The number of women and young children who die in South Africa is incomprehensible given the resources that the government has invested in health care compared to other countries with similar or weaker economies. Predictably, the mortality patterns vary by provinces. For child mortality, the Eastern Cape, KwaZulu-Natal and the Free State have by far the majority of deaths. Gauteng, the Northern and Western Cape contribute the least share of the 60 000 children who die between the ages of one month and five years. Deaths are ‘€œdue to different reasons, but malnutrition and HIV/AIDS are the key under-lying causes’€, according to Dr Neil McKerrow, chairperson of the ministerial review committee on child mortality.

‘€œThe children are dying of common, preventable diseases, and if we interrogate this a little bit further, the underlying factors giving rise to child mortality are two-fold in terms of patho-physiological processes’€¦ About 60% of children who die are malnourished and well over half of them are HIV-infected, and this 50% of HIV-infected children are those where we know that they are HIV-infected. There’€™s a proportion of the remainder in whom we suspect, but we haven’€™t confirmed this fact, and then on top of that we’€™ve got gastro-enteritis, acute respiratory infections, tuberculosis and sepsis’€, says Dr McKerrow.

The country is one of a few countries in the world where child mortality continues to increase. We are not doing well to prevent maternal mortality due to pregnancy or child-birth, either. Just under 2 000 women die in South Africa, annually, as a result – and the number has increased from less than a thousand in 1998.

‘€œThe number of deaths has increased and we get about 1 400 deaths per year. KZN has the largest percentage of deaths and that’€™s because KZN is the most populous and it’€™s probably the most rural of provinces’€, says obstetrician, Professor Jack Moodley, chairperson of the ministerial review committee on maternal deaths.          

The committee found that complications related to hyper-tension are the most common cause of death in women under the age of 20, while women aged 35 and older are more likely to die from obstetric haemorrhage, the occurrence of ectopic pregnancies and pre-existing conditions that the women might have had. These are directly related to pregnancy.    

It was found that among the causes that are unrelated to pregnancy, HIV was the major cause of death. Close to 44% of the 1 400 women died of AIDS-related conditions in the current review.

‘€œThe number of deaths from non-pregnancy related infections has increased, and most of these are due to AIDS. We were asked a number of times:

‘€˜What would our maternal mortality ratio be if we, in fact, didn’€™t have AIDS?’€™ If you did not have HIV then the ratio would be 31, and obviously, with the HIV, the ratio is 10 times higher.

‘€œIt’€™s definitely not acceptable’€, said Health Minister, Dr Aaron Motsoaledi when responding to the reports.

Motsoaledi said, ‘€œSouth Africa has good health policies but the challenge lies with implementing them’€.

‘€œI want to hear first-hand from provincial programme managers what the bottle-necks to implementation (are) and what we can do to remove them’€, he said, challenging provinces to identify the impediments to policy implementation.