By her country’s standards at the time, there was nothing too unusual about how Nosipho Mshengu arrived in the world. She was born on the side of the road on 20 September 1993, as her mother tried to get from Mafakatini, a rural village in South Africa where there was then no health facility, to a Roman Catholic clinic an hour away. The bus she awaited was nowhere in sight when time ran out, and Mshengu made her entry then and there.
In 1994, as apartheid ended, 60 of every 1000 babies born in South Africa died before their fifth birthday. The death rate was so concerning that after Nelson Mandela’s African National Congress handily won the country’s first multiracial election that year, the new president immediately announced health care would be free for pregnant women and young children. It remains that way today in the nation of more than 60 million, of whom 81% are black and 36% are younger than 20.
Yet apartheid’s collapse also ushered in transformative changes in health care that went well beyond free services for pregnant women and young children. Within a few years, Mandela’s government launched a national immunization program to replace one that required “homelands,” where black people lived, to have separate vaccination schemes. It built 1345 community health clinics and refurbished another 263—today there are more than twice as many—while making primary health care free to all.
Today, Archary tells me, such children rarely turn up on the pediatric wards. Last year, 87% of babies received a first shot for measles, according to estimates from UNICEF—an all-time high. South Africa has also been a continental leader in introducing vaccines against bacteria that cause meningitis and pneumonia, and against rotavirus, which can cause fatal diarrhea in young children.
Chronic malnutrition, meanwhile, is widespread. Twenty-seven percent of children under age 5 were growth-stunted in 2016, the same fraction as in 2003. And the COVID-19 pandemic—a “catastrophe” for kids, Masekela says—worsened malnutrition because schools, where many children get daily meals, were closed and parents lost their jobs.
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