Newborns still dying needlessly

Budget cuts, staff shortages and socio-economic barriers continue to undermine efforts to improve neonatal care and reduce infant mortality

- Aarti Bhana

Pregnant women in South Africa face significant barriers to getting care for themselves and their newborns, prompting renewed calls for grassroots interventions to reduce neonatal and perinatal deaths.

"The persistently high burden of neonatal and perinatal mortality in South Africa reflects deeper systematic challenges," said Shakti Pillay, a neonatologist at Groote Schuur Hospital in Cape Town.

Those difficulties include inequitable access to quality maternal and newborn baby care; staff shortages; resource constraints and the broader social determinants of health, such as poverty, food insecurity and a lack of transport.

Although the number of live births increased annually in 88% of districts from 2019 to 2020, the longer-term trend shows a national decline in live birth rates.

"There has been a trend of declining live birth rates year on year across most districts with only one district reporting an increased number of live births in 2023-24 compared to 2022-23," according to the 2023-24 District Health Barometer Report.

"The overall downward trend in birth rates is confirmed by decreasing home affairs [department] birth registration rates."

The report also found that the projected census estimate of the number of children under the age of one, as used in the District Health Information System, "is in line with this trend" — showing a decline from 1139380 in 2021-22 to 1135 771 in 2022-23 and to 1132896 in 2023-24.

Despite declining birth rates, neonatal mortality has remained constant over the past decade. Though it is still within the UN's sustainable development goals of 12 deaths per 1000 live births, the goal is to reduce this to below 12 by 2030.