s family also should be considered, given the observable factors in magadi-lobola negotiations, which have been capitalized to an extent that some men think that women are a commodity because families make a “profit” when daughters marry. As Hayes (2004) stated, one can imagine how a woman’s judged worth can be exploited by her family in order to make a profit. Therefore, to understand the views of the men in this study, it is necessary to think of the broader society’s role in cocreating the culture that gives men control over married women.

However, although the broader society plays a fundamental role in shaping men’s societal position and how they behave in intimate relationships, the findings of the present study suggest a bigger role played by men themselves. Men’s belief that they have control over their wives’ SRHR can also be driven by men’s own personal perceptions and behaviors. Thus, some of them perpetuate sexual coercion, marital rape, and depriving their wives of opportunities to exercise their sexual and reproductive rights. Those men seem to understand these as correct behaviors, part of what they view as a package of marriage.

In other ways, magadi-lobola has long been practiced and has worked effectively for societal cohesion and building family institutions (Chireshe & Chireshe, 2010; Shope, 2006). However, according to the findings from the present study, there are some men who do not have a clear understanding of how this culture is practiced. The findings suggest that some men believe that paying magadi-lobola means acquiring power over their wives. It is this thinking that makes some men want to control women’s SRHR with usually negative effects on the women’s health and rights. Similarly, in other studies conducted in South Africa, there is evidence that it is this power that results in social problems such as femicides, marital rapes, gender-based violence, intimate partner violence, and high rates of HIV/AIDS among women (Leburu & Phetlho-Thekisho, 2015; Ndlovu et al., 2020).

A misunderstanding of the cultural practice of paying magadi-lobola also leads to men’s refusal to acknowledge that their wives must be equal to them. Because men believe that they have more power than their wives because they have paid magadi-lobola, some argue that, if women are to be afforded equal power, then they also have to pay magadi-lobola. Because they believe they have greater power in their relationships, they feel free to exert control over women. As such, they believe they have the right to control women’s SRHR. For example, they decide if, when, and how often women should become pregnant, which is contrary to IPPF and UNFPA’s (2017) findings of various positive sexual and reproductive health outcomes for women when such decisions are made by the couple rather than by only one person in the relationship (Kavanagh, 2010).

Furthermore, equality refers to the power to make critical decisions by married men and women as equal partners in a marriage, and it is often shaped by the financial contribution each of them makes. Some men believe that a woman can be equal to a man only if she earns more than the husband; in such cases, she will be afforded power to make decisions, including those concerning SRH. This perception has also been noted by Blumberg (1991), who indicated that women in Third World countries experienced greater decision-making power regarding reproduction when they earned higher incomes.

It is a challenge to advocate for equality when it may be perceived as the introduction of a foreign culture to those who do not understand the concept Ubuntu and cannot apply it in their marriages. According to Muxe-Nkondo (2007), Ubuntu emphasizes “motho ke motho ka batho,” which translates as “a person is a person because of others.” Without applying Ubuntu as an African principle, misinterpretation of cultural practices can exacerbate the struggle against inequalities within marriage. Berry, Poortiga, Segall, and Dasen (2004) argued that people who value their culture will not respond positively to changes that appear to threaten the preservation of that culture. However, the correct interpretation of such practices is important so that ultimately no one feels oppressed by her or his own culture due to incorrect interpretations. If gender equality is perceived to impact negatively on lobola as a cultural practice, then one may anticipate that gender equality will receive little attention from people who misinterpret the role of magadi-lobola.

“Ubuntu’s respect for the particularity of the other links up closely to its respect for individuality” (Letseka, 2014). This is because Ubuntu defines the individual in terms of his/her relationship with others. According to Letseka (2014), “Ubuntu the self or individual is constituted by its relationships with others, hence umuntu ngumuntu ngabantu, or a person is a person through others.” Thus, the Ubuntu perception of the other acknowledges the irreducibility of the other—that is, it never reduces the other to any specific characteristic, conduct, or function.

