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Paper short abstract

Ethnography among migrant and South African women shows how fractured healthcare systems, discrimination and chronic insecurity obstruct contraception, abortion and mental health care, producing layered forms of reproductive vulnerability.

Paper long abstract

This paper examines how sociopolitical and institutional polarisation fractures healthcare infrastructures and reshapes reproductive care trajectories in South Africa. Drawing on ethnographic research in Lorentzville and Mqanduli, the analysis shows how women encounter chronic barriers in accessing contraception, abortion services, antenatal care, and mental health support. Clinic gatekeeping, documentation requirements, erratic service availability, and moral judgments create unstable therapeutic pathways that exacerbate long-term reproductive vulnerability. For undocumented migrant women, fear of arrest or deportation deepens this fracture, deterring engagement with formal healthcare and reinforcing parallel informal routes to care. These dynamics are intensified by broader structural conditions, including food insecurity, insecure housing, and intimate partner violence, making reproductive care an ongoing negotiation of risk, worthiness, and belonging. Engaging critical medical anthropology and structural vulnerability, the paper illustrates how chronicity in this context is produced not by disease alone but by enduring political, bureaucratic, and moral fractures that shape who receives care, how, and under what conditions. Women respond through collective strategies, escorting one another to clinics, circulating advice, and mobilising informal networks that reveal reparative practices emerging within scarcity. By foregrounding lived experience from a Global South perspective, the paper offers insight into how healthcare systems become sites of exclusion, struggle, and creative reorganisation in a polarised world.