Food insecurity, intimate partner violence, and barriers to sexual and reproductive health care among women in Lorentzville, South Africa

In this article, we explored the ways that food insecurity, gender, migration, and intimate partner violence (IPV) intersect with and restrict access to sexual and reproductive health (SRH) services among women engaging in sex work in South Africa. We draw on broader qualitative data collected between 2022 and 2023 through ethnographic methods. This article specifically draws on data from in-depth semi-structured interviews with 15 participants. Thematic analysis was employed to examine the socio-economic and structural conditions shaping women's lived experiences, focusing on their adaptive strategies to mitigate food insecurity and access SRH services. We argue that food insecurity drives transactional relationships, with hunger influencing economic choices while contributing to women's vulnerability to gender-based violence and limiting their access to SRH services. This limited access, especially to contraception and abortion, further exacerbates the risks faced by these women, exposing them to compounded health and social challenges. We show that impoverished inner-city women experience significant gaps in healthcare and social welfare systems. We emphasize the need to view women's actions as adaptive strategies to constrained circumstances. We underscore the need for comprehensive policy interventions that expand healthcare access for migrant populations and address the economic vulnerabilities that propel women into transactional sex. Our findings contribute to the literature on gender, migration, and survival strategies, demonstrating the importance of intersectional approaches in addressing food insecurity, violence, and reproductive justice. • Food insecurity increases women's vulnerability to intimate partner violence in transactional sex relationships. • Barriers to reproductive and general health care limit access for women engaging in transactional sex. • Intimate partner violence worsens health outcomes for marginalised women in South Africa. • Structural inequalities link food insecurity, violence, and limited health care access. • Addressing food insecurity and violence requires intersectional, community-focused interventions.