Introduction
Setting
Methods
Quantitative sub-study
District | A Bojanala | B Klipfontein | C King Cetshwayo | D Ehlanzeni | E Nelson Mandela Bay | F Thabo Mofutsanyana | Total |
---|---|---|---|---|---|---|---|
Freq (%) | Freq (%) | Freq (%) | Freq (%) | Freq (%) | Freq (%) | ||
Principal Recipient | PR 1 | PR 1 | PR 2 | PR 2 | PR 3 | PR 3 | |
AGYW 15–19 years in school | 24/200 (12.0%) | 6/200 (3.0%) | 43/200 (21.5%) | 79/200 (39.5%) | 30/200 (15.0%) | 30/200 (15.0%) | 212/1200 (17.7%) |
AGYW 15–19 years out of school | 9/40 (22.5%) | 9/40 (22.5%) | 15/40 (37.5%) | 1/40 (2.5%) | 5/40 (12.5%) | 13/40 (32.5%) | 52/240 (21.7%) |
AGYW 20–24 years | 30/120 (25.0%) | 43/120 (35.8%) | 68/120 (56.7%) | 28/120 (23.3%) | 35/120 (29.2%) | 47/120 (39.2%) | 251/720 (34.9%) |
Total AGYW | 63/360 (17.5%) | 58/360 (16.1%) | 126/360 (35.0%) | 108/360 (30.0%) | 70/360 (19.4%) | 90/360 (25.0%) | 515/2160 (23.8%) |
Survey measures
Analysis of survey data
Qualitative sub-study
Ethical considerations
Results
Survey sample realization
Characteristics of survey participants and risk profiles by safe space access
Variable | Total sample N (%) | Accessed a Safe Space = 1 Freq (%) | Pearson Chi2 comparing those who did and did not access a Safe Space for each variable (Test statistic) P value |
---|---|---|---|
Age group | |||
15–19 years | 264 (51.3) | 52 (18.7) | (1.5837) 0.21 |
20–24 years | 251 (48.7) | 61 (24.3) | |
SES* | |||
Relatively low | 147 (28.5) | 29 (13.6) | (8.3471) < 0.01 |
Relatively high | 368 (71.5) | 93 (25.3) | |
Hunger in household in past month | |||
Yes | 86 (16.7) | 23 (26.7) | (1.3902) 0.24 |
No | 429 (83.3) | 90 (21.9) | |
Orphan status | |||
Maternal and/or paternal orphan | 196 (38.1) | 40 (20.4%) | (0.4345) 0.51 |
Not orphaned | 319 (61.9) | 73 (22.9%) | |
Maternal orphan status | |||
Maternal orphan | 102 (19.8) | 24 (23.5) | (0.1872) 0.68 |
Not a maternal orphan | 413 (80.2) | 89 (21.6) | |
NEETa | |||
Yes | 62 (12.0) | 18 (29.0) | (2.0690) 0.15 |
No | 453 (88.0) | 95 (21.0) | |
Ever been pregnant | |||
Yes | 159 (30.9) | 32 (20.1) | (0.4429) 0.51 |
No | 356 (69.1) | 81 (22.8) | |
Ever had a transactional relationship with a man or transactional sex | |||
Yes | 26 (5.1) | 8 (30.8) | (1.2458) 0.26 |
No | 489 (95.0) | 105 (21.5) | |
Fear of male partner in past 6 months | |||
Yes | 77 (15.0) | 21 (27.3) | (1.5023) 0.22 |
No | 438 (85.0) | 92 (21.0) | |
Ever had sex | |||
Yes | 389 (75.5) | 87 (22.4) | (0.1663) 0.68 |
No | 126 (24.5) | 26 (20.6) | |
Had early sexual debut (< 15 years)b | |||
Yes | 26 (6.7) | 5 (19.2) | (0.1576) 0.69 |
No | 363 (93.3) | 82 (22.6) | |
Age disparate sex in past 6 months (>/= 5 years)b | |||
Yes | 58 (14.9) | 10 (17.2) | (1.0306) 0.31 |
No | 331 (85.1) | 77 (23.3) | |
Multiple male partners in past 6 months (> 1)b | |||
Yes | 81 (20.8) | 25 (30.9) | (4.2561) 0.04 |
No | 308 (79.2) | 62 (20.1) | |
Inconsistent condom use with last one (or two) partners b | |||
Yes | 303 (77.9) | 69 (22.7) | (0.1309) 0.72 |
No | 86 (22.1) | 18 (20.9) | |
Inconsistent use of contraceptives in past 6 monthsb | |||
Yes | 258 (66.3) | 56 (21.7) | (0.1920) 0.66 |
No | 131 (33.7) | 31 (23.7) | |
Languishing in terms of emotional well-being | |||
Yes | 74 (14.4) | 15 (20.3) | (0.1410) 0.71 |
No | 441 (85.6) | 98 (22.2) | |
High risk of depression | |||
Yes | 145 (28.2) | 31 (21.4) | (0.0373) 0.85 |
No | 379 (71.8) | 82 (22.2) | |
High Audit C Score (>/=2) | |||
Yes | 248 (48.2) | 52 (21.0) | (0.2650) 0.61 |
No | 267 (51.8) | 61 (22.9) |
Survey participants’ reports of experiences at the safe space among participants who had visited a safe space
Implementers’ views of acceptability of safe spaces and factors affecting implementation
Concerns around the safety of Safe Spaces was most notable in the Klipfontein district in Cape Town, Western Cape, where implementers were concerned that their Safe Spaces were not ‘safe’ for AGYW and their staff due to gang violence. Some implementers did not feel that it was safe to ask AGYW to come to the established venues, while others were unable to establish Safe Spaces due to these safety concerns. In these areas, implementers felt that it was particularly important to have strong relationships with local community members who could advise on safety concerns and protocols.Finding a safe enough space in a safe enough area, with access to a hall and office space, that was quite a long process. So, we eventually started just begging churches to let us in. (Western Cape, Implementer)
