Pregnancy
Antenatal care and delivery are free in public facilities for all pregnant women, including non-nationals. Maternity leave is four consecutive months, unpaid by the employer but partly replaced by the Unemployment Insurance Fund at a sliding rate. The private sector has one of the highest caesarean rates in the world, far above any clinical justification.
Antenatal care and delivery are free in the public sector for South Africans, and the maternal health programme is built around midwife-run obstetric units with referral to hospitals. Leave is four consecutive months, unpaid by the employer but partly compensated by the Unemployment Insurance Fund at a sliding rate — a system that works when the claim goes smoothly and leaves families exposed when it does not.
Key points
| Cost | Free antenatal care and delivery in the public sector |
|---|---|
| Maternity leave | Four consecutive months, with UIF paying a percentage of earnings |
| Parental leave | Ten days for the other parent, with a court having found the framework unconstitutional |
| Antenatal visits | Eight contacts recommended; first visit encouraged before twenty weeks |
| HIV | Testing and treatment integrated into antenatal care, with very high coverage |
| Private sector | Caesarean rates among the highest in the world |
| Road to Health | Booklet used for the child's follow-up from birth |
In practice
- Book antenatal care before twenty weeks: late booking is the main modifiable risk here.
- Claim UIF maternity benefits as soon as your leave starts; claims are time-limited.
- Ask for the clinical reason for any proposed caesarean, especially in private care.
- Keep the Road to Health booklet: it is the child's health record for years.
Cost and coverage
Public antenatal care and delivery are free; UIF replaces part of earnings during leave.
Recent changes
Parental leave provisions have been the subject of a constitutional challenge over the unequal treatment of mothers and other parents, with the courts directing Parliament to revise the framework.
Where to go
- Department of Labour offices for UIF maternity benefits.
- District hospitals for delivery and complications.
Worth knowing
Maternity care in public facilities is free for everyone, including women without documents. Being turned away on that basis is unlawful.
Frequently asked questions
Is maternity leave paid in South Africa?
Not by the employer, unless the contract says so. You are entitled to four consecutive months of leave, and you claim maternity benefits from the Unemployment Insurance Fund at between thirty-eight and sixty per cent of earnings depending on income. Claim early: processing delays are common.
What does public maternity care cover?
Free antenatal visits, delivery and postnatal care in public facilities, with midwife obstetric units handling uncomplicated births and referral to a hospital where needed. Bring your clinic card to every visit; continuity of records is the weak point of the system.
The general article: Pregnancy · Compare with another country
Periods and period products
South Africa zero-rated sanitary pads for VAT from 1 April 2019, after the tax review that followed the increase of the standard rate to 15 %. The Sanitary Dignity Implementation Framework, adopted the same year, funds free pads for learners in the poorest public schools — quintiles 1 to 3 — through the provinces, with uneven delivery. There is no menstrual leave in the Basic Conditions of Employment Act; absence is sick leave.
Endometriosis is treated in public gynaecology at district and tertiary hospitals, with long waits for laparoscopy, and in private practice for members of medical aids, which cover consultations and surgery within their rules. Patient organisations have pushed for recognition and shorter diagnosis times.
Tampons, cups and period underwear are not all zero-rated: the zero rate targets sanitary pads specifically, so other products may still carry VAT. Reusable pads distributed by NGOs and some provinces are the affordable long-term option.
Key points
| VAT | Sanitary pads zero-rated since 1 April 2019; other products may still carry VAT |
|---|---|
| Schools | Sanitary Dignity Programme: free pads for learners in quintile 1–3 public schools, since 2019 |
| Endometriosis | Public gynaecology with waits; medical aids in the private sector |
| Reusable products | Promoted by NGOs and some provinces |
In practice
- Ask the school whether it is in the programme and whether stock has arrived; provinces deliver unevenly.
- Check the till slip: only pads are zero-rated, so a tampon box may still carry VAT.
- For pelvic pain, the district hospital gynaecology clinic is the public route; medical aid members can go private.
What it costs
A cycle costs roughly 30 to 80 rand in pads at zero VAT. Free pads in the poorest public schools; nothing otherwise reimbursed.
What has changed recently
The zero rate and the dignity programme both date from 2019; delivery in schools has been the recurrent problem since.
Where to find help
- Department of Women, Youth and Persons with Disabilities: Sanitary Dignity Programme.
- Provincial education departments: school distribution.
- Endometriosis South Africa and patient groups.
- District hospital gynaecology clinics.
Worth knowing
The programme depends on provincial budgets and logistics; an eligible school may receive nothing for a term. Persistence with the school and the province works.
Frequently asked questions
Is there VAT on pads in South Africa?
No, sanitary pads have been zero-rated since 1 April 2019. Other menstrual products may still carry it.
