South Africa - WHO · South Africa 1998 South Africa 2003 % of women (15–19 years old) pregnant with their first child 10. Adolescent pregnancy by subregion Adolescent pregnancy

WHO Director-General Roundtable with Women Leaderson Millennium Development Goal 5

South AfricaCountry profileFor Demographic and Health Surveys, the years refer to when the Surveys were conducted. Estimates from the Surveys refer to three or five years before the Surveys.

Lead the fight for MDG 5

4. Causes of maternal deaths, 1997–2002A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to the pregnancy or its management but not from accidental or incidental causes. The most frequent causes of maternal deaths in Africa (for the period of 1997/2002) were haemorrhage (uncontrolled bleeding), sepsis or infections including HIV, hypertensive disorders (high blood pressure) and other causes. There are no country-specific data for South Africa.

South Africa and the world

5. Total fertilityThe total fertility is the average number of children that would be born to a woman over her lifetime. The total fertility rate can be separated into the births that were planned (wanted total fertility rate) and those that were unintended (unwanted total fertility rate). According to a survey conducted in 2003, the total fertility rate was 2.9 per woman in South Africa.

Demographic and health data

1. Maternal mortality ratio: global, regional and country data, 2005

A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to the pregnancy or its management but not from accidental or incidental causes. The maternal mortality ratio is the number of maternal deaths per 100 000 live births per year. The ratio in South Africa is 400 per 1 00 000 live births which is lower than the average of 900 per 100 000 live births in sub-Saharan Africa, and the same as the global average of 400 per 100 000 live births.

2. Lifetime risk of maternal death (1 in N), 2005

The lifetime risk of maternal death is the estimated risk of an individual woman dying from pregnancy or childbirth during her adult lifetime based on maternal mortality and the fertility rate in the country. The lifetime risk of dying from pregnancy-related causes in South Africa is 1 in 110 which is much lower than the average of 1 in 22 in sub-Saharan Africa, and lower than the global figure of 1 in 92.

Source: Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html).

Source: Khan KS et al. WHO analysis of causes of maternal death: a systematic review. Lancet, 2006, 367:1066–1074.

Sources: Making Pregnancy Safer country profiles [online database]. Geneva, World Health Organization, in press (Department of Making Pregnancy Safer; http://www.who.int/making_pregnancy_safer/en).Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/search/start.cfm).

3. Total population (in thousands)1 48 282 (2006) Lifetime risk of maternal death (1 in N)2 110 (2005) Total maternal deaths2 4 300 (2005)

Sources: 1World Health Organization 2008, World Health Statistics 2008 Geneva, Switzerland (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf). 2Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html).

Source: Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html).

2.3

0.6

1.6

0.5

0

1

2

3

South Africa 1998 South Africa 2003

Wanted total fertility rate Unwanted total fertility rate

Tota

l fer

tilit

y ra

te p

er w

om

an

Other causes30%

Anaemia 4%

Haemorrhage34%

Abortion 4%

Obstructed labour 4%

Hypertensive disorders 9%

Sepsis or Infections,including HIV 16%

Afr

ica

Dea

ths

per

100

000

liv

e b

irth

s

South Africa Sub-Saharan Africa World

400

900

400

0 100 200 300 400 500 600 700 800 900

1000

Lif

etim

e ri

sk o

f d

eath

(1

in N

)

1 /1 1 0

1 /2 2

1 /92

0

1 /1 0 0

1 /5 0

3 /1 0 0

1 /2 5

1 /2 0

South Africa Sub-Saharan Africa World

South Africa

9. Adolescent pregnancy rate by urban versus rural location

In South Africa, a survey conducted in 2003 indicated that 2.3% of women aged 15-19 years were pregnant with their first child. The rate was higher in rural than in urban areas.

8. Adolescent pregnancy rate by age for girls 15–19 years old

Adolescent pregnancy is pregnancy in an adolescent girl (girls 10–19 years old). The adolescent pregnancy rate indicates the proportion of adolescent girls who become pregnant among all girls in the same age group in a given year. According to a survey conducted in 2003 the rate differed across all age groups, with the highest rate among the 18 and 19 year old girls.

7. Perinatal mortality rate

Perinatal mortality refers to deaths of fetuses in womb and newborn babies early after delivery. It includes (1) death of a fetus in the womb after 22 weeks of gestation and during childbirth, and (2) death of a live-born child within the first seven days of life. These deaths are considered a reflection of the availability and quality of both maternal and newborn health care. There are no country-specific data for South Africa.