Some implementers explained that they were considering a strategy of implementing flexible/mobile Safe Spaces in these areas, to enable better access for AGYW.The issue of shootings in Manenberg and Hanover Park, that has made going to these areas very hard; there are areas that we did not go to at all because of these shootings… There are places where we had relationships with stakeholders, as a result they would tell us not to come, not to enter certain areas at certain times because there was a shooting. (Western Cape, Social worker)
Respondents explained that safety in implementing areas impacted on the retention of AGYW beneficiaries, and AGYW’s ability to access Safe Space venues and attend sessions consistently.If I just reflect on Manenberg as an example, our Safe Space that we identified, is located in one area of Manenberg, and obviously there is opposing gang turf… There are girls from one sector of Manenberg that can’t access our Safe Space because they can’t cross turf and they are known from a different part… so that is why we are looking to change from the established Safe Space to something that is more flexible so that we can actually then go into the different areas and access the young women in the different areas… our Safe Space is next to a shop where most of the gang leaders of the area hang out, and we didn’t know that initially… we had one of our staff members stuck at a traffic light with gangs shooting around her, hiding behind a car… so like lots of trauma! (Western Cape, Implementer)
The appropriate positioning of Safe Spaces, in locations that were easily accessible, convenient, and safe, was described as a key factor in their successful use.It’s very difficult for us at times to retain them in the programme... Because if you’re starting a session… even if it’s IMPOWER (self-defence), Teen Parenting or Grief (counselling). They will drop out! Reason being at times the areas where they are living it’s very dangerous… even for us if we have to go to the community at times, it’s difficult there’s a shooting, the area is vulnerable, the area you can’t walk in… you would find that our offices are in an area where they cannot go that side because the gangs are that side. (Western Cape, Social worker)
The Safe Space is very far for most of them, so I usually alternate the place, using a hall nearby, a place where people usually go… the community hall… or a school or the church. (KwaZulu Natal, Implementer)
Experiences across districts differed, with some Safe Space venues described as accessible and appropriate, whilst in other areas, most notably in rural areas, Safe Space venues had been difficult to reach. In some cases, where Safe Spaces and satellites had been inaccessible to AGYW, or poorly located, implementers hired community venues to improve service uptake. An additional factor impacting the accessibility of Safe Spaces related to transport. Using conveniently located community venues as Safe Spaces avoided complications of having to arrange transport for, or provide transport reimbursement money to, AGYW beneficiaries to get them to Safe Space venues.A place where you don’t need money for transport and other things. You just go there because it is in the centre of the location… anybody can access it from around the location… it’s a people-centred approach... Some are remote and are not accessible… take the programme or the service to the people. (Mpumalanga, Social worker)
Some implementers felt that barriers to accessibility, and challenges in recruiting AGYW, could be addressed through roaming/mobile satellite Safe Spaces offering services.We try to find venues closer to where they reside instead of doing this up and down of transport… we find a venue there so that it can be within walking distance. (Western Cape, Social worker)
Challenges in the implementation of the Safe Spaces component of the intervention highlighted the importance of having dedicated physical spaces/venues. However, there had been delays and difficulties in identifying and setting up Safe Spaces which meant that temporary Safe Spaces had to be created within clinics, schools, colleges or hired venues, which negatively impacted on service provision.We are actually looking at having Safe Spaces that move, like satellites… so that we actually get more access to girls that we are not currently able to reach in the current spaces. (Western Cape, Implementer)
