south africa

ARROW collaborates with AIDS Accountability International (AAI) to monitor the SRHR of adolescents and young people in the African region and highlight government progress in implementing the ICPD PoA, as well as gaps in implementation.



South Africa, situated in the sub-tropical region at the southern tip of the African continent, covers 1.2 million sq. km. Most of the country is on a plateau that rises above the 1000 m sea level. Swaziland and Lesotho are two land-locked countries encompassed by South Africa. They are also economically dependent on South Africa. Mozambique, Zimbabwe, Botswana and Namibia are South Africa’s neighbours and share a long and diverse history of violation and dependence.


The people of South Africa have diverse origins. The “Native Land Act” of 1913, set aside only 7.3 percent of South African territory as reservations for Africans and barred them from buying land outside these areas. This act divided South Africa into “White” and “Black” areas forming the cornerstone of Apartheid. A resistance movement spearheaded by South Africans living in exile culminated in a negotiated settlement which led to the first national election in South Africa on 27 April 1994. Today, South Africa is a democratic nation divided into 9 provinces under a semi-federal system. Pretoria is the administrative capital; Cape Town the legislative capital and Bloemfontein the judicial capital.


According to the most recent census in 2011, the population of South Africa is 51.8 million. The population size has increased noticeably from 40.6 million in 1996. Among the population groups, black African population constituted more than 75%.


Source: extracted from South Africa Demographic and Health Survey 2003; Census 2011 Statistical release; South Africa Demographic and Health Survey 2016


Sexual and Reproductive Health


Key findings from the 2016 SADHS on the situation of SRHR in South Africa are as follows:


Maternal Health:

  • The pregnancy-related mortality ratio during the 7-year period before the SADHS 2016 was 536 pregnancy-related deaths per 100,000 live births.
  • Ninety-four percent of women received antenatal care from a skilled provider for their most recent birth.
  • Almost all of the live births (96%) in the 5 years before the survey took place in a health facility; only 4% were delivered at home.
  • Nearly all births (97%) are assisted by a skilled provider, most often a nurse or midwife (68% of all deliveries); 29% of deliveries are assisted by a doctor.
  • Eighty-seven percent of mothers received a postnatal check; 84% had this check within the first 2 days after the birth.



  • The total fertility rate is 2.6 children per woman, a decline from 2.9 in 1998.
  • The fertility rate declines with increasing household wealth, from 3.1 children among women in the lowest wealth quintile to 2.1 children among women in the highest wealth quintile.
  • Black African women have the highest fertility rate (2.7 children per woman), followed by Coloured (2.5 children), Indian/Asian (1.7 children), and White (1.5 children) women.
  • The median age at first birth among women aged 25-49 is 21.3 years.
  • Forty-eight percent of women are currently using a method of contraception and nearly all (99%) use a modern method.
  • Among sexually active women, the most commonly used methods are injectables (25%), male condoms (16%), contraceptive pills (7%), and female sterilisation (6%).
  • 80% of all modern contraceptive users obtain their methods from the public sector.





  • Eighty-three percent of women are aware that HIV can be transmitted during pregnancy, during delivery (78%), and through breastfeeding (77%).
  • The vast majority of respondents (93%) know where to obtain an HIV test. Fifty-nine percent of women aged 15-49 were tested for HIV in the past 12 months and received the results of their last test.
  • Twelve percent of women either had an STI or symptoms of an STI during the 12 months before the survey.
  • Sixty-six percent of women who had an STI or STI symptoms sought advice or treatment from a clinic, hospital, private doctor, or other health professional.
  • The proportion of young people tested for HIV in the last 12 months increases with age, rising from 58% among women aged 15-17 to 71% among those aged 23-24.


Sexual and Reproductive Rights


Child Early & Forced Marriage (CEFM):

  • Early unions (marriage or living together with a partner as though married) are rare in South Africa. Among women who are currently aged 25-49, 2% were in a union by age 15, 7% by age 18, 13% by age 20, 20% by age 22, and 31% by age 25.
  • The median age at first sexual intercourse among women aged 20-49 is 18.1 years.
  • Seven percent of women first have sex before age 15 and 49% before age 18.
  • Nine percent of women aged 15-17 and 16% of women aged 15-19 have begun childbearing.
  • Urban women (14%) are less likely than nonurban women (19%) to begin childbearing in their teen years.
  • Two percent of in-union women report that their husband or partner has more than one wife.


Violence Against Women (VAW):

  • One in four (26%) ever-partnered women aged 18 or older have experienced physical, sexual, or emotional violence committed by a partner in their lifetime.
  • The most common form of violence experienced by women is physical violence (21%); 17% of women have experienced emotional violence, and 6% have experienced sexual violence.
  • Six percent of women believe that a husband is justified in beating his wife in at least one of five specified circumstances. Neglecting the children is the most acceptable reason for wife beating.
  • 72% of in-union women aged 15-49 report that they can say no to their partners if they do not want to have sexual intercourse.