Rural 35%

Urban65%

6. Proportions of births by urban versus rural location

Among the women interviewed in a survey conducted in 2003, approximately 65% of births occurred in urban areas.

The total number of births (in thousands): 1 110 (2005)2

Sources: 1Making Pregnancy Safer country profiles [online database]. Geneva, World Health Organization, in press (Department of Making Pregnancy Safer; http://www.who.int/making_pregnancy_safer/en).Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/search/start.cfm).

2World population prospects: the 2006 revision. CD-ROM edition – extended dataset in Excel and ASCII formats. New York, United Nations Department of Economic and Social Affairs, Population Division, 2007 (United Nations publications, ST/ESA/SER.A/266).



2

2.82.3

1.72.1

4.0

2.8

0

1

2

3

4

Total Urban Rural


% o

f w

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15-1

9 ye

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old

) p

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t w

ith

th

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0.40.9

2.7

1.9

2.9

1.7

3.6 3.84.3

3.7

0

1

2

3

4

5

15 16 17 18 19


% o

f w

om

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15–1

9 ye

ars

old

) p

reg

nan

t w

ith

th

eir

firs

t ch

ild

10. Adolescent pregnancy by subregionAdolescent pregnancy rates vary between different parts of South Africa. According to a 2003 survey, the lowest overall rate was in KwaZulu Natal, while the highest rate was in Eastern Cape. Adolescent pregnancy rates can vary for many reasons including cultural norms, socioeconomic deprivation, education, access to sexual health information and contraceptive services and supplies.


0

1.0

2.4

0

2.4

3.7

2.63.0

2.6

6.4

2.92.5

4.2

2.8

4.7

5.4

1.1

0

1

2

3

4

5

6

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Lead the fight for MDG

12. Family planning: modern contraceptive use by age group

Modern contraceptive methods include oral and injectable hormones, intrauterine devices, diaphragms, hormonal implants, female and male sterilization, spermicides and condoms. In general, according to a survey conducted in 2003, contraceptive use was highest in the 35-39 years age group.

16. Utilization of skilled birth attendants

A skilled birth attendant is an accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications among women and newborns. All women should have access to skilled care during pregnancy and at delivery to ensure that complications are detected and managed. According to a survey conducted in 2003, 92% of childbirths were assisted by a skilled birth attendant.

14. Contraceptive use by subregionThe prevalence of contraceptive use varies in different subregions of South Africa. According to a 2003 survey, the prevalence was highest in KwaZulu Natal, compared to all other regions of South Africa. The lowest rate was in Northern Province.

15. Antenatal careAntenatal care visits (ANC) include all visits made by pregnant women for reasons relating to pregnancy. According to a survey conducted in 2003, approximately 92% of women received ANC for their latest pregnancy that ended in a live birth from a skilled provider at least once.

13. Contraceptive use by urban versus rural location

In South Africa, according to a 2003 survey, contraceptive use was higher (about 66%) in the urban than in the rural areas (about 62%).

Intervention coverage for mothers and newborns

11. Unmet need for family planning, 2003 15.0%




Source: Countdown to 2015. Tracking progress in maternal, newborn & child survival: the 2008 report. New York, United Nations Children’s Fund, 2008 (http://www.countdown2015mnch.org/index.php?option=com_content&view=article&id=68&itemid=61).

Sources: Countdown to 2015. Tracking progress in maternal, newborn & child survival: the 2008 report. New York, United Nations Children’s Fund, 2008 (http://www.countdown2015mnch.org/index.php?option=com_content&view=article&id=68&itemid=61).

3

The unmet need for family planning is the proportion of all women who are at risk of pregnancy and who want to space or limit their childbearing, but are not using contraceptives.Source: World contraceptive use 2007. New York, United Nations Department of Economic and Social Affairs, Population Division, 2007 (http://www.un.org/esa/population/publications/contraceptive2007/contraceptive2007.htm).

