URBANIZATION, HOUSEHOLD COMPOSITION AND THE REPRODUCTIVE HEALTH OF WOMEN IN A SOUTH-AFRICAN CITY

Post-apartheid South Africa is faced with the effects of a distorted u rbanisation process. A coherent response to urbanisation includes the mitigation of the adverse health effects of urbanisation. Women, by vi rtue of the stringent control of their movements to urban areas under apartheid, have migrated to the urban areas at an increasing rate rece ntly. One consequence has been the transformation of traditional house hold structures consonant with changing patterns of fertility and infe rtility in the urban areas. This paper describes the composition of ho useholds in Khayelitsha, South Africa, a suburb that has seen an explo sive increase in population over a 5-year period, from 5000 to an esti mated 250,000 people. A survey of 659 households revealed that woman-h eaded households increased from 11% in those women who had been in the urban areas for fewer than 5 years, to 35% in those who had been in t he urban areas for more than 20 years. This was not a function of wido whood or divorce, but appears to be an adaptive strategy adopted by wo men in the face of gender oppression in a harsh urban environment. The study also revealed the phenomenon of ''alliance'' household formatio n. in which atypical households made up of a variety of non-descript c ombinations of people provide support for women from remote rural area s, another adaptive strategy. Fertility was related to age, income, ed ucation and urbanisation. Women who had been in the urban areas for lo nger than 10 years had a total fertility rate (TFR) of 2.5, while thos e who had been in the urban areas for less than 10 years had a TFR of 5.8. Reported infertility was related to marital status, education, gy naecological illness and urbanisation, with recently urbanised women r eporting more infertility. This probably reflects the different expect ations of rural women and changes the mix of attitudes to fertility in the urban areas substantially. These findings have major implications for population policies in South Africa and an eclectic mix of approa ches, including small area-specific approaches, to family spacing is r ecommended. Copyright (C) 1996 Elsevier Science Ltd