Browsing by Author "Cooper, Diane"

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    Conscientious objection and its impact on abortion service provision in South Africa: a qualitative study
    (2014-02-26) Harries, Jane; Cooper, Diane; Strebel, Anna; Colvin, Christopher J
    Abstract Background Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion often on the grounds of religious or moral beliefs including the unregulated practice of conscientious objection. Few studies have explored how providers in South Africa make sense of, or understand, conscientious objection in terms of refusing to provide abortion care services and the consequent impact on abortion access. Methods A qualitative approach was used which included 48 in-depth interviews with a purposively selected population of abortion related health service providers, managers and policy influentials in the Western Cape Province, South Africa. Data were analyzed using a thematic analysis approach. Results The ways in which conscientious objection was interpreted and practiced, and its impact on abortion service provision was explored. In most public sector facilities there was a general lack of understanding concerning the circumstances in which health care providers were entitled to invoke their right to refuse to provide, or assist in abortion services. Providers seemed to have poor understandings of how conscientious objection was to be implemented, but were also constrained in that there were few guidelines or systems in place to guide them in the process. Conclusions Exploring the ways in which conscientious objection was interpreted and applied by differing levels of health care workers in relation to abortion provision raised multiple and contradictory issues. From providers’ accounts it was often difficult to distinguish what constituted confusion with regards to the specifics of how conscientious objection was to be implemented in terms of the Choice on Termination of Pregnancy Act, and what was refusal of abortion care based on opposition to abortion in general. In order to disentangle what is resistance to abortion provision in general, and what is conscientious objection on religious or moral grounds, clear guidelines need to be provided including what measures need to be undertaken in order to lodge one’s right to conscientious objection. This would facilitate long term contingency plans for overall abortion service provision.
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    Determinants of sexual activity and its relation to cervical cancer risk among South African Women
    (BioMed Central Ltd, 2007) Cooper, Diane; Hoffman, Margaret; Carrara, Henri; Rosenberg, Lynn; Kelly, Judy; Stander, Ilse; Denny, Lynnette; Williamson, Anna-Lise; Shapiro, Samuel
    BACKGROUND:Invasive cervical cancer is the commonest cause of cancer morbidity and mortality in South African women. This study provides information on adult women's sexual activity and cervical cancer risk in South Africa. METHODS: The data were derived from a case-control study of hormonal contraceptives and cervical cancer risk. Information on age of sexual debut and number of lifetime sexual partners was collected from 524 incident cases and 1541 hospital controls. Prevalence ratios and adjusted prevalence ratios were utilised to estimate risk in exposures considered common. Crude and adjusted relative risks were estimated where the outcome was uncommon, using multiple logistic regression analysis. RESULTS: The median age of sexual debut and number of sexual partners was 17 years and 2 respectively. Early sexual debut was associated with lower education, increased number of life time partners and alcohol use. Having a greater number of sexual partners was associated with younger sexual debut, being black, single, higher educational levels and alcohol use. The adjusted odds ratio for sexual debut < 16 years and [greater than or equal to] 4 life-time sexual partners and cervical cancer risk were 1.6 (95% CI 1.2 - 2.2) and 1.7 (95% CI 1.2 - 2.2), respectively. CONCLUSION: Lower socio-economic status, alcohol intake, and being single or black, appear to be determinants of increased sexual activity in South African women. Education had an ambiguous effect. As expected, cervical cancer risk is associated with increased sexual activity. Initiatives to encourage later commencement of sex, and limiting the number of sexual partners would have a favourable impact on risk of cancer of the cervix and other sexually transmitted infections
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    Health care provider perspectives on pregnancy and parenting in HIV-positive individuals in South Africa
    (BioMed Central, 2014-09-12) Moodley, Jennifer; Cooper, Diane; Mantell, Joanne E; Stern, Erin
    Background: Within the health system, limited attention is given to supporting the fertility and parenting desires on HIV-positive people. In this study, we explore health care providers’ knowledge and perspectives on safer conception and alternate parenting strategies for HIV-positive people. Methods Between November 2007 and January 2008, in-depth interviews were conducted with 28 health care workers involved in providing HIV and/or antiretroviral services at public sector clinics in Cape Town, South Africa. Views on sexual and reproductive health services, pregnancy, childbearing and parenting in HIV-positive men and women were explored using a semi-structured interview guide. Data were analyzed using a thematic approach. Results: Providers recognized the sexual and reproductive rights of HIV-positive individuals, but struggled with the tension between supporting these rights and concerns about spreading infection. Limited knowledge of safer conception methods constrained their ability to counsel and support clients in realizing fertility desires. Providers believed that parenting alternatives that do not maintain biological and cultural linkage are unlikely to be acceptable options. Conclusions: Health care provider training and support is critical to providing comprehensive sexual and reproductive health care and meeting the fertility desires of HIV-positive people.
