Twenty-nine. That’s how many babies died in public hospitals in South Africa every day in 2024 before they were one month old, figures from the latest District Health Barometer, released at the end of April, show.
It’s a total of 10 560 newborns who died that year.
And although the rate of newborns dying in government hospitals is at 13 per 1 000 births according to the newest figures — which is close to the United Nations sustainable development target of not having more than 12 deaths per 1 000 births by 2030 — the broader picture is not promising.
That’s because the maternal mortality in-facility rate — which is the number of moms, per 100 000 births, who died at a health centre because of a complication during their pregnancy or delivery — stood at just over 105 per 100 000 births in 2024 (in absolute numbers the count is 902 women).
The rate is 1.5x higher than the United Nations 2030 target of no more than 70 deaths per 100 000 births — and it’s been hovering around this level since 2016 (apart for some ups and downs between 2019 and 2021).
Experts say the numbers are a sign of serious cracks along the system that’s meant to keep moms and their babies safe.
We dug into the latest District Health Barometer to see what the data shows about maternal and newborn deaths.
Will the public health system keep you and your baby safe?
It depends on where you live, the data shows.
Nationally, 13 out of every 1 000 newborns under a month old died in public health facilities in 2024. But although it’s close to the sustainable development target of 12 or fewer, the performance is uneven: only every second district managed to hit the mark.
And there’s more to consider.
Only 29% — that is, 15 out of 52 districts — have a maternal mortality rate below the sustainable development target of 70 per 100 000 live births, and only about half even come in under the national rate of 105.4 per 100 000.
For instance, if you live in Zululand (28.1) in KwaZulu-Natal or the Cape Winelands (33.9) in the Western Cape, your chances of dying during pregnancy or giving birth is much lower than that of someone giving birth in the Capricorn district (182.3) in Limpopo, Lejweleputswa (216.5) in the Free State or OR Tambo (205.4) in the Eastern Cape.
Getting maternal deaths down to under 70 per 100 000 live births is a big goal but not an impossible one, says Peter Barron, who helped start the District Health Barometer 20 years ago and now chairs the Health Systems Trust, who publishes the Barometer.
Barron explains that the number of maternal deaths recorded in a country is almost like a report card on how well its health system is working. Some things have a direct impact on whether a mother survives, he says — like health workers’ skill during a complicated birth or their access to working equipment or supplies. Understanding where the gaps are and fixing them “is like peeling back the layers of an onion”, he says.
What does the past predict about the future?
Over the past nine years, South Africa’s maternal mortality has been hovering in a fairly narrow band around 100 and 110 per 100 000 births — barring the low of just under 90 in 2019 and the highs at around 120 the following two years.
So, despite a big drop in the number of mothers dying because of a complicated pregnancy or delivery after 2014, our calculations suggest that, nationally, South Africa will still be about 20% off target by 2030 if things keep going as they are.
Newborn deaths show a worrying trend, too.
Rates have idled between 12 and 13 per 1 000 live births since 2010, going up or down by a few tenths every year. The lowest value — 11.4 — was in 2013, with the highest — 13.4 — a decade later.
A change of a few tenths year on year — in other words, less than one unit count — could seem negligible if we think of the numbers just in terms of maths. But when the scale is taken into account, the significance of a decimal change becomes clear: these are not just numbers; they’re lives.
Newborn deaths are reported per 1 000 live births. This means that for every 1-million babies born, a 0.1 change in the mortality rate translates to 100 babies either dying or surviving.
Where are the hotspots and the top spots?
We put two maps together to show the 15 best-performing districts (blue dots) and the 15 worst-performing districts (red dots) for each measure, both as a snapshot in 2024 and as an average over the past six years. The smaller the dot, the lower the rate — whether for red or blue.
Tracking numbers for each district is useful to get a sense of how different areas compare, and also to see how things change — or not — over time.
For example, when looking at maternal mortality rates, we saw that three Eastern Cape municipalities — namely the Nelson Mandela Bay metro, Buffalo City metro and OR Tambo district — were among the 15 worst-performing areas.
What also stood out for us was that five of the 15 worst-performing areas in 2024 were metro municipalities. But Barron explains that this is not necessarily a reflection of the quality of care in these spots. Rather, he says, because these municipalities have “the big tertiary and academic hospitals, all the complicated cases get referred to them and if a woman or baby dies while in their care, the death will be counted in that municipality, not the home address of the patient”.
