“Kudliwa imali, kudliwe umuntu”: In-school Adolescent Girls’ Experiences of Umqasho and Transactional Sex in a Rural Sub-District of Northern KwaZulu-Natal


  • Nompumelelo Gloria Mfeka-Nkabinde University of KwaZulu-Natal
  • Relebohile Moletsane University of KwaZulu-Natal
  • Anna Silvia Voce University of KwaZulu-Natal




rural adolescents, structural inequality, transactional sex, health and educational outcomes


This study examined the intersecting impact of structural inequalities and transactional sex on in-school adolescent girls’ risk of pregnancy and poor educational outcomes in rural northern KwaZulu-Natal. In this article, we understand structural inequalities as providing a basis for transactional relationships between adolescent girls and older men. Participatory visual research methods were employed with 18- and 19-year-old girls and boys to examine multiple systems of oppression and inequalities experienced by in-school rural adolescent girls, focusing particularly on their vulnerability to transactional sex, pregnancy and poor educational outcomes. In this context, moralising discourses on transactional sexual relationships are unhelpful if structural barriers placing girls at risk are not addressed.  

Author Biographies

Nompumelelo Gloria Mfeka-Nkabinde, University of KwaZulu-Natal

Nompumelelo Gloria Mfeka-Nkabinde, MBChB, FCFP, MMed (Family Medicine)

Family Physician and Lecturer – University of KwaZulu-Natal Department of Family Medicine

PhD candidate: Adolescent sexual and reproductive health

Relebohile Moletsane, University of KwaZulu-Natal

Relebohile Moletsane is Professor and the JL Dube Chair in Rural Education in the School of Education at the University of KwaZulu-Natal. Her research focuses on girlhood studies, gender-based violence, sexual and reproductive health and rights (SRHR) and participatory visual methodology.  She is co-editor (with Claudia Mitchell) of the 2018 book, Disrupting Shameful Legacies: Girls and Young Women Speak Back Through the Arts to Address Sexual Violence. Rotterdam: Brill/Sense Publishers; and co-editor (with Lisa Wiebeisek, Astrid Treffry-Goately and April Mandrona) of the 2021 book: Ethical Practice in Participatory Visual Research with Girls and Young Women in Rural Communities. New York; Oxford: Berghahn Books. 

Anna Silvia Voce, University of KwaZulu-Natal

Anna Voce PhD

Associate Professor

Dean/Head of School (Acting)

School of Nursing and Public Health

College of Health Sciences

University of KwaZulu-Natal


Atwood, K. A., S. B. Kennedy, E. M. Barbu, W. Nagbe, W. Seekey, P. Sirleaf, O. Perry, R. B. Martin, and F. Sosu. 2011. “Transactional Sex among Youths in Post-Conflict Liberia.” Journal of Health, Population, and Nutrition 29 (2): 113–22. https://doi.org/10.3329/jhpn.v29i2.7853. DOI: https://doi.org/10.3329/jhpn.v29i2.7853

Austrian, K., E. Soler‐Hampejsek, Z. Duby, and P. C. Hewett. 2019. “‘When He Asks for Sex, You Will Never Refuse’: Transactional Sex and Adolescent Pregnancy in Zambia.” Studies in Family Planning 50 (3): 243–56. https://doi.org/10.1111/sifp.12100. DOI: https://doi.org/10.1111/sifp.12100

Brouard, P., and M. Crewe. 2012. “Sweetening the Deal? Sugar Daddies, Sugar Mummies, Sugar Babies and HIV in Contemporary South Africa.” In “Gender, Ageing and Intergenerationality,” edited by V. Reddy and N. Sanger, special issue, Agenda: Empowering Women for Gender Equity 26 (4): 48–56. https://doi.org/10.1080/10130950.2012.757862. DOI: https://doi.org/10.1080/10130950.2012.757862

Burnett, C., M. Swanberg, A. Hudson, and D. Schminkey. 2018. “Structural Justice: A Critical Feminist Framework Exploring the Intersection between Justice, Equity and Structural Reconciliation.” Journal of Health Disparities Research and Practice 11 (4): 4. https://digitalscholarship.unlv.edu/jhdrp/vol11/iss4/4/.

Choudhry, V., A.-E. Ambresin, V. N. Nyakato, and A. Agardh. 2015. “Transactional Sex and HIV Risks—Evidence from a Cross-Sectional National Survey among Young People in Uganda.” Global Health Action 8 (1): 27249. https://doi.org/10.3402/gha.v8.27249. DOI: https://doi.org/10.3402/gha.v8.27249

Collins, P. H. 2002. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. New York, NY: Routledge.