Are pads free in schools?
In quintile 1–3 public schools, through the Sanitary Dignity Programme, subject to delivery.
Sources
- Department of Women, Youth and Persons with Disabilities — Sanitary Dignity Programme
- South African Revenue Service — zero-rated items
The general article: Periods and period products · Compare with another country
Sex therapy
“Sexologist” is unregulated, but SASHA accreditation requires an HPCSA or equivalent registration; medical aids fund a capped number of psychology sessions with registered practitioners.
South Africa registers psychologists, registered counsellors and doctors with the Health Professions Council of South Africa, social workers with their own council and nurses with the Nursing Council. “Sexologist” and “sex therapist” are not registered categories: anyone may use the words, and the HPCSA has no jurisdiction over someone who holds no registration.
The reference body is the Southern African Sexual Health Association (SASHA), whose professional members must hold an active registration with a South African regulatory body — HPCSA, the Council for Social Service Professions, the Nursing Council or the counselling bodies — and complete recognised training in sexology. A sexologist who is a registered psychologist or doctor is thus accountable to two bodies; one who is not registered is accountable to none.
Medical aid schemes pay only practitioners registered with the HPCSA and holding a practice number. Psychology sessions are usually funded from day-to-day benefits, capped at around twelve to fifteen sessions a year depending on the plan, and prescribed minimum benefits cover certain psychiatric conditions. A doctor's consultation for erectile dysfunction, pain or hormonal problems is covered as ordinary care. Privately, a psychologist or sexologist charges roughly 900 to 1,600 rand a session.
The public sector offers psychology at district hospitals and community clinics, with waits, and free sexual and reproductive health clinics; specialised sex therapy is rare outside the academic hospitals.
Key points
| Title | Unregulated; underlying registration with HPCSA or equivalent required for accountability |
|---|---|
| Regulated professions nearby | Psychologist, registered counsellor, doctor (HPCSA); social worker (SACSSP); nurse (SANC) |
| Reference accreditation | SASHA professional membership: active registration plus sexology training |
| Medical aid | Registered practitioners only; psychology capped at about 12–15 sessions a year, plan-dependent |
| Public sector | Psychology at district hospitals; free sexual and reproductive health clinics |
| Private cost | About 900–1,600 rand a session |
In practice
- Check the HPCSA register for the underlying profession and SASHA for sexology accreditation.
- Ask your medical aid what psychology benefit your plan carries and whether pre-authorisation is required.
- See a general practitioner first for physical symptoms; investigations are covered as ordinary care.
- Academic hospitals in the big cities have sexual-health or psychiatry clinics that accept referrals.
Cost and reimbursement
Medical aid: psychology sessions funded within the plan's cap, with a registered practitioner. Private: 900–1,600 rand a session. Public: low or no fee, with waits.
What has changed recently
SASHA has kept its requirement of statutory registration for professional members, which excludes unregistered “sexologists”; medical schemes have generally left psychology caps unchanged.
Where to go
- Health Professions Council of South Africa: register of psychologists, counsellors and doctors.
- Southern African Sexual Health Association: accredited members.
- Your medical aid scheme: psychology benefit and pre-authorisation.
- District hospitals and community clinics: public psychology and sexual health services.
Worth knowing
An unregistered sexologist cannot bill a medical aid and cannot be disciplined by the HPCSA. If a practitioner has no practice number, ask why.
Frequently asked questions
Is “sexologist” a registered profession in South Africa?
No. The HPCSA registers psychologists, counsellors and doctors; SASHA accredits sexologists who hold one of those registrations.
Will my medical aid pay for sex therapy?
If delivered by an HPCSA-registered psychologist with a practice number, within the plan's annual psychology cap. Unregistered practitioners cannot claim.
Is there public sex therapy?
Rarely. Public psychology exists at district hospitals, and sexual and reproductive health clinics are free, but specialised sex therapy is mostly private.
Sources
- Health Professions Council of South Africa — register of psychologists, counsellors and doctors
- Southern African Sexual Health Association — accredited members, membership criteria
The general article: Sex therapy · Compare with another country
Mental health
A strong legal framework, a large treatment gap, and helplines that carry much of the load.
The Mental Health Care Act of 2002 set out rights-based provisions and shifted care towards community and general hospital settings. Public provision remains thin relative to need, with the great majority of people with a diagnosable condition receiving no treatment. Non-governmental helplines provide free counselling and crisis support in several languages and are, in practice, the most accessible entry point.
South Africa's Mental Health Care Act of 2002 is a strong, rights-based statute providing for community care and regulated involuntary admission, but the treatment gap is very large: most people with a diagnosable condition receive no care, and the public system is concentrated in a small number of specialised hospitals. Helplines run by non-governmental organisations carry a great deal of the immediate load.