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    HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case-control study
    (BioMed Central Ltd, 2006) Moodley, Jennifer; Hoffman, Margaret; Carrara, Henri; Allan, Bruce; Cooper, Diane; Rosenberg, Lynn; Denny, Lynette; Shapiro, Samuel; Williamson, Anna-Lise
    BACKGROUND:Cervical cancer and infection with human immunodeficiency virus (HIV) are both major public health problems in South Africa. The aim of this study was to determine the risk of cervical pre-cancer and cancer among HIV positive women in South Africa. METHODS: Data were derived from a case-control study that examined the association between hormonal contraceptives and invasive cervical cancer. The study was conducted in the Western Cape (South Africa), from January 1998 to December 2001. There were 486 women with invasive cervical cancer, 103 control women with atypical squamous cells of undetermined significance (ASCUS), 53 with low-grade squamous intraepithelial lesions (LSIL), 50 with high-grade squamous intraepithelial lesions (HSIL) and 1159 with normal cytology. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multiple logistic regression. RESULTS: The adjusted odds ratios associated with HIV infection were: 4.4 [95% CI (2.3 - 8.4) for ASCUS, 7.4 (3.5 - 15.7) for LSIL, 5.8 (2.4 - 13.6) for HSIL and 1.17 (0.75 - 1.85) for invasive cervical cancer. HIV positive women were nearly 5 times more likely to have high-risk human papillomavirus infection (HR-HPV) present compared to HIV negative women [OR 4.6 (95 % CI 2.8 - 7.5)]. Women infected with both HIV and high-risk HPV had a more than 40 fold higher risk of SIL than women infected with neither of these viruses. CONCLUSION: HIV positive women were at an increased risk of cervical pre-cancer, but did not demonstrate an excess risk of invasive cervical cancer. An interaction between HIV and HR-HPV infection was demonstrated. Our findings underscore the importance of developing locally relevant screening and management guidelines for HIV positive women in South Africa.
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    The HIV epidemic and sexual and reproductive health policy integration: views of South African policymakers
    (BioMed Central, 2015-03-04) Cooper, Diane; Mantell, Joanne E; Moodley, Jennifer; Mall, Sumaya
    Background: Integration of sexual and reproductive health (SRH) and HIV policies and services delivered by the same provider is prioritised worldwide, especially in sub-Saharan Africa where HIV prevalence is highest. South Africa has the largest antiretroviral treatment (ART) programme in the world, with an estimated 2.7 million people on ART, elevating South Africa’s prominence as a global leader in HIV treatment. In 2011, the Southern African HIV Clinicians Society published safer conception guidelines for people living with HIV (PLWH) and in 2013, the South African government published contraceptive guidelines highlighting the importance of SRH and fertility planning services for people living with HIV. Addressing unintended pregnancies, safer conception and maternal health issues is crucial for improving PLWH’s SRH and combatting the global HIV epidemic. This paper explores South African policymakers’ perspectives on public sector SRH-HIV policy integration, with a special focus on the need for national and regional policies on safer conception for PLWH and contraceptive guidelines implementation. Methods: It draws on 42 in-depth interviews with national, provincial and civil society policymakers conducted between 2008–2009 and 2011–2012, as the number of people on ART escalated. Interviews focused on three key domains: opinions on PLWH’s childbearing; the status of SRH-HIV integration policies and services; and thoughts and suggestions on SRH-HIV integration within the restructuring of South African primary care services. Data were coded and analysed according to themes. Results: Participants supported SRH-HIV integrated policy and services. However, integration challenges identified included a lack of policy and guidelines, inadequately trained providers, vertical programming, provider work overload, and a weak health system. Participants acknowledged that SRH-HIV integration policies, particularly for safer conception, contraception and cervical cancer, had been neglected. Policymakers supported public sector adoption of safer conception policy and services. Participants interviewed after expanded ART were more positive about safer conception policies for PLWH than participants interviewed earlier. Conclusion: The past decade’s HIV policy changes have increased opportunities for SRH–HIV integration. The findings provide important insights for international, regional and national SRH-HIV policy and service integration initiatives.
