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Poverty and inequality are major obstacles to equitable human development, with income poverty affecting 52.9 per cent of the South African population. The country also is one of the most unequal societies in the world, with a Gini Coefficient of 0.66 (with 0 expressing total equality in wealth between citizens and 1 complete inequality). One in four working-aged South Africans is unemployed and the current rate of economic growth is not enough to reduce unemployment and poverty significantly.South Africa is a land of contrast and diversity where opportunities for children and women to lead healthy, safe and productive lives vary greatly. The country has sophisticated and technologically advanced cities that contrast sharply to impoverished townships and rural areas. There are 11 official languages in South Africa and a multitude of peoples and cultures that comprise one of the world’s most diverse societies.

The new democratic South Africa has made substantial progress in transforming its health sector. Primary healthcare has vastly expanded to more than 4,000 clinics across the country and government health services are free for children under the age of five and for pregnant and breastfeeding women. Remarkable progress has been made in rolling out antiretroviral (ARV) treatment. The country has the largest number of people enrolled on ARVs in the world – close to one million people in 2009. A national food fortification programme has also reduced the number of birth defects by more than a third.
The government spends about 11 per cent of its total budget on health – more than any other country in Southern Africa. New legislation has been passed to make the health system more equitable and accessible to all South Africans.

Despite this, child and maternal survival has stagnated over the past 10 years, more than 200 children under the age of five die every day of mainly preventable causes. HIV/AIDS-related diseases are a major cause of death in young children, followed by pneumonia and acute diarrhoea. South Africa has also recently identified problems in the levels of coverage of routine childhood vaccinations.

Malnutrition is a major contributing factor to child death. One in four children is stunted and many are deficient in vitamins and minerals essential to preventing disease and disability. Given these current trends it is unlikely that South Africa will meet the 2015 Millennium Development Goal of reducing child mortality.

Of great concern are the high death rates of newborn babies and mothers. Almost 40 per cent of all under-five deaths occur in the first 28 days of life – the neonatal period. Around 20,000 babies are stillborn every year; many die during labour. The maternal mortality rate was last recorded at 400 per 100,000 in 2005.

These deaths happen in a context where a high proportion of women attend antenatal care and deliver babies in hospitals and maternity clinics with skilled attendants. It is clear that the quality of maternity and neonatal health services is inadequate and that many lives are needlessly lost.

South Africa has the highest global burden of HIV and AIDS – 16 per cent of the world’s population with the disease lives here.