Some implementers based at health facilities had conducive relationships with clinic staff and were assigned a dedicated room in the clinic to be used as a temporary Safe Space, however most struggled to obtain a dedicated space in clinics to receive AGYW. Implementers reported that clinic staff perceived the presence of AGYW programme staff as an added burden, and that they were less accommodating of implementers of programme components other than biomedical components, questioning their contribution to the clinic.If we could have had the Safe Spaces operating from day one, it would have been easy because they (AGYW) would know I come here and there is a room for biomedical, a room for psychosocial and a room for activities… there is an open place where we can do our CVs and what not. (Free State, Implementer)
Implementers who were working within schools but did not have Safe Spaces established, lamented that they could not offer AGYW more comprehensive services, for example access to computers and WIFI, homework support, and assistance to AGYW applying for scholarships and to universities.We seem to not be in clinics as often because they question why are community organizations actually working within a clinic structure… we have gone via the biomedical teams at points because they get access… then they’d know that we are affiliated and then we sort of had more of a right to be in the space because we’re with a biomedical organization or team. (Western Cape, Implementer)
Some implementers operating at schools and on college campuses described challenges in cases where they were not provided with a dedicated room or office space, that was appropriately private and confidential, where facilitators could base themselves. Lacking a dedicated space acted as a barrier to access, as AGYW would not know where to come to access services, or did not like being seen with programme staff at school due to fear of being stigmatised by their peers.We are based in schools and based out of schools… we don’t have that space where a person can stay for an hour or even two with you assisting them and guiding them and helping them to apply for the learnerships and internships, especially those who have finished matric. (Free State, Implementer)
AGYW’s concerns over the confidentiality of Safe Spaces emerged as a critical issue. One implementer described confidentiality concerns that emerged when temporary Safe Spaces were set up in schools.(We need) a space where the facilitator can be found in case a young girl needs something, they will know where to go and find her. Instead of looking for me amongst the teachers, you see. Because others might be afraid to come to me because she is afraid to come to the staffroom where there are all the teachers. (KwaZulu Natal, Implementer)
In the design of the intervention, the intention was to leverage on local infrastructure, such as existing governmental multi-purpose community care centres serving youth and vulnerable children and community halls, to act as Safe Spaces where AGYW could ‘drop in’ to access resources and services. However, implementers reported challenges setting up Safe Spaces in community venues due to bureaucracy and political dynamics of working with local power structures, such as ward councillors, traditional leaders, and municipal staff members, who acted as gatekeepers to community venues.When I go meet with her at school I will not divulge the reason for my visit, I will talk to the principal or teacher and inform them that there is a case of a learner that I’m attending but the fact that a child will be seen with me at school or leaving school with me is one of the things that make them uncomfortable sometimes. (Free State, Social worker)
Most open spaces and halls are taken up by other programmes… communities are quite programme heavy. (Western Cape, Implementer)
Implementers explained that local Ward Councillors could either enable or constrain their ability to locate and use suitable community venues. Relationships with Ward Councillors and traditional leaders also impacted on community acceptability of the programme and the recruitment of AGYW into Safe Spaces; in some cases assistance was provided by these community stakeholders with recruiting AGYW into Safe Spaces and other programme activities. Fostering good relationships with local leadership and authorities also enhanced the safety of the implementing team in the field, especially in districts where safety was a concern. In some communities, implementers experienced resistance from traditional leaders towards the programme, as it was perceived to be a threat to traditional customs and cultural norms. This was particularly the case in rural areas where the institution of traditional leadership has a stronger presence.We struggle for space… you have to ask, especially with things involving councillors... You are told you have to speak to so and so, in order for you to access the area… even though you have spoken about the matter you will find that the issue of getting a space becomes difficult. (Western Cape, Social worker)