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    Meeting the contraceptive needs of HIV positive adolescent females living in urban townships in Western Cape, South Africa: perspectives of clients and primary health care providers
    (University of Cape Town, 2020) Olagbuji, Biodun Nelson; Moodley, Jennifer; Mathews, Catherine; Cooper, Diane
    Background: Contraception remains the cornerstone of the global strategy to prevent unintended pregnancy, as well as horizontal and perinatal/postnatal HIV transmission in women living with HIV (WLHIV), including female adolescents living with HIV (ALHIV). Although increased data and research on WLHIV contraception has provided opportunities to strengthen contraception services in HIV programmes, little is known about ALHIV contraceptive behaviours and needs, as well influences on their access to and utilisation of contraceptive services to inform the design of strategies that would enhance optimal contraceptive services in ALHIV programmes. Methods: A mixed-methods design included a cross-sectional study of female ALHIV (n=303) through a questionnaire survey, and semi-structured in-depth interviews with both system- and service delivery-level providers (N=19). Quantitative data were analysed using Stata 15. Quantitative analyses include descriptive statistics and regression modelling, including multinomial and multivariate logistic regressions. Thematic analysis of qualitative data was conducted using Nvivo 11. Quantitative and qualitative data were triangulated in the interpretation of results. Results: Contraceptive prevalence (83.5%) is extremely high among all the female ALHIV and even higher among sexually active female ALHIV (86.8%), and contraceptive prevalence rates are at least 20% higher than the South Africa Demographic and Health Survey (SADHS) rate for the general population of female adolescents or sexually active female adolescents. The rate of unmet need for contraception (23.6%) remains considerable. Contraceptive prevalence is also high among both female with peri/postnatally acquired HIV (pALHIV) and horizontally acquired HIV (hALHIV). The majority of current contraceptive users relied on injectables (60.5%), followed by condoms alone (27.7%), then long-acting reversible contraceptives [LARC](9.1%) and hormonal pills (2.7%). Almost 1 in 5 (18.8%) female ALHIV had an unintended pregnancy. When contraceptive use consistency was restricted to the three months preceding the survey, levels of consistent condom use and dual-method use were 37.9% and 20.6%, respectively. Also, the quantitative data shows multiple barriers and facilitating factors for contraceptive uptake among female ALHIV. Overall, both the quantitative and qualitative data generally found that the receipt of contraceptive provision and use are similar between female pALHIV and hALHIV; however, the quantitative data suggest that pALHIV were more likely to experience unintended pregnancies compared to hALHIV. Though the quantitative data lack information on the particular hormonal method associated with HIV-specific safety concerns, there is evidence suggesting that the concern about HIV-specific hormonal contraceptive-related risks does not impact hormonal contraceptive uptake among ALHIV. Furthermore, adolescent-friendly services (AFS) appear to have been reasonably well-mainstreamed into routine care in the Cape Town context at least, to the extent that standalone youth clinics do not appear to provide significant added value to contraception-related outcomes among female ALHIV. The qualitative data highlighted preponderance of injectable contraception, inconsistent contraceptive use, fears about the intrauterine device (IUD) use, positive and negative provider attitudes to contraceptive services for ALHIV, and provider competency and training, among others. Conclusion: Overall, the thesis supports socioecological-based approaches to contraceptive care for female ALHIV as well as mainstreaming AFS within public sector facilities. Moreover, potential risk-reducing interventions, such as a client-centred approach to contraceptive care, are needed to improve pALHIV's risk of unintended pregnancies.
