Before we begin…
- Marcia Moyana
Investing in antenatal care is crucial for South Africa’s future, but women need support even earlier than in pregnancy.
The health of a child, their ability to learn, resist disease and reach their potential, starts before they are even born. However, extreme inequality in South Africa threatens the health and welfare of future generations. Integrated policy around nutrition support, the promotion of health behaviours, mental health screening and social protection that begins before conception could support pregnant women and break the cycle of poverty.
Inequality affects women more
According to World Bank statistics for 2025, 68% of South Africans live below the upper-middle-income poverty line. Of these, at least 51% are female and it is women who face higher unemployment, dominate informal work and carry the burden of caregiving.
“This means that women of reproductive age make up a large number of South Africa’s poor,” explains Dr Pooja Nair, an obstetrics and gynaecology specialist and lecturer at Wits.
The consequences of high poverty rates amongst women include delayed or absent antenatal care, poor nutrition, chronic diseases like obesity and hypertension and heightened exposure to gender-based violence and mental-health struggles. Nair says that each of these factors directly affects not only pregnancy outcomes but the child’s long-term development.
Mother and child links
"Nutritional status, stress and chronic diseases are directly related to placental function and development. When these are compromised, there is a rise in preterm births and intrauterine growth restriction, as well as long-term metabolic changes in the child due to epigenetics,” says Nair.
Dr Alessandra Prioreschi, a scientist consultant at the Wits Developmental Pathways for Health Research Unit concurs and explains that women’s poor nutrition, stress or social hardship alter the biological environment in which the baby develops, putting children at a disadvantage before they are even born.
These biological consequences, which span generations, begin pre-conception and continue during pregnancy as the programming of a child's metabolic health and organ function occurs. Research shows that women experiencing food insecurity or chronic stress face higher rates of anaemia, obesity and depression – all of which affect infant growth and development.
Very young mums
The alarm bells to the looming crisis have already begun ringing and teenage girls are among the most vulnerable. Reports show that 150 000 South African teenage girls were made pregnant between 2022 and 2023. In the Eastern Cape alone, 117 girls aged 10 to 14 gave birth between April and July 2025.
“These early pregnancies perpetuate the same disadvantages that shaped the mother’s life, passing them on to the next generation,” cautions Nair.
Some premature births happen as a result of early pregnancies. When a baby is born prematurely, the costs are enormous and the infant will require specialised neonatal care, long hospital stays and years of developmental and neurological follow-up.
Nair believes that saving future generations requires investment in the education of children, communities and families. “Better education means fewer teenage pregnancies, less gender-based violence and young people who understand their bodies and choices. Health information must reach households, teaching how nutrition, healthy habits and managing chronic illness affect pregnancy and a child’s future,” she adds.
Government putting real resources into primary and regional healthcare, strengthening the health system and ensuring that clinics are staffed, accessible and consistent, are also critical to the success of future generations.
Lifesaving immunisation
Holistic pre-natal and maternal support includes lifesaving vaccination. Vaccines are critical for improving maternal and child health outcomes because they protect both mothers and infants from life-threatening infections during pregnancy and early childhood, according to Professor Michelle Groome, a researcher at the Wits Vaccines and Infectious Diseases Analytics (Wits VIDA) research unit.
“Protection in the first months of life is especially vital because newborns cannot receive many vaccines directly, leaving them vulnerable and without protection from maternal antibodies, which are then transferred to the baby. When vaccines are missed, mothers and babies face a high risk of disease, hospitalisation and even death from preventable infections,” says Groome.
Some of the studies at Wits VIDA have included the pneumococcal conjugate vaccines and rotavirus vaccines in infants, which significantly influenced public immunisation programmes in South Africa and other low- and middle-income countries.
The first randomised controlled trials of inactivated influenza vaccine in women (with and without HIV) demonstrated safety and efficacy in the women and their young infants.
Another study was the first globally on the clinical development of Group B Streptococcus vaccines and respiratory syncytial virus vaccines in pregnant women.
Before 1 000 days
Prioreschi acknowledges that mothers want to do the best for their children but do not always have the means, knowledge or support.
“We need to make it easier for women to be healthy before, during and after pregnancy through access to affordable nutritious food, antenatal care that includes mental health support, safe environments for physical activity and education around breastfeeding and responsive caregiving,” she says.
South Africa already recognises ‘the first 1 000 days’ – the period from conception to a child’s second birthday – as critical. Prioreschi argues that the focus should be extended to pre-conception so that maternal health and nutrition is embedded into social protection, education and labour policies.
The health of mothers and children should not be seen as a cost but as an investment in the foundation of the country’s future wellbeing and productivity.
- Marcia Moyana is a freelance writer.
- This article first appeared in CURIOS.TY, a research magazine produced by Wits Communications and the Research Office.
- Read more in the 20thissue, themed #Thrive, which explores what it truly means to flourish — across a lifespan, within communities, and on and with our planet.
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