Key points
| Legal framework | Mental Health Care Act of 2002, rights-based, community-oriented |
|---|---|
| Treatment gap | The great majority of affected people receive no care |
| Public services | Free at clinics and hospitals, but thinly spread |
| Helplines | Free counselling and crisis lines in several languages |
| Medical schemes | Required to cover a defined set of mental health conditions |
| Involuntary care | Governed by the Act, with review board oversight |
| Substance use | Frequently co-occurring; dedicated services exist but are scarce |
In practice
- Free helplines operate in several languages and can refer you to a clinic.
- Public clinic consultations and medication are free at the point of use.
- If you belong to a medical scheme, a defined set of mental health conditions must be covered in full.
- Community health workers can arrange an assessment without a doctor's referral.
Cost and coverage
Public care is free at the point of use; helplines are free; private care and medical schemes vary.
Where to go
- Public clinics and general hospital psychiatric units.
- National non-governmental counselling and crisis helplines.
- Community health workers, for assessment and referral.
Worth knowing
Medical schemes must cover certain mental health conditions as prescribed minimum benefits, in full. Schemes frequently do not volunteer this: cite it if a claim is refused.
Frequently asked questions
How do you access public mental health care?
Through a primary health clinic, which can treat common conditions and refer to a district hospital and onward to a specialist service. Care in the public sector is free or income-related. The pathway works; the waiting times and the distances are what make it difficult.
What help is available immediately?
Free national helplines operate around the clock, including specific lines for suicide crisis, depression and substance use, and several operate by WhatsApp and SMS. They are staffed by counsellors and can arrange referral into the public system.
The general article: Mental health · Compare with another country
Dental care
A two-tier system: public clinics that mostly extract, and medical schemes that pay for the rest.
Public dental services are provided free or at low cost in clinics and hospitals according to a means test, but capacity is concentrated on emergency care and extraction. About one person in six belongs to a medical scheme, and dental benefits within schemes are limited, typically with an annual threshold and exclusions for major work.
The gap between public extraction-led care and private restorative care is the defining feature of the system.
Dental faculties in Pretoria, Johannesburg, Cape Town and Durban treat patients at reduced fees.
Private prices are modest by European standards, and the country receives dental travellers from neighbouring states and from Europe as part of wider medical travel.
Medical scheme dental benefits are commonly paid from a savings account that runs out early in the year.
Key points
| Public | Free or means-tested, focused on emergency and extraction |
|---|---|
| Medical schemes | Limited dental benefits, annual thresholds |
| Dental faculties | Reduced fees, supervised treatment |
| Private prices | Modest by European standards |
In practice
- Ask whether the tooth can be restored before accepting extraction in a public clinic.
- Check what your scheme's dental benefit actually covers and from which pot it is paid.
- Dental faculties are the best value for crowns, dentures and implants.
Cost and coverage
Public consultation free or nominal. Private examination R400–R900. Crown R6,000–R12,000. Implant with crown R18,000–R35,000.
Recent changes
Debate around National Health Insurance has raised the question of what dental care a universal package would include.
Where to go
- Public dental clinics and hospital dental departments.
- Dental faculties in Pretoria, Johannesburg, Cape Town and Durban.
- Health Professions Council of South Africa register.
Worth knowing
Scheme dental savings accounts empty quickly. Ask the practice to check your available benefit before starting a multi-visit treatment plan.
Frequently asked questions
Is public dental care free?
Free or low-cost according to a means test, but focused on emergencies and extraction.
Where is the best value for major work?
The dental faculties, where treatment is supervised and substantially cheaper.
The general article: Dental care · Compare with another country
HIV and AIDS
The largest treatment programme in the world, free at public clinics, with PrEP available since 2016.
South Africa runs the largest antiretroviral programme anywhere, with millions of people on treatment, provided free at public clinics. Treatment is offered to everyone on diagnosis regardless of CD4 count, and pre-exposure prophylaxis has been available in the public sector since 2016, initially for specific groups and progressively widened.
South Africa runs the largest antiretroviral treatment programme in the world, free through the public system, and has made PrEP available at public facilities. The clinical infrastructure is extensive; the persistent challenges are keeping people in care over years and reaching young women, among whom incidence remains high.
Key points
| Scale | The largest antiretroviral programme in the world |
|---|---|
| Treatment | Free at public clinics, offered on diagnosis regardless of CD4 count |
| PrEP | Available in the public sector since 2016, progressively widened |
| Testing | Free at clinics; self-tests widely distributed |
| PMTCT | A long-established programme with high coverage |
| Prevalence | Among the highest in the world, with wide provincial variation |
| Adherence clubs | Community collection points reduce clinic visits for stable patients |
In practice
- Ask to join an adherence club or a community collection point if you are stable: it cuts clinic queues dramatically.
