You’ve just found out you’re pregnant. You want to do what’s best for your child – attend your check-ups, ask questions, eat right, and prepare yourself for the journey ahead. But already, you’re up against a wall of challenges, such as long waits at the clinic, inconsistent care, overburdened and exhausted medical staff, and on some days, no care at all. You go through the pregnancy period with stress and anxiety from these issues and other problems at home. But luckily, you give birth to a healthy child. You breathe a breath of relief, telling yourself it’s over, now you can relax, but the first two years of your child’s life are critical. You still need quality care for your child and yourself because these are the years of your child’s development, but you still face the same problems. Now, your entire child’s future is affected because of these issues!
This isn’t an isolated experience – it’s the daily reality for many mothers across South Africa. And not all of them are as lucky to give birth to a healthy baby. Some babies are stillborn. Some don’t make it to their fifth birthday. Some mothers die. And for many who do survive, the future of their child is bleak – marked by compromised development and limited opportunities.
In 2022, the Medical Research Council estimated that 30 out of every 1,000 infants born alive in South Africa did not survive their first year. The under-five mortality rate also rose, from 29 per 1,000 live births in 2020 to 40 in 2022. Premature births and delivery complications remain major contributors. And when mothers can’t get regular check-ups during pregnancy, the chances of picking up problems early drop even more. The Saving Mothers Report of 2023 reported 902 maternal deaths in that year alone.
Yes, healthcare for mothers and their babies (maternal healthcare) does exist. But the issue isn’t about existence. It’s about whether they’re actually within reach for everyone who needs them.
Access to care goes beyond geography. It’s also about availability – are the services actually there, fully staffed, and functional when you need them? Accessibility – can you reach them safely and affordably? Acceptability – are you treated with respect and dignity? Accommodation – do the hours and systems work for your life? And quality – is the care safe, consistent, and responsive to your needs?
Understanding the Realities of Access
Despite policy improvements and a constitution that upholds the right to health, access to maternal health services remains unevenly distributed in South Africa. Geography is still destiny. Women in rural areas often face long, expensive journeys to reach the nearest clinic, and when they get there, the care may be unavailable due to staff shortages or broken equipment.
But distance is just one piece of the access puzzle. Due to cultural beliefs, many mothers delay seeking pregnancy check-ups, often keeping the pregnancy hidden for the first three months due to fears of witchcraft and other beliefs. For some, it’s the fear of what they’ll find at the clinic – harsh treatment, long queues, or being turned away because services just aren’t available that day.
Cost is another barrier. While public healthcare may be free at the point of access, the indirect costs – transport, time off work, childcare – make it inaccessible for many. The reality is that some women only start pregnancy check-ups in their second or even third trimester, increasing the risks for themselves and their babies.
Improving access means reimagining the system. Through our investments, we’re exploring solutions that bring care closer to women – remote and mobile health models, support for local community-based programmes, and digital platforms that help mothers connect to healthcare services early and consistently.
Why Quality Shouldn’t Be Compromised
Even when mothers do make it to a facility, there’s no guarantee the care they receive is of sufficient quality. Many clinics are overcrowded, healthcare workers are stretched to the brink, and equipment is often outdated or broken. Because the system is under such pressure, the service tends to become transactional – focused more on checking boxes than on listening, educating, and empowering.
The World Health Organization defines quality maternal care as being safe, effective, timely, efficient, equitable, and people centred. In too many parts of South Africa, we’re still falling short on nearly all of those measures.
High-quality maternal care is especially critical during the first 1,000 days – from pregnancy through the child’s second birthday – when brain development is rapid and foundational. A missed diagnosis, a delayed referral, or a mental health issue overlooked can have lifelong consequences for both mother and child.
As an innovation catalyst, we’re committed to investing in solutions that elevate care standards. Whether it’s using technology to support clinical decision-making or upskilling healthcare workers to better detect maternal and neonatal risk factors, we believe quality shouldn’t be a luxury – it should be the baseline.
Investing in the Maternal Health Workforce
Behind every maternal health journey is a nurse, midwife, or doctor doing the best they can, often with too little resources, for too many patients, and for far too long. South Africa faces a critical shortage of trained maternal health professionals, especially in under-resourced areas. According to the Allied Health Association of South Africa there is a lack of about 26,000 nurses nationwide, especially in rural areas. This shortage, driven by factors such as inadequate training, emigration, and burnout, has profound implications, straining the healthcare system and compromising the quality of care provided to patients.
The burnout is real. Staff shortages lead to long waiting times, rushed consultations, and inconsistent follow-up care. This wears down both patients and health workers. It also affects the culture within clinics, sometimes leading to negative attitudes or even neglect.
Training and retention are core to delivering effective maternal care. But we need to think beyond technical skills. The emotional toll of this work is heavy. If we want mothers to receive compassionate, people-centred care, then we must also prioritise the wellbeing of those who provide it.
At Innovation Edge, we see a chance to rethink the system. What if we co-designed solutions with frontline workers? What if technology lightened the admin load and gave health professionals more time with their patients? What if mental health support was a built-in part of the system – for both the mothers and those carrying the weight of the services?
Laying the Groundwork for Lifelong Impact
Our mandate is clear: we invest early in solutions that can transform the first six years of life – and maternal health is central to this mission. If we want children to thrive, we must start by ensuring their mothers survive, feel supported, and receive the care they need – physically, emotionally, and mentally. And that care begins with the people who deliver it. To truly support mothers, we must also support the healthcare workers who walk the journey with them.
Addressing the challenges faced by healthcare systems and the dedicated professionals within them is complex, but essential. If this is an area that resonates with you, there’s much to consider and explore as we look towards solutions for a stronger, more sustainable system.
Author: Dimpho Lephaila – Communications Associate at Innovation Edge