Collins, P. H. 2015. “Intersectionality’s Definitional Dilemmas.” Annual Review of Sociology 41: 1–20. https://doi.org/10.1146/annurev-soc-073014-112142. DOI: https://doi.org/10.1146/annurev-soc-073014-112142

Collins, P. H., and S. Bilge. 2020. Intersectionality. New York, NY: John Wiley and Sons.

Connell, R. 1987. Gender and Power: Society, the Person, and Sexual Politics. Cambridge: Polity Press in association with Basil Blackwell.

Crenshaw, K. 1989. “Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics.” University of Chicago Legal Forum 1: Article 8. https://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8/.

Dellar, R. C., S. Dlamini, and Q. A. Karim. 2015. “Adolescent Girls and Young Women: Key Populations for HIV Epidemic Control.” Journal of the International AIDS Society 18 (2S1): 19408. https://doi.org/10.7448/IAS.18.2.19408. DOI: https://doi.org/10.7448/IAS.18.2.19408

Dhamoon, R. K. 2011. “Considerations on Mainstreaming Intersectionality.” Political Research Quarterly 64 (1): 230–43. https://doi.org/10.1177/1065912910379227. DOI: https://doi.org/10.1177/1065912910379227

Dockney, J., and K. G. Tomaselli. 2009. “Fit for the Small(er) Screen: Films, Mobile TV and the New Individual Television Experience.” Journal of African Cinema 1 (1): 126–32.

Duby, Z., K. Jonas, T. McClinton Appollis, K. Maruping, L. Vanleeuw, C. Kuo, and C. Mathews. 2021. “From Survival to Glamour: Motivations for Engaging in Transactional Sex and Relationships among Adolescent Girls and Young Women in South Africa.” AIDS and Behavior 25 (10): 3238–254. https://doi.org/10.1007/s10461-021-03291-z. DOI: https://doi.org/10.1007/s10461-021-03291-z

Dunkle, K. L., R. Jewkes, M. Nduna, N. Jama, J. Levin, Y. Sikweyiya, and M. P. Koss. 2007. “Transactional Sex with Casual and Main Partners among Young South African Men in the Rural Eastern Cape: Prevalence, Predictors, and Associations with Gender-Based Violence.” Social Science and Medicine 65 (6): 1235–248. https://doi.org/10.1016/j.socscimed.2007.04.029. DOI: https://doi.org/10.1016/j.socscimed.2007.04.029

Dunkle, K. L., R. K. Jewkes, H. C. Brown, G. E. Gray, J. A. McIntryre, and S. D. Harlow. 2004. “Transactional Sex among Women in Soweto, South Africa: Prevalence, Risk Factors and Association with HIV Infection.” Social Science and Medicine 59 (8): 1581–592. https://doi.org/10.1016/j.socscimed.2004.02.003. DOI: https://doi.org/10.1016/j.socscimed.2004.02.003

Gregson, S., C. A. Nyamukapa, G. P. Garnett, P. R. Mason, T. Zhuwau, M. Caraël, S. K. Chandiwana, and R. M. Anderson. 2002. “Sexual Mixing Patterns and Sex-Differentials in Teenage Exposure to HIV Infection in Rural Zimbabwe.” The Lancet 359 (9321): 1896–903. https://doi.org/10.1016/S0140-6736(02)08780-9. DOI: https://doi.org/10.1016/S0140-6736(02)08780-9

Hunter, M. 2002. “The Materiality of Everyday Sex: Thinking beyond ‘Prostitution’.” African Studies 61 (1): 99–120. https://doi.org/10.1080/00020180220140091. DOI: https://doi.org/10.1080/00020180220140091

Jewkes, R., R. Morrell, Y. Sikweyiya, K. Dunkle, and L. Penn-Kekana. 2012. “Men, Prostitution and the Provider Role: Understanding the Intersections of Economic Exchange, Sex, Crime and Violence in South Africa.” PLoS One 7 (7): e40821. https://doi.org/10.1371/journal.pone.0040821. DOI: https://doi.org/10.1371/journal.pone.0040821

Jewkes, R., C. Vundule, F. Maforah, and E. Jordaan. 2001. “Relationship Dynamics and Teenage Pregnancy in South Africa.” Social Science and Medicine 52 (5): 733–44. https://doi.org/10.1016/S0277-9536(00)00177-5. DOI: https://doi.org/10.1016/S0277-9536(00)00177-5

Kaufman, C. E., and S. E. Stavrou. 2004. “‘Bus Fare Please’: The Economics of Sex and Gifts among Young People in Urban South Africa.” Culture, Health and Sexuality 6 (5): 377–91. https://doi.org/10.1080/13691050410001680492. DOI: https://doi.org/10.1080/13691050410001680492

