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    The unravelling of person-centred care: The value and necessity of analysing power relations in contraceptive services
    (SAGE Publications, 2025-04-30) Morison T; Macleod CI; Ndabul Y
    Global research indicates ongoing challenges in delivering person-centred contraceptive care. Much of the contraceptive research investigates this issue using systems-focussed approaches to map institutional constraints (e.g. institutional or health system barriers to accessing contraception). The assumption underlying this research approach is that simply removing structural barriers can address issues and enhance contraceptive autonomy, but this is not the case. Our research shows how discursively constructed power relations undermine bodily integrity and contraceptive agency even as contraceptive providers endorse the principles of patient-centred care. Using a synthetic narrative/discourse approach to analyse provider interviews in South Africa and New Zealand, we draw on Foucauldian analytics of biopower to show how an idealised person-centred care narrative collapses under the weight of discourses of medicalised risk, protectionism, and biomedical expertise, signalling practices of power through confession, responsibilisation and surveillance. Our findings highlight an essential perspective frequently missing in systems-focussed research on contraceptive care: the crucial dimension of power and reproductive politics. Thus, we argue for the necessity of investigating this dimension, in addition to systemic challenges. Our work demonstrates the value of frameworks that illuminate power dynamics, such as the Foucauldian analytics of biopower we undertook. Expanding the range of research perspectives in contraceptive research can deepen understandings of how systems constraints and power relations together undermine relational person-centred contraceptive care.
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    Use and perceptions of public Sexual and Reproductive Health services: A quantitative situational analysis in OR Tambo and Gert Sibande districts
    (Human Sciences Research Council, 2016) Morison T; Lynch I
    This report presents the findings of a quantitative situational analysis of the use and perceptions of the quality of health care services among healthcare users in two districts, using survey methodology. The report was commissioned by the AIDS Foundation of South Africa (AFSA) as part of their three-year Sexual and Reproductive Health and Rights (SRHR) programme. The study is framed within a Sexual and Reproductive Justice framework. This conceptual approach expands the rights-based perspective to consider wider contextual factors like socio-economic status, gender, disability, race, and sexuality as potential barriers to Sexual and Reproductive Health and Rights (SRHR). The primary aim of the study was to identify the key advocacy strategies and levers for change with respect to access to SRHR, identified from a situational analysis of selected facilities. These will inform the work of AFSA’s implementing partners. Survey methodology was used to ascertain people’s own perceptions and experiences of services in terms of access, quality, and satisfaction with general as well as SRH-specific services in the public health system.