In 1956, an increasingly systematic stripping of black South Africans’ freedom of movement, their equality and very dignity was unfolding across the country. On August 9 20 000 South African women converged at the Union Buildings to protest the pass laws. Placing themselves at the heart of the struggle for non-racial equality, these early women champions were defiant. Fiercely committed to securing the future for the country, women faced down police batons, guns and teargas. As we honour them on Women’s Day, we must ask: What would these women freedom fighters think of South African women’s health today, their prospects for human development, what women are able to be and do?
Three comparative global health indicators reveal the picture of black South African women’s health: HIV prevalence, life expectancy and maternal mortality. First, HIV. A concerted effort to prevent newborns from acquiring HIV has been made in recent years, with great improvements. Yet reductions in mother-to-child HIV transmission effectively mask the health of black South African women. Black women of reproductive age still bear the brunt of HIV infection. Average HIV prevalence in pregnant women was 29.5% in the latest ANC survey. What’s more, that figure has stood unchanged for 10 years, and lies in sharp contrast with 10% national HIV prevalence. Women aged 30-34 years have an even higher HIV prevalence of 42.8%. That figure should shock and appal.
Second, life expectancy. Gains have been achieved, but against major losses, attributed to HIV-related infections. Life expectancy at birth for all South African women increased from 54.4 years in 2003 to 61.4 years in 2013. Contrast this with women in Japan who will expect to live 87 years. Similarly, women in Spain, Switzerland, Singapore and France can expect to live to 85. This means South African women enjoy roughly 20 fewer years of life than their counterparts in other countries.
Third, maternal mortality. Quality cause of death data have their limitations, yet all research indicates that HIV-related diseases contribute to 40% of maternal deaths. South Africa will not achieve millennium development goal 5, which seeks to reduce the maternal mortality ratio in the country by three-quarters, by 2015. The department of health has made strides to address premature mortality through HIV service delivery targeted to pregnant women and mothers. This is necessary. When significantly high numbers of South African women of reproductive age are contracting HIV with such frequency and consistency, more transformative efforts are essential, and not just by the department of health. But it is insufficient: women are pregnant for a short time, not all women become pregnant.
Across these three global health indicators — HIV, life expectancy and maternal mortality — black South African women today have one of the poorest health trajectories, globally. Yet these deep inequalities in health outcomes for South African women are changeable. Political will and support for women and women’s health exists across key sectors of society. South Africa is an upper middle-income country with the enabling conditions — human and financial resources, medical and health expertise and infrastructure, the enabling legal framework and progressive Constitution — to deliver on the promise of good health and human development for women.
The department of health’s current health strategy for women is maternal and child health. It must move beyond this narrow band to embrace an integrated guiding life course approach to women’s health, which encompasses mental and physical, reproductive and sexual health. A life course approach to women’s health recognises that allowing babies to be born HIV-free only ensures a healthy start. Those babies will become girls, surrounded by a high-risk environment for HIV and other health threats. Interventions to address women’s health must cut across sectors. If girls are lucky, they will go to school. This place of learning is increasingly becoming a site where sexual abuse of pupils by teachers is common. Condoned. Our women freedom fighters would ask: “Why is it acceptable for South African girls to be abused and raped on the way to school or at school by the very educators entrusted to teach them?”
A fundamental set of enabling economic and social conditions that allow girls and women to gain hold of the reins of development are needed: multi-pronged programmes that link education, employment and labour. South African girls and women must be able to complete their education without getting ill, pregnant or dying, to allow them to be placed on a sure-footed path of wellbeing.
A girl’s ability to secure a university education and employment will have direct impact on her ability to be healthy, to contribute to her family, community and society. It will determine whether she is able to construct a life she has reason to value. Women must be able to access information and services that enable them to make informed choices related to safe contraception, family planning, sexual and reproductive health and rights, knowledge about and control over their own bodies, and freedom from sexual violence. Girls must understand both the threats to and opportunities for their health.
We must chart a new vision for South African women’s human development. This begins by valuing South African women, valuing women’s health. It requires multi-sectoral commitment and action, clear and steadfast work in policy and programming. It requires thinking across silos, breaking with existing paradigms, staging a revolution. This is in the spirit of the path breakers, Lillian Ngoyi, Helen Joseph and Amina Cachalia, who accumulated 100 000 signatures of people all over South Africa. Those women leaders saw the future and collected signed petitions to fight the reprehensible pass laws. The women who gathered on August 9 stood in silence for 30 minutes. They broke out into the freedom song: “Strijdom, you have touched the women. You have struck a rock; you have dislodged a boulder — you will be crushed” and they sang the beloved anthem Nkosi Sikelel’iAfrika. On this Women’s Day, let us sign a symbolic petition to advance South African women’s health and human development. Let us recommit ourselves to the task — freedom, equality and good health — for all.
Image – Patients wait to collect their medication at Chris Hani Baragwanath Hospital in Johannesburg, South Africa, September 28 2010. (Gallo)