Kelly, R. J., R. H. Gray, N. K. Sewankambo, D. Serwadda, F. Wabwire-Mangen, T. Lutalo, and M. J. Wawer. 2003. “Age Differences in Sexual Partners and Risk of HIV-1 Infection in Rural Uganda.” JAIDS: Journal of Acquired Immune Deficiency Syndromes 32 (4): 446–51. https://doi.org/10.1097/00126334-200304010-00016. DOI: https://doi.org/10.1097/00126334-200304010-00016

Kuate-Defo, B. 2004. “Young People’s Relationships with Sugar Daddies and Sugar Mummies: What Do We Know and What Do We Need To Know?” African Journal of Reproductive Health 8 (2): 13–37. https://doi.org/10.2307/3583175. DOI: https://doi.org/10.2307/3583175

Leclerc-Madlala, S. M. 2003. “Transactional Sex and the Pursuit of Modernity.” Social Dynamics 29 (2): 213–33. https://doi.org/10.1080/02533950308628681. DOI: https://doi.org/10.1080/02533950308628681

Leclerc-Madlala, S. M. 2013. “Transactional Sex, HIV and Young African Women: Are We There Yet?” Future Virology 8 (11): 1041–43. https://doi.org/10.2217/fvl.13.90. DOI: https://doi.org/10.2217/fvl.13.90

Lomax, H. 2012. “Contested Voices? Methodological Tensions in Creative Visual Research with Children.” International Journal of Social Research Methodology 15 (2): 105–17. https://doi.org/10.1080/13645579.2012.649408. DOI: https://doi.org/10.1080/13645579.2012.649408

MacEntee, K., C. Burkholder, and J. Schwab-Cartas, eds. 2016. What’s a Cellphilm? Integrating Mobile Phone Technology into Participatory Visual Research and Activism. Rotterdam: Springer. https://doi.org/10.1007/978-94-6300-573-9. DOI: https://doi.org/10.1007/978-94-6300-573-9

Masenya, M. 2017. “Reading Proverbs 7 in the Context of Female ‘Blessers’ and Sugar Mamas in South Africa.” Scriptura: Journal for Biblical, Theological and Contextual Hermeneutics 116 (2): 120–32. https://doi.org/10.7833/116-2-1316. DOI: https://doi.org/10.7833/116-2-1316

Massyn, N., C. Day, N. Ndlovu, and T. Padayachee, eds. 2020. District Health Barometer 2019/20. Durban: Health Systems Trust. Accessed June 14, 2022. https://www.hst.org.za/publications/District%20Health%20Barometers/DHB%202019-20%20Complete%20Book.pdf.

Mitchell, C., N. De Lange, and R. Moletsane. 2018. Participatory Visual Methodologies: Social Change, Community and Policy. London: SAGE Publications. https://doi.org/10.4135/9781526416117. DOI: https://doi.org/10.4135/9781526416117

Mitchell, C., L. Theron, A. Smith, J. Stuart, and Z. Campbell. 2011. “Drawings as Research Method.” In Picturing Research, edited by L. Theron, C. Mitchell, C. Mitchell, A. Smith, A. Smith and J. Stuart, 19–36. Cham: Sense Publishers. https://doi.org/10.1007/978-94-6091-596-3_2. DOI: https://doi.org/10.1007/978-94-6091-596-3_2

Mkwananzi, S. 2017. “Teenage Mothers and Fathers: A Demographic Perspective.” In Young Families: Gender, Sexuality and Care, edited by N. Mkhwanazi and D. Bhana, 31–48. Cape Town: HSRC Press.

Pettifor, A. E., H. V. Rees, I. Kleinschmidt, A. E. Steffenson, C. MacPhail, L. Hlongwa-Madikizela, K. Vermaak, and N. S. Padian. 2005. “Young People’s Sexual Health in South Africa: HIV Prevalence and Sexual Behaviors from a Nationally Representative Household Survey.” Aids 19 (14): 1525–534. https://doi.org/10.1097/01.aids.0000183129.16830.06. DOI: https://doi.org/10.1097/01.aids.0000183129.16830.06

Prosser, J. 2007. “Visual Methods and the Visual Culture of Schools.” Visual Studies 22 (1): 13–30. https://doi.org/10.1080/14725860601167143. DOI: https://doi.org/10.1080/14725860601167143

Ramazanoğlu, C., and J. Holland. 2002. Feminist Methodology: Challenges and Choices. London: SAGE Publications. DOI: https://doi.org/10.4135/9781849209144