% o

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tly

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wo

men

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sin

g m

od

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co

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55.862.4

53.7

46.150.2

58.6

57.8

28.5

56.5

26.5

58.8

58.2

0

10

20

30

40

50

60

70


Age (years)

15–19 20–24 25–29 30–34 35–39 40–44 45–49

54.0

38.0

45.9

76.8

65.9

60.5 58.663.1

45.9

62.3

43.5

0

1 0

2 0

3 0

4 0

5 0

6 0

7 0

8 0

WesternCape Cape

Northern

KwaZulu Gauteng NorthernNatal

Eastern Cape

MpumalangaNorth WestFree StateProvince


% c

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48.9

59.7

65.863.4 62.4

65.360.1

70.7

% w

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ho

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89.0

20

0

40

60

80

100

1994-1995 2003

92.0

1998

94.0

% o

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bir

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t

20

0

40

60

80

10082.0

1995 2003

92.0

1998

84.0

55.164.7 62.8 65.8

43.7

61.9

0

20

40

60

80

Total Urban Rural


% o

f cu

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South Africa

17. Utilization of skilled birth attendants by wealth quintile, 2003

Whether a woman delivers with the assistance of a skilled attendant is highly influenced by how rich she is. There are no country-specific data for South Africa.

21. Caesarean section by subregion

Caesarean section rates also vary between subregions in South Africa. According to a survey conducted in 1998, the caesarean section rate varied from about 10% in Mpumalanga to about 22% in Western Cape.

19. Place of delivery

Delivery in a health facility can reduce maternal and neonatal death and morbidity. A survey conducted in 2003 indicated that most pregnant women in South Africa (about 83%) gave birth in a health facility. Some women (about 14%) delivered at home with the associated risks.

20. Caesarean section rates by urban versus rural location

Caesarean section is a surgical procedure in which incisions are made through a woman’s abdomen and womb to deliver her baby. It is performed whenever abnormal conditions complicate vaginal delivery, threatening the life and health of the mother and/or the baby. According to a survey conducted in 1998, about 16% of births were delivered by caesarean section in South Africa. The rate in the rural areas was lower (about 12%) than in the urban areas (about 19%).

18. Utilization of skilled birth attendants by subregion

The percentage of women giving birth with the assistance of a skilled attendant varies by regions within South Africa. According to a survey conducted in 1998, the coverage ranged from about 75% in Eastern Cape to about 96% in Western Cape.

22. Low birth weightBabies weighing less than 2500 g at birth are considered to have low birth weight. According to a survey conducted in 1998, of those babies who were weighed at birth, about 8% were reported to weigh less than 2500 g (2.5 kg). In 2003, this value was 8%. Low-birth-weight babies often face severe short- and long-term health consequences and tend to have higher mortality and morbidity.





4


% o

f b

irth

s

88.7

14.36.6

0.24.7

0

10

20

30

40

50

60

70

80

90

83.4

Health facility At home Other


% o

f b

irth

s d

eliv

ered

by

caes

area

n s

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on

15.5

20.6 19.4

23.7

11.714.8

0

5

1 0

1 5

2 0

2 5

Tota l U rba n R ura l


% b

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7.8

7.9

8

8.1

8.2

8.3


8.0

8.3

0 5 10 15 20 25 30 35

Mpumalanga

Northern Province

Eastern C ape

Northern C ape

Free State

North W est

KwaZulu Natal

Gauteng

W estern C ape

% o

f b

irth

s d

eliv

ered

by

caes

area

n s

ecti

on


33.621.5

20.519.3

14.118.0

14.521.9

15.413.6

13.618.9

21.813.1

10.7

20.49.7

% o

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bir

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dan

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0 1 0 2 0 3 0 4 0 5 0 6 0 7 0 8 0 9 0 1 0 0

91


.

95.294

0

.0

88.091.7

911.82.6

92.576.0

3.3

90.3

72.874.6

Western Cape

Gauteng

Northern Cape

North West

Free State

KwaZulu Natal

Northern Province

Mpumalanga

Eastern Cape

88.3

94.4

961.

78.5

Lead the fight for MDG

25. Equity – gap in coverage of four major interventions by wealth quintile

This graph illustrates the gap in coverage of four key interventions (family planning, maternal and newborn care, immunization and treatment of childhood illness) by wealth. The coverage gap reflects the difference between the goal of universal coverage of everyone in these four intervention areas and actual coverage. Where the gap is larger, it means that there is less adequate coverage. The opposite indicates better coverage. The graph indicates that, in the Demographic and Health Surveys (DHS) conducted in 1998, the coverage gap is highest for the poorest and is lowest for the richer members of society (wealthiest quintile). Overall, the coverage gap in 1998 was 23%. Achieving equity requires improving coverage levels in the poorest quintiles.

24. Prevention of mother-to-child transmission of HIV

The percentage of pregnant mothers living with HIV and receiving antiretroviral drugs (ARVs) to prevent the transmission of HIV to their child increased from 15% in 2004 to 50% in 2006.