Political interference could undermine not only the Safe Spaces but all aspects of the intervention, for example when Ward Councillors threatened to prevent programme activities in their ward, unless they agree to give financial rewards or preferential access to job opportunities for their kin and political constituents.There are cultural factors because we are staying in a rural area and under the rulership of a traditional council. So there are girls that are still going for virginity testing. Some leaders, like the traditional headmen, are against our programme because they feel like we are introducing the virgin girls into sex… If I’m being honest, I don’t think they will accept topics that deal with sex. Because it is against their culture, their beliefs and they think it is Western culture. (Mpumalanga, Implementer)
The ward councillors and the municipality, they said that for any programme or activity that will take place we should first start with them, yes. So, they just wanted to be the first priority in the programmes, before the target group. (Free State, Health worker)
Opinions were mixed amongst implementers as to the best way to engage community gatekeepers to facilitate the establishment of Safe Spaces and recruitment of AGYW. Some implementers motivated for a top-down approach, accessing communities through local gatekeepers like ward councillors and traditional leaders.When we started, we had to sit in one of the constituency offices of the [political party name] somewhere in a hall whereby we were asked questions: Who are you? How many millions are you bringing? … Because there you will find a ward councillor whose interest will be to benefit from the programme. So, one ward councillor would say: ‘you hire my wife or create a good position for my wife, otherwise, you won’t implement in my ward’ … It's all about politics. Now we are going to elections, they look at organisations like us to say, how many people are you going to employ in my ward? (Mpumalanga, Implementer)
Others emphasised the importance of reaching beneficiaries directly and avoiding political interference in the programme.One challenge that we've experienced... the interference of… political and your civil society… I wish we implemented differently… (like in the) PEPFAR approach, you work directly with the stakeholders. You don't start from the ground, because here for you to implement, you have to go to the ward councillor. (Mpumalanga, Implementer)
Contrary to the one of the key objectives in setting up spaces being the provision of biomedical services, implementer respondents explained that AGYW tended to value Safe Spaces for other reasons, such as for accessing the internet for job searching, receiving career guidance, mentorship and assistance with homework and applications for tertiary education from staff, receiving food, toiletries and menstrual management products, as a space to interact with peers, and for general psychosocial support. Having social workers at the Safe Spaces, increased AGYW access psychosocial support, as social workers were able to offer support in private, confidential, and youth friendly venues. Implementers emphasised that especially for AGYW from particularly poor households, being able to come to the Safe Space and access the internet and receive help from peer group trainers to complete homework, had a positive impact on school performance. Offering assistance with homework was also a means to potentially attract AGYW into other programme services including the SRH services; especially for Grade 11 and 12 learners who were very busy with the school curriculum and otherwise difficult to access.The mistake with an intervention is that, if you don’t include the leadership of that community. They will also make sure that your programme is rejected… I usually say it should be an up down process. The district should introduce the programme to the locals and the locals should introduce it to the people on the ground. (KwaZulu Natal, Implementer)