Ranganathan, M., L. Heise, C. MacPhail, H. Stӧckl, R. J. Silverwood, K. Kahn, A. Selin, F. X. Gomez-Olive, C. Watts, and A. Pettifor. 2018. “‘It’s Because I Like Things ... It’s a Status and He Buys Me Airtime’: Exploring the Role of Transactional Sex in Young Women’s Consumption Patterns in Rural South Africa (Secondary Findings from HPTN 068).” Reproductive Health 15 (1): 102. https://doi.org/10.1186/s12978-018-0539-y. DOI: https://doi.org/10.1186/s12978-018-0539-y

Reddy, V., and R. Moletsane. 2009. “The Gendered Dimensions of Food Security in South Africa: A Review of the Literature.” Unpublished paper, Centre for Poverty, Employment and Growth, Human Sciences Research Council.

Schippers, M. 2007. “Recovering the Feminine Other: Masculinity, Femininity, and Gender Hegemony.” Theory and Society 36 (1): 85–102. https://doi.org/10.1007/s11186-007-9022-4. DOI: https://doi.org/10.1007/s11186-007-9022-4

Silberschmidt, M., and V. Rasch. 2001. “Adolescent Girls, Illegal Abortions and ‘Sugar-Daddies’ in Dar Es Salaam: Vulnerable Victims and Active Social Agents.” Social Science and Medicine 52 (12): 1815–826. DOI: https://doi.org/10.1016/S0277-9536(00)00299-9

Stats SA (Statistics South Africa). 2016. Community Survey 2016: Provincial Profile: KwaZulu-Natal. Pretoria: Statistics South Africa. http://cs2016.statssa.gov.za/wp-content/uploads/2018/07/KZN.pdf.

Stoebenau, K., L. Heise, J. Wamoyi, and N. Bobrova. 2016. “Revisiting the Understanding of ‘Transactional Sex’ in Sub-Saharan Africa: A Review and Synthesis of the Literature.” Social Science and Medicine 168: 186–97. https://doi.org/10.1016/j.socscimed.2016.09.023. DOI: https://doi.org/10.1016/j.socscimed.2016.09.023

Van der Heijden, I., and S. Swartz. 2014. “‘Something for Something’: The Importance of Talking about Transactional Sex with Youth in South Africa Using a Resilience-Based Approach.” African Journal of AIDS Research 13 (1): 53–63. https://doi.org/10.2989/16085906.2014.886602. DOI: https://doi.org/10.2989/16085906.2014.886602

Wamoyi, J., K. Stobeanau, N. Bobrova, T. Abramsky, and C. Watts. 2016. “Transactional Sex and Risk for HIV Infection in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.” JIAS: Journal of the International AIDS Society 19 (1): 20992. https://doi.org/10.7448/IAS.19.1.20992. DOI: https://doi.org/10.7448/IAS.19.1.20992

Wesp, L. M., L. H. Malcoe, A. Elliott, and T. Poteat. 2019. “Intersectionality Research for Transgender Health Justice: A Theory-Driven Conceptual Framework for Structural Analysis of Transgender Health Inequities.” Transgender Health 4 (1): 287–96. https://doi.org/10.1089/trgh.2019.0039. DOI: https://doi.org/10.1089/trgh.2019.0039

WHO (World Health Organization) and the Partnership for Maternal, Newborn and Child Health. 2017. The Partnership for Maternal, Newborn and Child Health 2016 Annual Report: Coming of Age in a Time of Transition. Geneva: WHO. https://apps.who.int/iris/handle/10665/258801.

World Bank. 2022. “The World Bank in South Africa.” Updated October 6, 2022. Accesed February 20, 2023. https://www.worldbank.org/en/country/southafrica/overview.

Zembe, Y. Z., L. Townsend, A. Thorson, and A. M. Ekström. 2013. “‘Money Talks, Bullshit Walks’: Interrogating Notions of Consumption and Survival Sex among Young Women Engaging in Transactional Sex in Post-Apartheid South Africa: A Qualitative Enquiry.” Globalization and Health 9 (1): 1–16. https://doi.org/10.1186/1744-8603-9-28. DOI: https://doi.org/10.1186/1744-8603-9-28




How to Cite

Mfeka-Nkabinde, Nompumelelo Gloria, Relebohile Moletsane, and Anna Silvia Voce. 2023. “‘Kudliwa Imali, Kudliwe umuntu’: In-School Adolescent Girls’ Experiences of Umqasho and Transactional Sex in a Rural Sub-District of Northern KwaZulu-Natal”. Gender Questions 11 (2):24 pages . https://doi.org/10.25159/2412-8457/11552.



Received 2022-06-21
Accepted 2022-11-16
Published 2023-12-01