23. Anaemia in pregnancy

Anaemia refers to abnormally low levels (less than 110 g/l) of haemoglobin (iron-containing oxygen proteins) in the blood. Severe anaemia is an important contributing factor to deaths due to haemorrhage during childbirth. There are no country-specific data on anaemia in pregnancy for South Africa.

Equity

Resources

Source: WHO/CAH, MPS and HSS Database on National Health Policies.

The work of at least 23 health workers (doctors, nurses or midwives) per 10 000 population is estimated to be necessary to support the delivery of the basic interventions required to achieve the Millennium Development Goals related to health. Globally, 57 countries have been identified with critical shortages below this minimum. These countries have a severe crisis in human resources for health. Of these 57 countries, 36 are in sub-Saharan Africa. South Africa, with about 49 health workers (as defined above) per 10 000 population, is above this minimum threshold and if pared from facing from facing this crisis daily, in mothers and children lacking access to proper maternal and child care, HIV/TB and malaria care, and sexual and reproductive health information and services, including skilled birth attendants.

Increasing the human resources around the world and establishing a balance between the services needed and the personnel available, and their distribution, are key elements of a well-functioning health system and critical requirements for achieving Millennium Development Goals.

26. Reproductive health Yes Maternal health Yes

27. Financial flow (per capita expenditure on health, in US dollars) 2007 748

28. Human resources

Policies


Source: WHO Global Atlas of the Health Workforce [online database]. Geneva, World Health Organization, 2008 (www.who.int/globalatlas/autologin/hrh_login.asp).

5


% p

reg

nan

t w

om

en li

vin

g w

ith

HIV

re

ceiv

ing

AR

Vs

for

PM

TC

T

0

20

40

60

80

100

15

34

50

2004 2005 2006


%

Poorest 2nd 3rd 4th Wealthiest

20

0

40

60

80

100

Coverage gap (%)

1998DHS

23

1.9

15

Ratiopoorest/wealthiest

Differencepoorest-wealthiest (%)

South Africa

29. Ratification of treaties and support of international consensus

For further information, contact:

Sources: Ratifications and reservations [web site]. Geneva, Office of the United Nations High Commissioner for Human Rights, 2008 (http://www2.ohchr.org/english/bodies/ratification/index.htm). Report of the Fourth World Conference on Women, Beijing, 4–15 September 1995. New York, United Nations, 1996 (http://www.un.org/womenwatch/confer/beijing/reports). Report of the International Conference on Population and Development, Cairo, 5–13 September 1994. New York, United Nations, 1994 (http://www.un.org/popin/icpd/conference/offeng/poa.html).

Source: World Bank indicators [online database]. Washington, DC, World Bank, 2008 (http://ddp-ext.worldbank.org/ext/ddpreports/ViewSharedReport?&CF=&REPORT_ID=9147&REQUEST_TYPE=VIEWADVANCED&HF=N/CPP&WSP=N).

Fixed-line and mobile phone subscribers (per 100 population) 94 (2006)

Internet users (per 100 population) 7.8 (2006)

Roads paved (% of total roads) 20 (2005)

Improved water source (% of population with access) 93 (2006)

Improved sanitation facilities (% of urban population with access) 66 (2006)

Convention on the Elimination of All Forms of Discrimination against Women Yes

Convention on the Rights of the Child Yes

International Covenant on Economic, Social and Cultural Rights Yes

International Conference on Population and Development Yes

Fourth World Conference on Women Yes

Child and Adolescent Health and DevelopmentTel: +41 22 791 3281E-mail: [email protected] site: www.who.int/child_adolescent_health/en

Reproductive Health and Research Tel: +41 22 791 3372E-mail: [email protected] site: www.who.int/reproductive-health

Making Pregnancy SaferTel: +41 22 791 3966E-mail: [email protected] site: www.who.int/making_pregnancy_safer/en

Immunization, Vaccines and BiologicalsTel: +41 22 791 4612E-mail: [email protected] site: www.who.int/immunization/en

Gender, Women and HealthTel: +41 22 791 2394E-mail: [email protected] site: www.who.int/gender

30. Other determinants of health: water, sanitation, communication and road networks

6

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South Africa - WHO · South Africa 1998 South Africa 2003 % of women (15–19 years old) pregnant with their first child 10. Adolescent pregnancy by subregion Adolescent pregnancy