In the Absence of Marriage: Relationship and Fertility Contexts of HIV and Pregnancy Risk among Young Adults in South Africa

Abigail Harrison, Brown University
Lucia O'Sullivan, University of New Brunswick

Global reproductive health policy prioritizes a reduction in HIV prevalence among young women in southern Africa. This paper examines qualitatively the relationships between marriage, partnering, fertility and HIV risk in rural KwaZulu/Natal, South Africa, based on in-depth interviews with 47 young adults aged 18-24 (23 men; 24 women), with follow-up interviews (n=29;10 men, 19 women) two years later. Long term primary relationships were common for young men and women, with simultaneous casual partnerships that changed frequently. Dynamic preventive behaviors reflected partnership type and expectations. Condom use increased over time in some primary relationships, but reduced in others due to perceived trust and marital aspirations; condoms were nearly universal with casual partners. Although not desired, pregnancy was common, and accepted within primary relationships, although childbearing increased women’s social vulnerability. With pregnancy prevention an important goal for most young people, reproductive health programs should emphasize the relationship and fertility contexts of risk.