Overview: Child and maternal health
The new democratic South Africa has made substantial progress in transforming its health sector. Primary healthcare has vastly expanded to more than 4,000 clinics across the country and government health services are free for children under the age of five and for pregnant and breastfeeding women. Remarkable progress has been made in rolling out antiretroviral (ARV) treatment. A national food fortification programme has also reduced the number of birth defects by more than a third.
Thousands of children under the age of 5 die every year of mainly preventable casues. HIV/AIDS-related diseases are a major cause of death in young children, followed by pneumonia and acute diarrhoea. South Africa has also recently identified problems in the levels of coverage of routine childhood vaccinations.
Malnutrition is a major contributing factor to child death. One in four children is stunted and many are deficient in vitamins and minerals essential to preventing disease and disability.
Of great concern are the high death rates of newborn babies and mothers. Almost 40 per cent of all under-five deaths occur in the first 28 days of life. Around 20,000 babies are stillborn every year; many die during labour. The maternal mortality rate was last recorded at 400 per 100,000 in 2005. These deaths happen in a context where a high proportion of women attend antenatal care and deliver babies in hospitals and maternity clinics with skilled attendants.
South Africa has the highest global burden of HIV and AIDS – 16 per cent of the world’s population with the disease lives here. HIV prevalence in pregnant women attending antenatal care is very high and around 300,000 children are born to HIV-infected mothers each year. Close to half of all orphans in the country have lost their parents to HIV/AIDS-related diseases.
Prevention of mother-to-child transmission (PMTCT) of HIV is now almost universally available in the public health sector. Eighty-eight per cent of pregnant HIV-positive women received ARV medication to reduce the risk of transmitting HIV to their babies in 2009. Of the children living with HIV and AIDS who were eligible for ARV treatment, 81 per cent received it in 2009 (Country Progress Report on the Declaration of Commitment on HIV/AIDS, 2010 Report, South Africa).
UNICEF estimates that close to 50,000 babies and young children could be saved every year through higher coverage of a few known high-impact healthcare interventions. The challenge is to ensure that these interventions reach the children and women who need them most.