Custodians of family health, women bear the brunt of systemic poverty

In South Africa, Women’s Month is celebrated annually during August. While it is a focused period for raising pertinent issues affecting women, the socio-economic toll on women’s health grows higher with each passing year.

Women’s employment has not been restored to pre-COVID levels. Reduced employment places economic constraints on women who are predominantly responsible for feeding and caring for families. They disproportionately carry the burden of disease because of the complex interplay of biological, social, economic and systemic factors. This gendered health disparity is deeply rooted in the country’s historical inequalities and is perpetuated by structural and policy gaps.

The economic strain: Employment, poverty, and survival

Poverty is a central barrier to women achieving prosperity. A greater proportion of women than men experience economic poverty, face limited access to resources and knowledge, and lack the agency and resilience needed to overcome multiple, intersecting challenges. Because of the rising level of unemployment, women are most likely to take low-paying jobs, forced to choose unprotected work like waste picking, informal trading and sex work. These untenable situations take a physical and mental toll on women, who consequently experience the highest levels of disease and death. In this context, it is impossible for women to provide adequately for themselves, let alone for their families.

Nutritional sacrifice: Women shielding families from hunger

With the vast majority of South African women involved in a daily struggle to put food (any food) on the table, the conversation cannot focus on adequacy and quality of food. Poor nutrition means fewer nutrients available to build healthy bodies and brains. Hunger plagues many homes, and it is women who forgo meals to shield their children and other members of the family. Women are self-sacrificing. And it is an impossible leap from self-sacrifice to self-care.

The toll of gender-based violence on women’s health

Households are stretched, and tensions run high. This is one of many reasons for South Africa’s high rate of gender-based violence (GBV) ( one of the highest globally). GBV has direct physical consequences and long-term psychological effects, like mental health declines with depression, anxiety, and post-traumatic stress disorder. In low-income communities, especially, these mental health challenges are often underdiagnosed and under-treated. It is hard to have a healthy mind in an unhealthy body. While in women’s health, there is an over-accentuation on healthy eating, it is hard to achieve healthy eating when your existence is fragile, bombarded with multiple onslaughts and insults. Women who experience poverty, and in addition violence, are also more likely to engage in high-risk behaviours, like multiple concurrent partners or unsafe sexual practices.

Biological and structural vulnerabilities to HIV/AIDS

Women are more susceptible to sexually transmitted infections like HIV. This susceptibility is biological, social and structural. The female reproductive tract has a larger mucosal surface area than the male urethra, making it more exposed to pathogens during heterosexual intercourse. The vaginal lining is also more delicate and prone to microscopic tears, especially during unprotected sex, which can serve as entry points for viruses like HIV. Retention of semen and disruptions in the vaginal microbiome, such as bacterial vaginosis, increase HIV risk due to inflammation and increased presence of target immune cells for the virus. In South Africa, HIV/AIDS remains one of the leading causes of death and disability-adjusted life years (DALYs) among women, particularly those aged 15–49. Gender inequality and intimate partner violence exacerbate their vulnerability.

The intergenerational cost: Protecting women to secure the future

While women are the bedrock of life – carrying life and sustaining life – this biological and social calling comes at a cost to their own health and wellbeing. What should be a happy time for a mother is often a burden and toll on her physical and psychological wellbeing. To have healthy infants and children, we need healthy mothers and fathers. The intergenerational impact of poor health on children is imprinted through their genes and nutrition programmes towards future ill-health and premature death. This is why every effort must be made to protect women’s health as well as maternal and infant health. It is imperative that we not only celebrate women’s month with pamper parties and inspirational speeches. We need the whole of society to understand that women’s bodies and minds shape the future generations. Women are like fertile social sprouting healthy fruit. If the soil is of poor quality, then the future yield may be compromised or worse, fail completely.

This is why policies and programmes should institute protections and safeguards to support women: a right on it own and a double dividend for future children. We need employment opportunities, living wages, maternity protection and food security. We need enabling environments for women that advocate for their engagement, empowerment and development. When you invest in women, you invest in the future.