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    Nurses and their work in tuberculosis control in the Western Cape : too close for comfort
    (1998) Van der Walt, Hester Maria; Swartz, Leslie; Cooper, Diane
    The setting for the research is the urban areas of Cape Town, South Africa where the notification rate of tuberculosis is the highest in the world. Despite the availability of modern drugs, the cure rate is low and approximately 40% of diagnosed patients do not adhere to treatment. This has serious implications for the spread of multiple drug-resistant tuberculosis. The relationship between the patient and health care providers is one of the main determinants of compliance to medical treatment. The main aim of the thesis is to develop an understanding of how nurses experience their work with patients who have pulmonary tuberculosis. The research explores how nurses interact with patients, how nurses perceive their relationship with patients and the processes and organisational arrangements which contribute to the patterns of nurse-patient interaction. The interpretive research design was largely informed by an ethnographic approach. The iterative research process led to several sub-studies; the analysis of each sub-study led to a further cycle of data collection. Data collection techniques include participant observation of nurse-patient interaction and depth interviews with nurses and key informants. An exploration of opportunities to change the prevailing work patterns yielded data on nurses' responses to change. The data were captured as field notes or audio taped and analysed thematically by using qualitative methods and by the application of psychodynamic theory. The research identifies task orientation and patient-centredness as the main patterns of nurse-patient interaction. Task orientation was found to be the dominant work pattern. Its origins are traced to the colonial history and to the influence of Taylorist labour practices. Task orientated work patterns are maintained because of complex mechanisms which operate at both intrapersonal and interpersonal levels. It is argued that the history of racial politics and racial identity has influenced the ways in which nurses manage the degree of distance between themselves and patients. The findings suggest that the closer the nurses identify with patients in terms of ethnic background, the more the nurses may feel the need to distance themselves from the patients. The notion of tuberculosis as a stigmatised disease, the concept of compliance, and the implementation of control measures such as directly observed therapy are critically examined. An exploration of the illness experiences of nurses who become infected with tuberculosis, provides an opportunity to explore how nurses perceive the role of the caregiver when they are in the unfamiliar position of being patients. The findings have implications for public health interventions aimed at transforming nurse-patient interaction. It is recommended that change management processes explicitly acknowledge the consequences of decades of apartheid policies and practices on the behaviour of health professionals and the users of health services. In the years to come change agents will need to address the emotional pain of the past, as well as the more well-known sources of organisational resistance to change.
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    Patterns, dynamics and influencing factors of Disclosure of HIV status among women and men living with HIV in Cape Town, South Africa
    (2012) Austin, Evelyn; Cooper, Diane
    The aim of this study was to explore and examine the patterns, dynamics and influencing factors of HIV status disclosure among men and women at ARV clinics in low-income area clinics in Cape Town, South Africa and highlight areas for intervention and counselling improvement. The specific objectives were to: * Understand the factors that are associated with disclosure * Explore factors that constrain/promote disclosure of HIV status * Explore who people disclose to and why? * Investigate what impact positive/negative reactions may have had on one's health and hopefulness of living with the virus. * Make recommendations on how to address disclosure in support and treatment programs for people living with HIV. This is a sub-study of a larger study to determine the effectiveness of reproductive health interventions in 4 clinics in Cape Town. This sub-study makes use of the first two sets of interviews out of a total of 3. This was a cohort study design with structured interviews and patient exit interviews. Data were collected between September 2007 and December 2008 in the four clinics. Ethics approval was granted by the Health Sciences Faculty Research Ethics Committee - REC REF: 429/2006. Given the constantly changing nature of HIV in South Africa, tracking changes in the dynamics of disclosure over time is important, rather than relying on 'snapshot' perspectives. Analysis was fore grounded in global and Sub-Saharan African trends to draw out specificities from the South African context. The study concluded by highlighting gaps for further research and practical implications for the future of HIV prevention, support, care and treatment programming.
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    Perspectives on contraceptive implant use in women living with HIV in Cape Town, South Africa: a qualitative study among primary healthcare providers and stakeholders
    (2019-07-26) Brown, Anna; Harries, Jane; Cooper, Diane; Morroni, Chelsea
    Abstract Background This study explored primary healthcare provider and HIV/contraception expert stakeholder perspectives on South Africa’s public sector provision of contraceptive implants to women living with HIV. We investigated the contraceptive service-impact of official advice against provision of implants to women using the HIV antiretroviral drug, efavirenz, issued by the South African National Department of Health (NDoH) in 2014. Methods Qualitative data was collected in Cape Town in 2017 from primary healthcare contraceptive providers in four clinics that provide implants, as well as from other expert stakeholders selected for expertise in HIV and/or contraception. In-depth interviews and a group discussion explored South Africa’s implant introduction and implant provision to women living with HIV. Data was analysed using an inductive thematic analysis approach. Results Interviews were conducted with 10 providers and 10 stakeholders. None of the four clinics where the providers worked currently offered the implant to women living with HIV. Stakeholders confirmed that this was consistent with patterns of implant provision at primary healthcare facilities across Cape Town. Factors contributing to providers’ decisions to suspend provision of the implant to women living with HIV included: inadequate initial and ongoing provider training; interpretation of NDoH communications about implant use with efavirenz; provider unwillingness to risk harming clients and concerns about professional liability; and other pressures related to provider capacity. Conclusions All South African women, including those living with HIV, should have access to the full range of contraceptive options for which they are medically eligible. Changing guidance should be initiated and communicated in consultation with primary-level providers and service beneficiaries. Guidance issued to providers needs to be clear and fully evidence-informed, and its correct interpretation and implementation facilitated and monitored. Guidance should be accompanied by provider training, as well as counselling messages and tools to support providers. Generalized retraining of providers in rights-based, client-centred family planning, and in particular implant provision for women with HIV, is needed. These recommendations accord with the right of women living with HIV to access the highest possible standard of sexual and reproductive healthcare, including informed contraceptive choice and access to the contraceptive implant.