- Request multi-month dispensing where available.
- Self-test kits are widely available and free at many sites.
- If you are refused PrEP at one clinic, ask at another: implementation is uneven.
Where to go
- Treatment Action Campaign and other civil society organisations.
- National AIDS Helpline.
Worth knowing
Missed appointments and clinic queues are the main cause of people stopping treatment. Adherence clubs and multi-month dispensing exist precisely to solve that, and you can ask for them.
Frequently asked questions
Is PrEP available at public clinics in South Africa?
Yes, PrEP has been rolled out through public sector facilities and is free, with an initial assessment and three-monthly follow-up. Availability varies between facilities; ask at a clinic offering HIV services rather than a general consulting room.
Hepatitis B
Infant vaccination since 1995, but the birth dose was added only much more recently.
South Africa introduced hepatitis B into routine infant immunisation in 1995, starting at six weeks. For many years there was no birth dose, which left transmission from mother to child inadequately addressed; a birth dose has since been introduced. Antenatal screening has historically not been universal, another difference from most comparable countries.
South Africa introduced hepatitis B into the expanded programme on immunisation in 1995, from six weeks of age, and added a universal birth dose to the schedule more recently — a significant change, since the six-week start left the perinatal window open. Prevalence is intermediate, and co-infection with HIV complicates management.
Key points
| Infant vaccination | In the routine schedule since 1995, from six weeks |
|---|---|
| Birth dose | Added only recently, after years without one |
| Antenatal screening | Historically not universal; practice is changing |
| Prevalence | Intermediate to high, varying by province |
| HIV co-infection | Common, and changes both monitoring and treatment |
| Treatment | Available in the public sector, often alongside HIV treatment |
| Testing | Available at clinics; ask for it explicitly |
In practice
- Ask for hepatitis B testing during pregnancy: it has not historically been routine.
- Ask for the birth dose for the newborn within 24 hours.
- If you are living with HIV, ask whether your treatment also covers hepatitis B — several regimens do.
Cost and coverage
Testing and treatment are free in the public sector.
Where to go
- Hepatology and infectious disease services of academic hospitals.
- HIV clinics, which often manage co-infection.
Worth knowing
If you are living with HIV, the antiretroviral regimen you take may already treat hepatitis B. Stopping or changing it without accounting for that can cause a dangerous flare — always mention both infections.
Frequently asked questions
Has the birth dose been added in South Africa?
Yes, a birth dose was added to the schedule to close the gap left by starting at six weeks, which is the period when mother-to-child transmission occurs. Ask that it is given and recorded in the Road to Health booklet.
HPV
A school programme for grade five girls since 2014, but an unusually sparse screening policy for adults.
South Africa introduced free school-based HPV vaccination for grade five girls in 2014 and has achieved reasonable coverage. Adult screening, by contrast, has been limited: national policy has long provided a small number of free cytology tests from age 30 at long intervals, which is far less than most comparable countries, although HPV testing is being introduced.
South Africa runs a free school-based HPV vaccination programme for girls in Grade 5, and has had a national cervical screening policy since 2000. The burden is compounded by HIV: women living with HIV have a much higher risk that an HPV infection persists and progresses, which is why screening intervals for them are shorter.
Key points
| School programme | Free for grade five girls since 2014 |
|---|---|
| Boys | Not included in the public programme |
| Screening policy | A small number of free cytology tests from age 30, at long intervals |
| HPV testing | Being introduced, including for women living with HIV |
| Women living with HIV | Screened more frequently, given substantially higher risk |
| Burden | Cervical cancer is a leading cause of cancer death in women |
| Cost | Free in the public sector within the policy limits |
In practice
- If you are living with HIV, ask for more frequent screening: the policy provides for it and the risk is much higher.
- Do not wait for an invitation: there is no call and recall system.
- Ask whether HPV testing is available at your facility.
Cost and coverage
Vaccination and screening within policy limits are free in the public sector.
Where to go
- Cancer Association of South Africa.
- HIV clinics, which increasingly integrate cervical screening.
Worth knowing
Women living with HIV have a far higher risk of cervical cancer and are entitled to more frequent screening. That entitlement is frequently not offered — ask for it explicitly.
Frequently asked questions
How does HIV change the screening advice?
Women living with HIV should be screened more frequently, because HPV infection is more likely to persist and progress to cancer. South African guidelines set shorter intervals for them. If you are living with HIV, ask specifically — the standard interval is not the one that applies to you.
General sources
- gov.za — official government portal
- South African Human Rights Commission — constitutional rights body