Biological and gender-related discrepancies influence health significantly more in developing countries than in developed ones. For example, due to sociocultural factors, women’s health in South Africa is jeopardized. Some of the reasons for this include unequal relationships of power between women and men, social norms bolstering the decrease in girls’ education and job opportunities, as well as the encouragement of the importance of women’s reproductive role. 

Maternal Mortality

Compared with other African countries, South Africa has one of the lowest rates of maternal mortality. The sub-Saharan nation has seen a decline in such deaths from 150 per 100,000 births in 1998 to 113 per 100,000 in 2019. Nonetheless, the leading causes of maternal mortality in South Africa are major obstetric hemorrhage (MOH), hypertensive disorders of pregnancy and human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS)-related infections. 

MOH – mostly occurring postpartum – is characterized by severe blood loss and provokes anemia, multi-organ failure and hysterectomy, disseminated intravascular coagulation and long-term trauma. Unskilled or understaffed birth attendance, delivery in poorly equipped facilities and lack of necessary obstetric care supplies (e.g., blood transfusion) are all factors that increase the likelihood of maternal death by MOH. 

Hypertension is the most common disorder that occurs during pregnancy, with four types: chronic, gestational, (pre)eclampsia and chronic hypertension with superimposed (pre)eclampsia. The American College of Obstetricians and Gynecologists (ACOG) defines it as “clinic maternal systolic blood pressure greater than or equal to 140 mm Hg and/or diastolic blood pressure greater than or equal to 90 mm Hg on two or more occasions at least four hours apart.”

HIV is a sexually transmitted, lifelong condition that harms the body’s immune system. Many people experience flu-like symptoms, but others do not show any signs at all. The virus can be treated with effective medical care; nevertheless, if left untreated, it can develop into acquired immunodeficiency syndrome (AIDS) and ultimately lead to death. The virus indirectly causes maternal mortality, as it triggers increased susceptibility to infections (e.g., pneumonia, malaria and tuberculosis). Many pregnant women are dying in South Africa because they do not attend antenatal care services for fear of having their HIV status revealed. 

Former Secretary General of Amnesty International Salil Shetty, said: “It is unacceptable that pregnant women and girls are continuing to die in South Africa because they fear their HIV status will be revealed or because of a lack of transportation or basic health and sexuality education. This cannot continue”. “The South African government must ensure all departments work together to urgently address all the barriers that place the health of pregnant women and girls at risk,” said Shetty.

HIV Education and Testing

There is a lot of stigma surrounding HIV-related topics in many communities – which increases women’s fear of discriminatory treatment if they test positive for the virus. South Africa has the highest rate of HIV in the world, with approximately 7.5 million infected inhabitants in 2021 – 60% of whom were women. Young women aged 15-24 are at greater risk of contracting the virus; in fact, they are four times more vulnerable than men in that age range. HIV education in schools can not only enhance safer sexual intercourse, but it can also incite pregnant young girls to get tested for disease and if the result comes back positive, prevent mother-to-child transmission by taking medication. 

However, gender inequalities, as well as conflicting cultural and traditional beliefs, significantly affect the teaching of and discussion about sexuality in the classroom. For example, teachers must follow guidelines implemented by the school, which include language use. More specifically, they cannot use terminology that might be deemed vulgar to the audience. As such, sensitive topics, such as sexual health, are not openly discussed, thereby compromising women’s health in South Africa.  

In many health clinics, women and girls living with HIV are treated differently than those who are not. That is, they must stand in separate queues for their antiretroviral medication, schedule different days for medical appointments and have other colored antenatal files.

Shetty said: “While HIV testing is an important public health intervention, it must be done in a manner that respects the rights of women and girls and does not expose them to additional harm. It is deeply worrying that the privacy of pregnant women and girls is not respected in health facilities. The South African government must take urgent steps to correct this.”

It is vital that health care workers in South Africa receive additional training on providing quality care that is both free of judgment and stigma and that women and girls accessing sexual and reproductive health services can trust that their confidentiality will be respected,” said Shetty.

Accessing Healthcare Services in South Africa

Most South Africans live within a 7km radius of a health care facility, while others are based 2km away from one. Despite the proximity, transport to health services is a struggle for women due to the shortage of available public transport services. In the rural provinces, some roads are impassable, especially after rainfall and even when the ground is dry, most ambulances will not drive beyond a certain point on specific routes. “The South African government must build better road networks in these rural provinces to guarantee access to healthcare facilities. The government must also ensure that ambulances are always available to transport those who are in need,” said Shetty.

Looking Ahead To Improve Women’s Health in South Africa

The South African Society of Obstetricians and Gynecologists (SASOG) strives to achieve excellence and equity in the health of South African women. To achieve this, SASOG puts the promotion of the highest standards in clinical practice, training and research in Obstetrics and Gynaecology and the support of continuous professional development at the forefront. Overall, SASOG pledges to redress healthcare injustices by eradicating gender oppression and inequality to enhance women’s health in South Africa.  

– Abigail Roch
Photo: Pixabay