Barron also cautions that it’s important to keep the population size of a district in mind when judging the numbers.
For example, a district with a very small population will likely not see many births in a year, and if a statistic is measured out of 100 000, it’s possible that a low mortality rate could be the result simply of small numbers, rather than great quality of care.
Yet the distribution of mapped data points does show that the care people receive depends on where they live — and that’s worth investigating if South Africa wants to find solutions to keep moms and their babies safe.
Barron explains that to improve impact, we need to get both coverage and quality of care right.
“Leadership is the most important factor. A clinician can only be as good as the ecosystem allows. If there are no drugs, no supplies, no nurses to support, it doesn’t matter if you’re a brilliant doctor; you won’t achieve success. It’s a team sport.”
- In 2024, South African public hospitals recorded 29 newborn deaths daily, totaling 10,560 deaths, with a neonatal mortality rate of 13 per 1,000 births—close to the UN target of 12 per 1,000 by 2030.
- Maternal mortality remains high at 105 deaths per 100,000 births in 2024, 1.5 times above the UN target of 70 per 100,000, with only 29% of districts meeting this goal.
- Significant regional disparities exist: some districts like Zululand and Cape Winelands have low maternal mortality, while areas like Capricorn, Lejweleputswa, and OR Tambo have rates exceeding 180 per 100,000 births.
- Despite some improvements post-2014, maternal mortality rates have plateaued and newborn death rates have fluctuated slightly since 2010, indicating South Africa is unlikely to meet 2030 targets without major health system reforms.
- Experts emphasize that leadership, adequate resources, and quality care are critical to lowering maternal and newborn deaths, with outcomes heavily dependent on geographic location and local health infrastructure.
Twenty-nine.
It’s a total of 10 560 newborns who died that year.
Experts say the numbers are a sign of serious cracks along the system that’s meant to keep moms and their babies safe.
We dug into the latest District
Will the public health system keep you and your baby safe?
It depends on where you live, the data shows.
Nationally, 13 out of every 1 000 newborns under a month old died in public health facilities in 2024. But although it’s close to the sustainable development target of 12 or fewer, the performance is uneven: only every second district managed to hit the mark.
Only 29% — that is, 15 out of 52 districts — have a maternal mortality rate below the sustainable development target of 70 per 100 000 live births, and only about half even come in under the national rate of 105.4 per 100 000.
For instance, if you live in
Barron explains that the number of maternal deaths recorded in a country is almost like a report card on how well its health system is working. Some things have a direct impact on whether a mother survives, he says — like health workers’ skill during a complicated birth or their access to working equipment or supplies.
What does the past predict about the future?
Over the past nine years,
So, despite a big drop in the number of mothers dying because of a complicated pregnancy or delivery after 2014, our calculations suggest that, nationally,
Newborn deaths show a worrying trend, too.
Rates have idled between 12 and 13 per 1 000 live births since 2010, going up or down by a few tenths every year.
A change of a few tenths year on year — in other words, less than one unit count — could seem negligible if we think of the numbers just in terms of maths. But when the scale is taken into account, the significance of a decimal change becomes clear: these are not just numbers; they’re lives.
Newborn deaths are reported per 1 000 live births.
Where are the hotspots and the top spots?
We put two maps together to show the 15 best-performing districts (blue dots) and the 15 worst-performing districts (red dots) for each measure, both as a snapshot in 2024 and as an average over the past six years.
For example, when looking at maternal mortality rates, we saw that three Eastern Cape municipalities — namely the Nelson
What also stood out for us was that five of the 15 worst-performing areas in 2024 were metro municipalities. But Barron explains that this is not necessarily a reflection of the quality of care in these spots.
Barron also cautions that it’s important to keep the population size of a district in mind when judging the numbers.
For example, a district with a very small population will likely not see many births in a year, and if a statistic is measured out of 100 000, it’s possible that a low mortality rate could be the result simply of small numbers, rather than great quality of care.
Yet the distribution of mapped data points does show that the care people receive depends on where they live — and that’s worth investigating if
Barron explains that to improve impact, we need to get both coverage and quality of care right.
“
