Women and Children in South Africa
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© UNICEF/South Africa/2008/Hearfield |
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The burden of poverty and unemployment falls unevenly on women and children. As a recent government review demonstrates, income poverty has a predominantly female face. |
South Africa has made extraordinary advances over the past 14 years, but there remain many challenges, all of them with consequences for children and women.
During this time, public expenditure on health, education and social grants have all increased dramatically. But despite this, the country faces challenges in delivering quality basic services.
While government social protection systems have resulted in a decrease in absolute poverty, there has been an increase in inequity between the highest and lowest income groups.
The burden of poverty and unemployment falls unevenly on women and children. As a recent government review demonstrates, income poverty has a predominantly female face. Its analysis shows that children in female-headed households are more likely to experience hunger. The proportion of children living in a household with at least one employed adult has decreased in recent years, thereby increasing the risk of child poverty.
Changing the Picture
A key achievement has been the establishment of a legislative framework with policies that protect children and guarantee their rights to social services. A new Children’s Act was signed into law in March 2008, and a Sexual Offences Bill and a Child Justice Bill have recently been passed by Parliament. Together these laws form a child protection framework on par with the best in the world.
Government will need to define a national strategy to ensure that quality services follow the new legislation. The task ahead is to ensure that childcare and protection services are strengthened, and UNICEF is contributing to this by supporting the establishment of strategies and standards for specialised systems and structures identified in the Children’s Act.
A rewarding development this year has been the greater integration of child health needs into wider government strategic plans. The Department of Health’s Demographic and Household Survey, which UNICEF is supporting, will for the first time contain questions relating specifically to post-natal care issues. National guidelines on paediatric access to antiretroviral therapy are being revised, and a focus is being placed on increasing access to prevention of mother-to-child transmission of HIV (PMTCT) programmes.
Tracking Progress
South Africa’s progress towards achieving the Millennium Development Goals is uneven. Substantial progress has been made towards the goals of universal access to primary education and of gender equality. However, despite newly introduced programmes, progress towards eradication of poverty and hunger is slow. South Africa is not likely to achieve the goals related to decreasing child and infant mortality and to reversing the spread of HIV and AIDS by 2015.
Poverty
Figures from 2006 indicate that two-thirds of children in South Africa were living on ZAR 7.75 a day – a level which is well below the one dollar a day international poverty line. But there are some indications that the lives of many poor people have improved through better targeted programmes, access to services and social grants. In particular, the South African Social Security Agency has positively transformed institutional capacity to deliver pensions and social grants more efficiently to the poor. It has increased coverage and access to security assistance from 2.5 million beneficiaries in 1998 to more than 12.3 million in 2008. Female headed households, those comprising single women supporting children, and granny headed households receive a larger than average share of social grants. The child support grant (CSG ) reached more than 8 million children each month in 2008, compared to 22,000 in 1998. More than 90% of adult beneficiaries of the CSG are women, and children’s nutritional status has been shown to improve when their caregiver receives the CSG . In October 2008, the Department of Social Development announced that the amount of the CSG will be automatically raised in the future to keep up with inflation, and as of January 2009, the age threshold will be extended from 14 to 17 years.
Health
There are no indications that the nutritional status of children has changed significantly over the past ten years. The National Food Consumption Survey, released in 2007, found that one child in ten was underweight. As important as a lack of food is the lack of micronutrients such as vitamin A and iodine. Breastfeeding rates are high in South Africa, with over 80% of mothers reporting having breastfed their infants. The greatest challenge is that the practice of exclusive breastfeeding is not a cultural norm, with most mothers practicing mixed feeding. The recently published results of the 2003 Demographic and Health Survey suggest that in 2003 only 11.9% of babies under the age of four months were being exclusively breastfed. Among infants in the age range four to six months the proportion being exclusively breastfed was only 1.5%.
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© UNICEF/South Africa/2008/Hearfield |
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South Africa is very close to achieving universal access to primary education. |
Education
South Africa is very close to achieving universal access to primary education. However, the increase in enrolment of children in school has not been matched by an improvement in the quality of education. Although the education sector receives a significant proportion of resources – 5.2% of GDP in 2007/8 – lack of capacity is preventing quality schooling from being widely delivered. Another concern is that a growing proportion of children is failing to meet the standards necessary for completing primary school.
One area where there has been success is in improving access to education for girls. There is now near parity between girls and boys enrolled at school.
Child mortality
In South Africa infant and child mortality has increased, primarily as a result of the country’s high prevalence of HIV and AIDS . Strategies to improve primary health care and care for pregnant women are fundamental to reversing this trend.
According to the 2009 State of the World’s Children report, the under-five mortality rate in South Africa was 59 per 1,000 live births in 2007, while the infant mortality rate was 49 per 1,000 live births. The main causes of under-five mortality are AIDS (representing 35% of all deaths of children under the age of five), neonatal causes (30%), diarrhoea (11%), pneumonia (6%), injuries (5%) and others (13%).
HIV and AIDS
With an estimated 5.35 million people living with HIV in 2008, or 11% of the population, South Africa carries a huge burden of disease from HIV and AIDS. It is possible that the epidemic may have levelled out in terms of new infections.
In South Africa, approximately 1,100,000 babies are born every year. With an HIV prevalence among pregnant women of 28%, about 300,000 babies are born exposed to HIV every year. The 2005 Household Survey of HIV and AIDS Prevalence estimated that 3.3% of children aged two to 14 years were living with HIV. AIDS therefore has become one of the leading causes of death amongst mothers and children in South Africa, accounting for 20% of maternal deaths.
Government has responded by implementing a Nevirapine based PMTCT programme since 2000. This programme has been rolled out to all hospitals and over 90% of primary health care facilities by 2008. According to official statistics, 61% of HIV positive pregnant women and 47% of HIV exposed babies received Nevirapine in 2007 to reduce the risk of mother-to-child transmission of HIV .
South Africa has the largest antiretroviral programme in the world, but it is falling far short of reaching all the people in need of treatment. According to the country’s recent UN General Assembly Special Session report, the estimated number of people needing treatment in 2007 was 889,000, of which 55% enrolled and 42% started on the antiretroviral therapy programme. Among children under 15 years of age needing treatment, 49% received treatment
in 2007.
With tuberculosis being the most widespread opportunistic infection among HIV positive people, its dramatic increase is a great concern in South Africa. The number of people who have died from tuberculosis has almost tripled over the past 16 years.
Violence Against Children
A vital area of intervention is in protecting women and children from violence. Rates of sexual assault in South Africa are amongst the highest in the world and children are most at risk: some 40% of reported cases are committed against children. In some centres for survivors of rape and sexual abuse, up to 80% of those seen are children.
More challenges for Women and Children
South Africa faced widespread disruption in 2008 when xenophobic attacks left thousands of foreign migrants – and their children – displaced and vulnerable; and the spreading cholera epidemic which came across the border from Zimbabwe, where water and sanitation systems have largely broken down, presented another challenge to health authorities and to UNICEF.
Rapid Assessment on the situation of children in South Africa
Children's Institute, University of Cape Town and Save the Children, November 2003
[PDF]
(PDF documents require Acrobat Reader to view.)
Government of South Africa National Census, 2001
[Web link]
