Women and Children in South Africa
To be a child in South Africa is to walk a fragile path to adulthood. The country is home to nearly 19 million children, many of whom are vulnerable. Two-thirds of all children live in poverty – many in homes with unemployed, single, chronically sick or elderly parents and caregivers. Poverty collides with the country’s severe AIDS epidemic, high unemployment and poor service delivery to create great hardship for thousands of South African families.
Much effort has gone into improving the welfare of children and their families over the past 15 years. South Africa has some of the most progressive policies and laws to protect children against child rights violations. The government is addressing the worst poverty through a massive social grants system, which grows in strength every year. Social grants increased from 2.5 million recipients in 1998 to 13 million in 2009. Much of the increase was due to the expansion of the child support grant, which reached nine million children under the age of 15 in 2009.
Primary healthcare is free for pregnant women and children under the age of six. The poorest children are exempt from paying school fees, a policy that aims to increase enrolment and retention of children who would otherwise be destined for a bleak future.
But despite the government’s huge social investments, South Africa’s entrenched structural problems, inherited from the apartheid era, continue to undermine children’s survival, development and protection. South Africa is still a very unequal society, with the richest 20 per cent of the population earning two-thirds of the country’s income. Many ordinary people are being left behind by the country’s development. Progress towards the 2015 Millennium Development Goals (MDGs) is uneven, with children bearing the consequences of unmet promises.
Child survival is the gold standard for measuring the likelihood of achieving the MDGs. In South Africa, mortality rates for children under the age of five have remained almost the same over the past two decades. One in 15 children dies from diseases that could be prevented. Intestinal infection, flu and pneumonia are the major child killers and HIV-related illnesses account for a large proportion of child deaths.
A perturbing statistic is that 22 per cent of under-five deaths happen in the first month of life – the neonatal period – mainly as a result of poor quality of newborn care. If care of newborns and services to prevent mother-to-child transmission of HIV were improved and scaled up significantly, close to 50,000 babies would be saved every year from 2015 onwards.
The country’s Expanded Programme of Immunisation (EPI) works to combat vaccine-preventable diseases. In 2009, the Department of Health introduced three new vaccines to prevent the most common forms of pneumonia and diarrhoea.
The District Health Information System showed that 84.2 per cent of children under one completed their primary course of immunisation in 2007/08. But an outbreak of measles in 2009, which affected more than 2,650 people, raised questions. Survey findings suggest that immunisation coverage is much lower and that the EPI system is not functioning well.
Child survival and maternal health are two sides of the same coin. Children need healthy mothers for their own optimal health and growth. Sadly, maternal mortality in South Africa is high and on the rise. With it, babies are dying or becoming orphans. The latest UN figures estimate that one in 250 women dies during pregnancy or childbirth. AIDS-related diseases account for 23 per cent of all maternal deaths, followed by complications of pregnancy-related hypertension.
Pregnant women are dying despite high coverage of antenatal care and the fact that 95 per cent of women give birth in hospitals and other medical facilities. Around 38 per cent of maternal deaths could be avoided by providing better health services. This has spurred the Department of Health to introduce a 10-point plan to improve the quality of healthcarefor mothers and babies and include a strong community outreach programme.
Basic education and gender equality
The government spends huge resources on the education sector – around 5.4 per cent of its gross domestic product in 2008/09. However, this significant level of investment is not matched by results. Students’ academic achievements are poor and South Africa consistently scores low on international literacy, reading and numeracy assessments.
The poor quality of education undermines children’s ability and desire to learn. Many children experience a broken journey through school, interrupted by irregular attendance, absent teachers, teenage pregnancy and abuse and violence in and around schools. South Africa’s high levels of poverty continue to deny thousands of children access to quality education. Around 27 per cent of public schools do not have running water, 78 per cent are without libraries and 78 per cent do not have computers.
Investment in early childhood development is beginning to yield results, although only 16.9 per cent of children under the age of five have access to day care, crèches, preschools and early childhood development centres. The government has put early childhood development high on its list of priorities, with funding for the sector projected to grow substantially in the next few years.
