This issue of Agenda goes to print at a time when a National Health Insurance Policy has been proposed by the state amid the failure of health service delivery to meet demands placed on it. Our country’s women carry a very high burden of disease testified by the relentless rise in the rate of maternal mortality (and the probable failure of South Africa to meet the Millennium Development Goal target on maternal health). The centrality of women to the crisis in health is hard to ignore: women also bear the brunt of inadequate health service provision, nationally, as social norms dictate that they should ‘naturally’ be the caretakers and nurturers who are responsible for the health in the household and often communities. If we are optimistic we might believe that the complete transformation of the health platform and the redistribution of available health resources proposed could achieve the sorely needed improvement in women’s health care delivery. However, as feminists we would be guilty of self-delusion if we believe this is possible without interrogation, critique and consultation among ourselves on the new NHI’s impact on women, as the policy is neither gender neutral,
nor does it provide guarantees that women’s gender-specific concerns will be respected and implemented.
This issue of Agenda, therefore, very timeously, brings the question of women’s health under the spotlight and at the same time reminds us of the critical links between recent struggles, feminist engagement and social activism around it. In the post-apartheid era, social movements, women’s reproductive rights organisations and alliances and coalitions of women’s groups have mobilised for the introduction of urgently needed reforms in law and policy for gender justice for women and women’s health rights. Groups within Parliament and the government’s gender machinery and health structures have not been unimportant in the progress that is made women’s enfranchisement and political representation mean that feminists can call for government accountability in terms of gender equity in relation to policy. Some milestones fresh in collective memory that this issue cannot ignore in contextualising the politics of women’s health are the legalisation of abortion, the right to effective treatment for people who are HIV positive, reform of the criminal law on sexual violence and reparation for victims of domestic violence, and the right of rape victims to post-exposure prophylaxis (PEP). Feminists need to question how far we have come in implementing reforms and why we have run short of success in important areas where women are still experiencing serious abuses in the health system. In so doing we need to frame our critiques of policy and the nature of the state in terms of ideology and women’s political situation. Such critiques will be necessary to overcome sexist bias in health services delivery in the country.
By focusing on politics and the processes which contribute to shifts in policy (and its implementation) we have an opportunity to question and enquire into how well it serves women’s gender-specific health needs and look at where we should be in terms of health policy. Apartheid health’s legacy and the HIV AIDS pandemic have been blamed, perhaps correctly, for many of the problems which beset women’s health and health care delivery by the public health system 18 years into the post-apartheid democracy. When Agenda published the issue ‘AIDS: Counting the cost’ (#39, 1998) women AIDS activists demanded that AIDS be seen in social terms and not in the narrow medico-legal framework. The authors in this issue also emphasised how the unequal power relations between men and women and gender difference were shaping HIV/AIDS and it needs to be said, they offered vehement resistance to the labelling of women as the ‘cause of disease’ and the stereotyping and stigma attached to HIV. That HIV/AIDS is a critical area of women’s political struggle for rights, particularly sexual and reproductive rights, may, therefore, be an understatement. As it continues to affect almost every area of women’s lives, feminists continue to interrogate and question the socio-economic and political drivers of women’s vulnerability to HIV infection. The guest editors of this issue Mandisa Mbali and Sethembiso Mthembu are both feminist health activists well known in the HIV/AIDS sector, as well as writers and researchers. They have brought to this special issue their knowledge and activist perspectives on women’s health in South Africa, as well as the question of what we can claim as its politics.