Fact Sheet: Focus on South Africa

1. OCTOBER 2015
Evidence from South Africa indicates that physical
distance to a health care facility is important for health
care access and outcomes. Specifically, research
on adolescent health in South Africa shows that the
distance to a care facility influences sexual health and
timing of teenage childbearing. Teenage childbearing
can have lasting health and economic consequences
for both mothers and their children. Furthermore,
racial disparities in teenage childbearing may further
perpetuate inequalities in health and education.
Findings From the Research
PROXIMITY TO HEALTH CARE MATTERS
Living further from a health care facility may increase
the cost of travel and the amount of time spent away
from regular activities—barriers that may impede
access to care. In South Africa, on average, 14 percent
of black, 8 percent of coloured, and 4 percent of white
households live more than five kilometers from the
nearest health facility.1
Those who live further from
health facilities are less likely to have consulted a
health care professional in the past year.2
While distance to care is important, travel costs, out-
of-pocket costs, perceptions about quality of care, and
disrespectful treatment may also serve as barriers.3
For example, disapproval from providers could prevent
young people from seeking necessary health care and
sexual health information.
The National Adolescent Friendly Clinic Initiative (NAFCI)
was launched in the early 2000s to meet the reproductive
and sexual health needs of young people in South Africa
and to eliminate barriers to care. NAFCI-accredited clinics
provide “youth-friendly” care and sex education without
disapproval from health care providers.4
Services oriented toward young people are important
because only 36 percent of sexually active South
African women ages 15 to 19 have ever used modern
contraception and 77 percent of teenage mothers report
their last birth was unwanted or mistimed.5
Preliminary results from a 2014 assessment of NAFCI’s
impact on fertility and sexual health suggest that
proximity to a NAFCI-accredited health care facility is
associated with delayed childbearing and reductions
in sexually-transmitted infections among adolescents.6
Findings indicate that NAFCI clinics increased young
people’s access to sexual health information and
contraception.
• Young women who lived within one kilometer of a
NAFCI clinic were significantly less likely than those
who lived further from a clinic to have a child by age 18.
Educational attainment for young women living within
one kilometer of a NAFCI-accredited clinic increased by
an average of half a year. The evidence suggests that
young women living near NAFCI clinics may have used
contraception to delay childbearing that could have
disrupted their schooling.
• Although the number of condoms distributed increased
at all clinics included in the study, the number of
condoms distributed increased more quickly at NAFCI-
accredited clinics than at other clinics.
• The rate of newly diagnosed sexually-transmitted
infections declined more quickly at NAFCI-accredited
clinics than at other clinics.
While the NAFCI clinic-based intervention shows promise,
school-based interventions may also have a positive
impact on health. The Siyakha Nentsha program piloted
in KwaZulu-Natal, South Africa, targeted both boys and
girls to build health, economic, and social skills. Evaluation
results showed that program participants were more likely
to know where to get a condom than nonparticipants,
and that girls were more likely to have greater confidence
in their ability to access condoms than the control group.
Boys who participated in the program were more likely
to have remained abstinent and reported fewer sexual
partners than the control group.7
ACCESS TO HEALTH CARE
AFFECTS TEENAGE CHILDBEARING
Fact Sheet
Focus on
South Africa
About the Population and
Poverty Research Initiative
The William and Flora Hewlett Foundation’s
Population and Poverty (PopPov) Research
Initiative, in partnership with other funders,
has supported a global group of researchers
looking at how population dynamics affect
economic outcomes. Research funded
through the PopPov Initiative sheds light
on pathways through which fertility, health,
and population growth affect economic
growth, providing insights and an evidence
base relevant to achieving the Sustainable
Development Goals (SDGs). Findings show
that investing in women’s health, education,
and empowerment improves economic
well-being for individuals and households,
and contributes to economic growth.

2. PRB is the Secretariat of the PopPov Research Network. For additional information, please visit www.poppov.org.
TEENAGE CHILDBEARING ADVERSELY AFFECTS
HEALTH AND EDUCATIONAL ATTAINMENT
Access to reproductive health care and family planning services helps
young women delay pregnancy and continue their education, which
can influence their employment opportunities and earnings. Research
shows that teenage childbearing has negative health and education
consequences for both women and their children.
• Women living in rural KwaZulu-Natal who give birth in their teens
(ages 15 to 19) are more likely to drop out of school, less likely to
graduate, and have significantly fewer years of education.8
• An analysis of data collected between 2000 and 2007 from
KwaZulu-Natal indicated that teenage mothers were more likely to
die before age 30 than their peers who did not give birth in their
teens.9
HIV/AIDS caused the majority of these deaths.
