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The number of newborns dying in South Africa’s public hospitals is rising, while maternal deaths remain high, exceeding United Nations targets for 2030.

The latest District Health Barometer, released in April, reported 10,560 infant deaths before their first month in 2024. That amounts to 29 newborn deaths daily. The neonatal mortality rate reached 13 per 1,000 live births, slightly above the UN’s goal of 12 by 2030. The figures show a worsening trend.

Maternal deaths far exceed global goals

The in-facility maternal mortality rate was 105.4 deaths per 100,000 live births in 2024, claiming 902 women. The UN’s 2030 target is 70, meaning South Africa’s rate is 1.5 times higher than required. Progress has stalled since 2016, with rates fluctuating between 90 and 120.

Other countries have achieved better results. Brazil, Colombia, and Peru have met or surpassed the UN target for over a decade. Zambia and Mozambique, despite lower healthcare spending, also report lower maternal mortality rates.

Direct factors, including skilled birth attendants and functioning equipment, play a role, but broader issues such as nutrition, education, and socioeconomic conditions also contribute. Addressing the problem requires examining multiple layers.

Where you live determines your risk

Data shows significant disparities across provinces and districts. Nationally, the neonatal mortality rate of 13 per 1,000 live births is close to the UN target, but performance is uneven: only every second district managed to hit the mark.

Population size and local conditions influence the numbers. A district with few births might report artificially low rates due to small sample sizes. Despite these variations, the data reveal a clear pattern: location affects the quality of care available.

Metro municipalities also appear on the list of high-risk areas. Large tertiary hospitals handle the most complex cases. Deaths occurring there are recorded in the municipality where the hospital is located, not the patient’s home district.

South Africa’s health system provides widespread access to care but struggles with quality. Success depends on teamwork.

The neonatal mortality rate has remained nearly unchanged since 2010, staying between 12 and 13 deaths per 1,000 live births. With nearly 813,000 births in public facilities last year, even a small change could mean differences in actual deaths.

Clinicians can only operate within existing systems. Without reliable supplies, trained staff, and coordinated care, even skilled doctors cannot save lives.

The District Health Barometer has monitored these figures for two decades, providing a resource for policymakers. With nearly half of provincial health budgets directed toward district-level care, the data could inform spending decisions—if leaders take action.

Efforts to improve outcomes must address systemic gaps in public hospital care.