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The latest District Health Barometer, released at the end of April, paints a troubling picture of South Africa’s public healthcare sector. Newborn deaths are low but rising, and maternal mortality rates remain high, showing little sign of dropping quickly enough to meet international goals. Tracking these figures provides a clear view of how well the country delivers health services to its most vulnerable residents. This monitoring is critical, as the Barometer has been tracking district-level data for the past two decades, serving as a vital tool for decision-makers given that close to half of a province’s health budget is allocated to the district health system. However, with purse strings tightening specifically for primary healthcare—services that include pregnancy check-ups and ensuring newborn safety—identifying where the system is failing is essential to directing spending choices for equitable care.

In 2024, 29 babies died in public hospitals every day before reaching one month old. This adds up to a total of 10,560 newborn deaths for the year. The current neonatal mortality rate is 13 per 1,000 live births, which is close to the United Nations sustainable development target of 12. However, the broader data suggests the system is under significant strain. This statistic is one of 12 indicators tracked to assess care for pregnant women and young children. While the national rate is near the global goal, performance is uneven across the country, with only every second district managing to hit the mark of 12 or fewer deaths per 1,000 live births.

The maternal mortality rate stands at just over 105 deaths per 100,000 live births. In absolute numbers, this represents 902 women who died due to complications during pregnancy or delivery at health centers. This is 1.5 times higher than the UN target of 70 for 2030. The rate has remained stuck around this level since 2016, with minor fluctuations between 2019 and 2021. Neighboring countries are performing better despite having fewer resources. Brazil, Colombia, and Peru all reported rates at or below 70 in 2023, with specific figures of 67, 59, and 51 respectively. Even Zambia and Mozambique, which spend significantly less on healthcare—at least seven times less—recorded lower maternal mortality rates of 85 and 99 than South Africa.

Safety levels vary drastically depending on a patient’s location, revealing deep inequities in service delivery. These disparities show that the care patients receive is heavily influenced by geography, a reality that experts say indicates serious cracks in the system meant to keep mothers and babies safe.