Sexuality and reproductive knowledge and justice in preconception and life course health: a small-scale qualitative gender analysis in Soweto, South Africa

Background Globally, research and public health interest in preconception health is growing. Preconception health is a public health agenda aiming to intervene before people reproduce to improve current and transgenerational disease risk. One key project of preconception health agendas will be to improve sexuality and reproductive (S&R) health knowledge through health promotion and education. Sexuality and reproductive knowledge is, however, influenced by specific historical, socio-political and structural contexts. We investigate gendered inequities existing in a South African population’s S&R knowledge that preconception health strategies must address. Methods Our research was guided by a feminist Sexual and Reproductive Justice lens. We collected qualitative data using single semi-structured interviews with Bukhali trial men ( n = 8) and women ( n = 9) in Soweto, Johannesburg. Bukhali is the South African cohort of the Healthy Life Trajectories Initiative - the flagship international consortium trial investigating the effects of a complex intervention on the life course, including the preconception period. Interviews were transcribed verbatim and de-identified and analysed using reflexive thematic analysis. Results Based on our interpretation of the data, we generated three dominant themes that make visible gendered inequities in South African’s S&R knowledge regarding access and content. The first theme makes visible the intergenerational avoidance of open S&R communication that disproportionately affects men. The second highlights the culturally significant value around gender-aligned S&R content and communication that emphasises heteronormativity. Finally, theme three shows how clinical spaces create and reproduce inequitable gendered epistemic norms around S&R knowledge. Conclusions We find that the content of and access to S&R knowledge amongst our participants is significantly and inequitably gendered, and influenced by historical, sociopolitical, cultural structures. Our findings show that men are more frequently excluded from S&R knowledge, and that women are disproportionately burdened with epistemic responsibilities. Based on our findings, we recommend that preconception health and life course agendas be epistemically and structurally gender-inclusive to promote sexual and reproductive justice.