The government is also committed to offering Grade R in every school in South Africa. Enrolment in this reception year, which caters for children between five and six years, currently stands at 50 per cent in public and independent ordinary schools.
Around 50,000 children were victims of violent crimes in 2008/09, according to the South African Police Service. Crimes of a sexual nature are the most frequent. Yet such crimes are committed in a climate of relative impunity: amongst the small proportion of rapes that actually get reported, no more than one in ten result in a conviction.
Social attitudes and behaviour at times condone child abuse. An example of this is parents’ use of corporal punishment. Young children are often smacked, hit and, in the worse cases, beaten, despite evidence of the devastating and long-term impact such abuse has on children’s self-esteem and development.
Furthermore, a Department of Labour survey estimates that around 850,000 children in South Africa are engaged in some form of child labour, often of a hazardous nature or to the detriment of the child’s full development. Other violations, which are often reported in the media, are harder to monitor; child trafficking, forced marriage and gang violence.
The country’s high prevalence of HIV and AIDS has resulted in equally high rates of orphaned children. Around 3.7 million children have lost one or both parents, many to HIV-related illnesses. Most orphans live in extended families, already under stress due to the impact of the pandemic. Childhoods are stolen as children take on adult roles, drop out of school and go without healthcare and good nutrition.
HIV and AIDS and children
With 5.2 million people living with HIV and AIDS and close to half a million new infections in 2009, the country continues to have the largest burden of HIV and AIDS in the world. The epidemic has levelled off at a high prevalence of 17 per cent for the adult population and 29 per cent among pregnant women attending antenatal clinics.
The good news is that HIV prevalence is declining among children and teenagers. For example, HIV prevalence among children between two and 14 years decreased from 5.6 per cent in 2002 to 2.5 per cent in 2008. This is most likely a result of several successful HIV prevention measures such as prevention of mother-to-child transmission (PMTCT).
There is also evidence that twice as many South Africans were aware of their HIV status in 2005 than in 2002. Another very encouraging trend is the dramatic increase in condom use among young people, with 87 per cent of males and 73 per cent of females reporting condom use during their last sexual encounter in 2008.
Nonetheless, HIV prevalence remains disproportionately high for girls and women. Girls and women in the 15 to 24 age group are four times more likely to be infected with HIV than boys and men. Sex with older men – an important risk factor for HIV infection – increased substantially, from 18.5 per cent of teen girls in 2005 to 27.6 per cent in 2008. Surveys have also reported that accurate knowledge about HIV transmission is worsening.
South Africa has the largest antiretroviral treatment programme in the world. By the end of July 2009, close to 800,000 adults and 76,000 children under the age of 15 were receiving free treatment. It is estimated that half of adults and two-thirds of children in need of antiretroviral medication are getting it, while 42.5 per cent of children are receiving co-trimoxazole, an antibiotic that prevents opportunistic infections in children who have been exposed to or are infected with HIV.
The Impact of the International Financial Crisis on Child Poverty in South Africa
UNICEF South Africa and the Financial and Fiscal Commission of South Africa
This paper reports on a study to provide insights into the magnitude of the shocks associated with the crisis in macroeconomic terms in South Africa, the country’s capacity to withstand or cushion these shocks, and the extent of fragility in terms of poverty levels and child well-being.
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Situation Analysis of Children in South Africa - April 2009
This situational analysis was commissioned by the Presidency, research was performed by the Children’s Institute at the University of Cape Town while UNICEF coordinated and funded the project. Download the report [PDF]
South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008
This report, which is the second one based on the third population-based HIV seroprevalence survey conducted in 2008 by the consortium led by the Human Sciences Research Council (HSRC), focuses on health of children 0–18 years of age. Download the report [PDF]
South African Child Gauge 2009/2010
The South African Child Gauge [external link] provides an annual snap-shot of the status of South Africa’s children. It is published by the Children’s Institute, University of Cape Town, to track South Africa’s progress towards realising children’s rights. The latest issue focuses on the theme 'Healthy children: From survival to optimal development'.