The results of the present study also show that men in marriages can use different religious attitudes and beliefs, especially those grounded in Christianity, to impose control over women’s SRHR. Some organizations that are concerned with SRH, such as UNFPA, have noted the role of Christianity in compromising advocacy for women’s SRHR (UNFPA, 2016). Similarly, findings have emerged from other studies that show that religion exerts an influence in reproduction decision making, such as abortion or prevention of pregnancy (Cense et al., 2018; Namasivayam, 2017). From some religious perspectives, the economic difficulties and inconveniences of raising children are not considered in decisions regarding birth control. According to some churches, abortion on demand is forbidden, but it may be performed if the mother's life is in danger. The attitude toward sexual and reproductive health practice differs among the various versions of Christianity. Use of contraceptives is not accepted by certain denominations but could be practiced by others. According to some denominations’ doctrines, the primary purpose of marriage is procreation. Therefore, they believe that contraceptives curtail the possibility of producing new life through sexual intercourse, violating the purpose of marriage, and thus constitute a sin. Therefore, it is fundamental that the findings of this study not be understood as only a representation of what individual participants reported but as a reflection of the broader religious understanding of SRHR for married women.

Findings of this study suggest that Christian attitudes and beliefs are used by husbands negatively, and this has potential negative outcomes for women’s SRHR. However, there are other findings to suggest that religious beliefs and attitudes could have positive SRHR outcomes. For example, Aggleton and Campbell (2000) and Brattan-Wolf and Portis (2001) found that men and women who regularly attend church are less likely to engage in unsafe sex at a young age. Therefore, adolescent girls are less likely to become pregnant.

Although some participants indicated that men and women have equal responsibility for decisions about contraceptive use, it seems unrealistic to assume that they are all involved equally with their partners in those decisions. Yet, it is likely that such attitudes and perceptions are strongly influenced by an individual's own behavior. Personal attitudes and perceptions shape sexual and contraceptive decisions as part of family planning. For example, a study by Mosha et al. (2013) has shown that a woman’s partner has a major effect on her sexual, contraceptive, and fertility behavior. Therefore, men’s understanding and support of their wives’ SRHR could have a positive effect on women’s sexual, contraceptive, and fertility behavior (IPPF & UNFPA, 2017; WHO, 2016).

Conclusion and Recommendations

In South Africa, issues regarding gender equality are prioritized and promoted. The Commission on Gender Equality (1997) requested that the South African Law Commission on Customary Marriages address inequalities within marriage (Meintjes, 2005). Yet, there is a gap among the general public with regard to interpretations of African cultural practices, such as magadi-lobola. It could be that this misinterpretation is fueled by the deviation from this practice that has occurred over the years as the parents of the bride demand exorbitant amounts as magadi-lobola. Furthermore, women’s economic status and some of society’s attitudes and beliefs are barriers to women’s exercise of their SRHR within their marriages, and this has a toll on their sexual and reproductive health.

Research on the enhancement of effective spousal family planning communication processes has focused on the empowerment of women, and the development of men’s communication skills could begin to provide avenues for building a better relationship between spousal communication and actual and timely contraceptive use. Such a study would be both longitudinal and experimental in nature to allow for comparisons between spouses enrolled in a program from the start of their marriage and those spouses who are not enrolled. Studies that employ both quantitative and qualitative methodology would be uniquely capable of providing valuable insights into pertinent elements that require further understanding.

Given the nature of qualitative data, and its limited applicability to Shongoane village, there is also a need for similar studies in different regions of the country to generate comparative data. Such studies could provide significant insights into the similarities or differences in fertility-regulation behavior among married couples in different regions of the country, including traditional and cultural aspects. An effective exploration would need to go beyond the usual socioeconomic and regional differences that are attributed to fertility-regulation patterns in literature and general perceptions.

Finally, churches should play an active role in ensuring that women’s value within marriage is promoted. This could positively change the mindset of many men and protect women from becoming victims of sexual and reproductive health–rights violation.

Acknowledgement

I would like to acknowledge Oncemore Mbeve, currently a PhD researcher at the African Centre for Migration and Society (ACMS), Wits, for his critical input in this article. His research expertise was very useful in providing advice and requested input.

Disclosure statement

No potential conflict of interest was reported by the author(s).