• An analysis of data from Cape Town revealed that children born
to teenage mothers were more likely to be born underweight, an
important indicator of health status and a predictor of future health
and well-being. These children were also more likely to be stunted
than their peers who were born to older mothers.10
• Data from Cape Town also showed that while both coloured and
black infants born to teenage mothers were more likely to be
underweight at birth than those born to older mothers, the adverse
outcomes were more pronounced for coloured infants.11
• Black and coloured teenagers have much higher rates of
childbearing among racial groups in South Africa. Among women
ages 15 to 19, about 22 percent of coloured women had given
birth compared to almost 15 percent of black women and nearly
4 percent of white women (see Figure).12
Black and coloured
teenagers may be disproportionately affected by the negative
consequences of teenage childbearing.
FIGURE
Black and Coloured Women Are More Likely to Have Given
Birth in Their Teens Than White Women
Percentage of Women Ages 15 to 19 Who Have Given Birth by Race, 2008
15
22
4
Coloured Black White
0
10
20
30
Source: Tom Moultrie and Rob Corrington, “Demography: Analysis of the NIDS Wave 1
Dataset,” discussion paper 9 (Cape Town, South Africa: National Income Dynamics Study,
Center for Actuarial Research, University of Cape Town, 2009).
Policy Implications
Pregnancy and childbearing can disrupt young women’s schooling
and have an adverse impact on their health and the health of their
children. The government of South Africa can take action to increase
access to high-quality, youth-friendly health care and information
in order to improve the human capital of South Africa’s young
people. Because of higher rates of teenage childbearing, black and
coloured young women are especially at risk for the adverse health
and educational outcomes associated with teenage childbearing.
Targeted efforts are needed to help young black and coloured women
prevent pregnancy until they are ready to become parents.
• Minimizing the distance to health care facilities, especially in black
and coloured neighborhoods, could improve health care utilization
and reduce disparities in teenage pregnancy and childbearing.
• To reduce unintended teenage pregnancy and childbearing,
reproductive and sexual health information and services should be
youth-friendly. Improving sexual health knowledge can empower
young people to avoid taking sexual risks and to use condoms
and other contraceptives that help young women avoid pregnancy
while in school and reduce their risk of adverse outcomes.
References
1 The South African population is primarily divided into four racial categories:
African or Black, White, Coloured people of mixed ancestry, and Asian. This
fact sheet shares information on Black, White, and Coloured racial groups.
2 Zoe McLaren, Cally Ardington, and Murray Leibbrandt, “Distance Decay
and Persistent Health Care Disparities in South Africa,” BMC Health
Services Research 14, no. 541 (2014); DOI: 10.1186/s12913-014-0541-1.
3 McLaren, Ardington, and Leibbrandt, “Distance Decay and Persistent
Health Care Disparities in South Africa.”
4 Nicola Branson and Tanya Byker, “Impact of a Youth-Targeted Reproductive
Health Initiative on Teen Childbearing in South Africa,” working paper
submitted to Population and Poverty (PopPov) conference on Population,
Reproductive Health, and Economic Development,” June 24-26, 2015.
5 Department of Health, Medical Research Council, South Africa, South
Africa Demographic and Health Survey 2003 (Pretoria, South Africa:
Department of Health, South Africa and OrcMacro, 2007).
6 Branson and Byker, “Impact of a Youth-Targeted Reproductive Health
Initiative on Teen Childbearing in South Africa.”
7 Kelly Hallman and Eva Roca, “Siyakha Nentsha: Building Economic,
Health, and Social Capabilities Among Highly Vulnerable Adolescents in
KwaZulu-Natal, South Africa,” Promoting Healthy, Safe, and Productive
Transitions to Adulthood Brief 4 (New York: Population Council, 2011).
8 Cally Ardington, Alicia Menendez, and Tinofa Mutevedzi, “Early Childbearing,
Human Capital Attainment and Mortality Risk: Evidence from a Longitudinal
Demographic Surveillance Area in Rural KwaZulu-Natal, South Africa,”
Economic Development and Cultural Change 63, no. 2 (2015): 281-317.
9 Ardington, Menendez, and Mutevedzi, “Early Childbearing, Human Capital
Attainment and Mortality Risk.”
10 Nicola Branson, Cally Ardington, and Murray Leibbrandt, “Health
Outcomes for Children Born to Teen Mothers in Cape Town, South Africa,”
Economic Development and Cultural Change 63, no. 3 (2015): 589-616.
11 Branson, Ardington, and Leibbrandt, “Health Outcomes for Children Born
to Teen Mothers in Cape Town, South Africa.
12 Tom Moultrie and Rob Corrington, “Demography: Analysis of the NIDS
Wave 1 Dataset,” discussion paper 9 (Cape Town, South Africa: National
Income Dynamics Study, Center for Actuarial Research, University of Cape
Town, 2009).