The country’s maternal health system is in crisis, and domestic violence is making it worse, experts say, warning that with just 11 maternal and foetal medicine sub-specialists serving the entire country, vast regions have no expert care to manage high-risk pregnancies or respond to trauma linked to gender-based violence, reports TimesLIVE.
According to the 2025 South African Child Gauge, violence before and during pregnancy is scarring not only mothers but the next generation, with devastating health, developmental and social consequences.
The gauge reveals that exposure to violence during pregnancy increases the risk of miscarriage, premature labour, low birth weight and maternal death, while also shaping how children’s brains develop in the earliest, most critical years of life.
More than 20% of South African women experience at least one act of physical, psychological, or sexual intimate partner violence (IPV) during pregnancy, with psychological abuse being the most prevalent, often continuing through the first four months after birth.
The report warns that IPV is the most common form of violence experienced by women, though other forms of gender-based and obstetric violence during the first 100 days can deepen women’s vulnerability.
Dr Lesego Thomas, recently honoured by the Discovery Foundation for her work in maternal and foetal medicine, said no woman should die giving birth, yet the shortage of maternal subspecialists means many do.
“The country only has 11 sub-specialists in maternal health, and in the North West, where I work, there are none,” she said.
“This means that all the high-risk pregnancies and babies with abnormalities or disabilities die if not referred to a tertiary centre. Sadly, there is no hope for them.”
Toll of violence on the developing brain
Professor Kirsten Donald, a paediatric neurologist at the University of Cape Town, said the first 1 000 days of life are a “sensitive window” when the brain develops at its fastest pace.
“During this period, exposure to violence or neglect may cause emotional harm but can also alter biology in ways that become embedded and difficult to change,” she wrote in the Child Gauge.
“In the longer term, trauma in the early years may fuel a cycle of violence. Those who experience multiple forms of childhood violence are more likely to be involved in violent relationships as adults, either as victims or perpetrators.”
Violence against a pregnant woman activates her stress response, raising cortisol levels that cross the placenta and shape foetal brain development.
After birth, witnessing or experiencing violence triggers an infant’s own “fight, flight, or freeze” response, disrupting emotional and physical development.
Donald said children exposed to violence also show higher rates of emotional distress, learning difficulties, asthma, infections and chronic diseases later in life.
Policy frameworks falling short
South Africa’s policy frameworks, including the National Integrated Early Childhood Development Policy (NIECD) and the National Strategic Plan on Gender-Based Violence and Femicide, recognise the importance of preventing violence early. Yet implementation remains weak.
The Child Gauge notes that while the Department of Health has a mandate to identify and respond to violence during antenatal, postnatal and child health visits, these services are not being effectively used as entry points for care and referral.
The NIECD outlines a package of services to support infants and caregivers and expands the health sector’s role beyond its traditional focus on nutrition and maternal care. But despite acknowledging the importance of violence prevention, it fails to prioritise it explicitly.
Key services such as home visits by community health workers, which could offer early support for at-risk mothers, remain underfunded and inconsistently implemented.
The Child Gauge stresses that violence often begins early in pregnancy and within the first few years of life, so early intervention was crucial to address risk factors when they first emerge.
Experts argue that integrating violence prevention into maternal and child health services could transform outcomes for women and children.
See more from MedicalBrief archives:
Pregnant women abuse risks babies’ brain development: SA cohort study
Violence during pregnancy a way of life for many SA women