Implementers emphasized the importance of proper resource allocation to Safe Spaces in order to ensure their attractiveness to AGYW. Some respondents felt that the resources allocated to Safe Spaces were not sufficient, resulting in Safe Spaces being under resourced, and lacking facilities such as computers and WiFi. Respondents also felt that additional funding to provide AGYW beneficiaries with food, stationary, toiletries and menstrual management products at Safe Spaces would have been beneficial; some field staff even spent their own money to provide these to AGYW at Safe Spaces.If you are in school and you do not have internet at home… even if they are crowded at home, these young girls can come to the Safe Space and do their homework and things like that. So, this girl has a safety net… she knows “I have people that can assist me”. (KwaZulu Natal, Implementer)
When it comes to sessions, HTS (HIV Testing) services, individual counselling we are able to render those services. But a child that is in need, who will say “I need stationery, food”, then it stops there, we cannot help any further. We as the field workers decided that to make sure that we work well with the community and make them to trust us again, that each of us who is capable should buy stuff like Vaseline, pads, toothpaste and everything that you can then we put them in a box at our Safe Space. (Free State, Implementer)
AGYW’s experiences and acceptability of safe spaces
One perceived value of Safe Spaces among AGYW respondents was that they offered a safe and comfortable place to relax, study, hang out with peers, and access information and support. In particular, AGYW valued access to computers and the internet.They helped us when we got there… typing documents… assisting with their machine and laptops and everything and give us information… We were able to go there and study because it was a safe environment. It was quiet… it was a good place for study. And at that time I was supposed to apply for varsity bursaries, again they are ones who helped me. I just went there and gave them my documents, reports, and everything for the application. They did everything for me. (Mpumalanga, AGYW 15-19 years)
Additionally, AGYW highly valued Safe Spaces as a place to interact with other AGYW, and get peer support.We just go there (to the Safe Space)... most of the time I just sit down and chill. Sometimes I go with my books, my novels. I just read or study… If I find others I just go there and talk about what affect us as women at this age… we find solutions. (Mpumalanga, AGYW 15-19 years)
However, accessing Safe Spaces was not easy for all AGYW beneficiaries. For some AGYW, as mentioned above the location of Safe Spaces, safety of the area, or lack of transport, impeded access.We were able to share ideas, advise each other and when I have a problem, I would talk to them and they will help me. It was better than making a decision alone on my own when I have a problem… We were a mixture of girls with different ages, some were 24 years of age and I was 18 years… there was a Safe Space and I felt comfortable when I was there… I was very comfortable when going there… I was never afraid to talk. (KwaZulu Natal, AGYW 15-19 years)
For others, competing priorities, such as childcare responsibilities, reduced their ability to access and make use of the spaces.They (implementers) sent us a message… and requested that we must come and get our services, but the problem was the issue of distance… so I am unable to go there… to get services (KwaZulu Natal, AGYW 20-24 years)
What affected my participation was my daughter... I am at home and I am a single parent. I have to take care of her. (Western Cape, AGYW 20-24 years)
Safe spaces in the context of COVID-19 lockdowns
These benefits were of additional value during the COVID-19 lockdowns and school closures.It was not normal that you study at home through WhatsApp and you don’t get to see teachers when they are explaining. Because for some of us… if you want to understand something a teacher must be in front for you to understand. But, for me it was not that hard because the programme was there for me at the Safe Space. If there were homework and assignments, I could go there (to Safe Space) get help and everything. (Mpumalanga, AGYW 15-19 years)
An additional benefit during school closures was that AGYW were able to access Safe Spaces while schools were closed, and have a place to study, get academic support and assistance with homework from the programme staff.I was doing my grade 12 last year… during lock down, as you know data and airtime is expensive and by then I was not working… the situation was bad. My two friends and I went there (Safe Space) to ask for assistance… We wanted to study but were unable to go to school… So we were able to go there (Safe Space) and study. (Mpumalanga, AGYW 15-19 years)
The programme was there for me at the Safe Space. If there were homework and assignments, I could go there get help. (Mpumalanga, AGYW 15-19 years)