South Africa and Maternal Child Health

August 6, 2011

A delegation from the Center for Strategic and International Studies (CSIS) Global Health Policy Center will be traveling to South Africa in August, 2011 to look at the major efforts underway to renew the United States’ bilateral relationship with South Africa, with a particular focus on creating sustainable partnerships in health and other areas of U.S. foreign assistance. South Africa is a leading strategic partner on development, health, and other critical issues. U.S. investments in South Africa are the single largest bilateral health account in the world. The CSIS staff will look specifcally at: The U.S.-South Africa Strategic Dialogue; South Africa's shift toward greater country ownership in the health sphere; and turning the tide on the HIV epidemic.

In the days to come, we will post blogs on the current HIV/AIDS, Tuberculosis, Maternal and Child Health, and Non-communicable diseases situations in the country.  Please let us know if you questions on any of these topics that you would like our experts to answer. 

Overview

Health Minister Motsoaledi said, “Remember that maternal mortality is not just death of a woman; it is death of a woman, because she dare fell pregnant!”  The maternal mortality ratio measures the number of women per 100,000 who die due to complications experienced during pregnancy and childbirth. In many countries these ratios are improving, but South Africa is one of the few countries in the world where the maternal mortality ratio (MMR) is rising. From 2001 to 2007, the MMR increased from 369 deaths per 100,000 live births to 625 deaths per 100,000 births. The lifetime risk of maternal death is 1 in 100.

The dramatic increase in MMR during the last decade is driven by HIV/AIDS and HIV-related infections, accounting for more than 40% of all deaths. A study conducted by the Medical Research Council found that post-partum death rates are high among HIV positive women at 2265 per 100,000 within 36 weeks of delivery.

Other main causes of maternal mortality are hypertension (15.7%), obstetric hemorrhage (12.4%), pregnancy-related sepsis (9.0%) and pre-existing conditions (6.0%). Hypertension primarily affects women under 20 years of age while hemorrhage, ectopic pregnancies and pre-existing medical diseases complicate birth for women older than 35 years. Most of these deaths can be avoided by improving the health care delivery system. Minister Motsoaledi criticizes the health system for being unsustainable, destructive, costly, and not putting the emphasis on prevention. To turn the tide on maternal mortality, special attention must be given to pregnant women with multiple conditions but many primary care centers are not equipped. There is a need to reorganize primary and community-level health centers to increase service utilization and promote safe delivery practices and use of skilled birth attendants. Increasing access to family planning information, procedures and commodities to allow women to plan and space their pregnancies also has the potential to greatly reduce maternal and child morbidity and mortality.

Implementing the national program for PMTCT and increasing access to ARTs for children has contributed to a slow decline in child deaths in recent years. Currently, the under-5 mortality ratio is 65 per 1,000 births. The infant mortality ratio is 43 deaths per 1,000 births, a significant improvement from 104 deaths per 1,000 births in 2005. The leading cause of death in newborns and children under 5 is HIV/AIDS followed by neonatal causes. Childhood infections such as diarrhea and lower respiratory infections kill the most children outside the neonatal period. For children older than 5 years, injuries and tuberculosis are the leading causes of death.

Figure 2.1. Data source: Norman R, Bradshaw D, Schneider M, Pieterse D & Groenewald P (2006) Revised burden of disease estimates for the comparative risk factor assessment, South Africa 2000. Cape Town: Medical Research Council. 

Recently, the South African government rolled out mass immunization campaigns against polio and measles. During the two rounds of polio campaign, a total of 9.3 million doses of Oral Polio Vaccine (OPV) were administered. While this has been a great success, the OPV coverage rate varies among districts. During the second round, the Northern Cape and North West districts recorded 52% and 62% respectively against the national coverage of 86% for the round. The measles campaign was a great success as well. For the 6-59 months age group, 117% of target number was immunized reaching over 5.3 million children. For the second age group, 60-179 months, 89% coverage was achieved. Both combined contributed to the overall national measles coverage of 98%.

Related Content

• South Africa and HIV/AIDS
• South Africa and Tuberculosis
• South Africa and Non-Communicable Diseases
• Healthy Dialogues, August 2011: South Africa Trip