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    Policy maker and health care provider perspectives on reproductive decision-making amongst HIV-infected individuals in South Africa
    (BioMed Central Ltd, 2007) Harries, Jane; Cooper, Diane; Myer, Landon; Bracken, Hillary; Zweigenthal, Virginia; Orner, Phyllis
    BACKGROUND:Worldwide there is growing attention paid to the reproductive decisions faced by HIV-infected individuals. Studies in both developed and developing countries have suggested that many HIV-infected women continue to desire children despite knowledge of their HIV status. Despite the increasing attention to the health care needs of HIV-infected individuals in low resource settings, little attention has been given to reproductive choice and intentions. Health care providers play a crucial role in determining access to reproductive health services and their influence is likely to be heightened in delivering services to HIV-infected women. We examined the attitudes of health care policy makers and providers towards reproductive decision-making among HIV-infected individuals. METHODS: In-depth interviews were conducted with 14 health care providers at two public sector health care facilities located in Cape Town, South Africa. In addition, 12 in-depth interviews with public sector policy makers and managers, and managers within HIV/AIDS and reproductive health NGOs were conducted. Data were analyzed using a grounded theory approach. RESULTS: Providers and policy makers approached the issues related to being HIV-infected and child bearing differently. Biomedical considerations were paramount in providers' approaches to HIV infection and reproductive decision-making, whereas, policy makers approached the issues more broadly recognizing the structural constraints that inform the provision of reproductive health care services and the possibility of "choice" for HIV-infected individuals. CONCLUSION: The findings highlight the diversity of perspectives among policy makers and providers regarding the reproductive decisions taken by HIV-infected people. There is a clear need for more explicit policies recognizing the reproductive rights and choices of HIV-infected individuals.
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    Renegotiating intimate relationships with men: how HIV shapes attitudes and experiences of marriage for South African women living with HIV: 'Now in my life, everything I do, looking at my health'
    (Juta Law, 2013) Cooper, Diane; Moore, Elena; Mantell, Joanne
    This paper explores marriage attitudes and practices among Xhosa-speaking women living with HIV (WLHIV) in Cape Town, South Africa. It reports on a study that assessed the fertility intentions of a cohort of people living with HIV, aimed at informing an HIV care intervention. It draws on qualitative data generated from 30 successive interviews with WHLIV in wave 1, 23 interviews in wave 2 and 20 follow-up interviews in wave 3. Gender inequality, marriage and HIV are strongly intertwined. Broader layers of South Africa's history, politics and socio-economic and cultural contexts have consequences for the fluidity in intimate relations, marriage and motherhood for WLHIV. Key and conflicting themes emerge that impact on marriage and motherhood. Firstly, marriage is the ‘last on a list of priorities’ for WLHIV, who wish to further their children's education, to work, to earn money, and to achieve this rapidly because of their HIV-positive status. We demonstrate that the pressure women face in marriage to bear children creates a different attitude to and experience of marriage for WLHIV. Some WLHIV wish to avoid marriage due to its accompanying pressure to have children. Other WLHIV experience difficulties securing intimacy. WLHIV may find it easier to seek partners who are also living with HIV. A partner living with HIV is perceived as sharing similar fertility goals. In this study, HIV accentuates existing issues and highlights new ones for WLHIV negotiating intimacy.
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    Utilization of a multi-sectoral approach in strengthening cross-sectoral referrals of survivors of sexual violence from the health sector in Kenya
    (2020) Agesa, Carolyne Ajema; Cooper, Diane; Artz, Lilian
    Background: Sexual violence policy frameworks and service delivery models are well defined in Kenya. However, little is known about the extent to which different sectors effectively work together to ensure survivors receive comprehensive care. The need for a multi-sectoral response framework has been cited in the literature. Nonetheless, it is not clearly defined what this entails in the Kenyan context. Aim: This thesis aimed at reviewing and documenting the processes involved in the delivery of services by the different sectors with a focus on patient flow, data systems, community perceptions and referral mechanisms The study also aimed to develop an in-depth understanding of the factors that influence reporting of cases of sexual violence, provision of services and uptake of available services. Also explored were the requisites for a coordinated and multi-sectoral approach to sexual violence. Methods: This is a cross-sectional study that applied a mixed-methods approach. Qualitative interviews were conducted with 23 service providers, survivors and caregivers. The quantitative component entailed abstraction of service statistics from records maintained for survivors. A total of 1259 records were obtained from two hospitals, two police stations and two courts in two counties in Kenya. Key informant guides were used for the qualitative interviews, while an Excel data abstraction tool was implemented to capture data obtained from service statistics. Thematic analysis of qualitative data was undertaken using NVivo 12. The records were analysed using SPSS Version 20.0 The Anderson model (1973) informed the interpretation of the qualitative data. Data were triangulated during the analysis across the interviews and service records. Findings: Defilement constitute the largest proportion of cases of sexual violence reported across different sectors. Poor quality of sexual violence data maintained for survivors across different service delivery points presents a difficulty in tracking survivors to examine completeness in service uptake. Existent difficulties persist in determining the extent to which the different sectors are responsive to the survivor's need for quality and comprehensive services. Survivors--more so female and children--do not have autonomy in decision making regarding whether to report a sexual violation meted on them or not. Lack of a standardized multi-sectoral referral framework contributes to survivor frustration in accessing services due to the multiple referral pathways, costs and time delays involved. There is continued reliance on informal community level arbitration of cases despite the existing legal provisions in the Sexual Offences Act. Conclusion: The Anderson (1973) framework provides a basis for an in-depth understanding of survivors' service utilization related behaviours and decisions. The findings reveal the interconnectedness of predisposing enabling and need factors in the context of the available services and decision making on what service to take up. While the health sector and police continue to play a key role in response to sexual violence, there still exist gaps that impede the comprehensiveness in response. Communities still prefer reaching out to informal sources of support. However, there is a disconnect between formal and informal sources of support. The need for a multi-sectoral and coordinated approach to sexual violence is critical, and its design should be informed by the needs of survivors. Measures should be put in place to address enabling factors to service access through training of providers on the management of survivors. This study provides anecdotal evidence to be utilized in informing development and implementation of multi-sectoral models of post-sexual violence service delivery models in Kenya and in Sub-Saharan Africa.
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    Women's social position and their health : a case study of the social determinants of the health of women in Khayelitsha, Cape Town, South Africa
    (1995) Cooper, Diane; Jonny Myers
    This thesis examines the social determinants of women's health status, health knowledge and knowledge and use of health services in a peri-urban area, using Kbayelitsha in Cape Town, South Africa as a case study. It argues for the importance of women's health as a specific focus, looks at some trends in women's health internationally over the past two decades and reviews the main factors affecting women's health. Some key issues in women's health of special relevance to developing countries such as South Africa are discussed. There is a special focus on newly urbanised women in peri-urban areas. Against this background the results of a community-based survey, preceded by indepth interviews, and conducted amongst 659 women in Kbayelitsha in 1989 and 1990 are presented. Data collected were statistically analysed using unIvariate,, bivariate and multivariate analysis. A number of priority social and health problems are identified: poverty; poor environmental conditions; lack of education, partlcularly skills training appropriate for finding work and the subordinate social status of women. Major health concerns included reproductive tract infections, especially sexually transmitted diseases, infertility, contraceptive use and ante-natal care during pregnancy. There were inadequacies in cervical screening conducted by health services and deficiencies in respondents' knowledge of AIDS. cervical smears and where to obtain various health services . Young, newly urbanised women, living in the poorly serviced and unserviced informal housing areas were partlcularly vulnerable in their socio-economic and health status within a peri-urban African community such as Khayelitsha. They also had poorest health knowledge and least knowledge of where to acquire health services. Some recommended interventions focussing on certain of these areas are suggested. It is argued that changes in the provision of women's health services within a primary health care setting can only be part of the process of improving women's health. Improvements in women's economic status and their social status are fundamental to any initiatives to improve their health status.