Ignoring sexual health costs South Africa $34bn, and counting
South Africa's failure to adequately invest in sexual and reproductive health and rights (SRHR) for young people is costing the nation a staggering $33.7 billion.
Image: Lebohang Mashiloane/Supplied
A DAMNING new report by UNAIDS revealed that South Africa's failure to adequately invest in sexual and reproductive health and rights (SRHR) for young people was costing the nation a staggering $33.7 billion (about R599bn) over a cohort's lifetime, equivalent to 10.1% of the country's annual gross domestic product (GDP).
The report, titled The Cost of Inaction and funded by the Swedish government, painted a grim picture of how policy failures in adolescent health were creating long-term economic consequences that far outweigh the costs of intervention.
The numbers told a devastating story. South Africa's cost of inaction on youth SRHR exceeded the country's entire annual education budget and was more than double its health budget. 'For every R100 spent in the country over a year, the cost of inaction on youth SRHR is equivalent to R8 in financial outlays paying for the effects of the lack of SRHR services, or opportunity costs of future value and income foregone,' the report stated with alarming clarity.
This economic burden manifested across three critical areas: early pregnancy, HIV transmission, and gender-based violence (GBV) — each creating ripple effects that extended across generations.
The report revealed that one in three South African girls who would fall pregnant during adolescence dropped out of school, with catastrophic consequences for their earning potential. A girl who completed secondary school would earn 3.1 times more annually than one who dropped out, creating a lifetime earnings gap of about $150 198 per individual at present value.
The situation was particularly dire because adolescent mothers faced multiple disadvantages. 'They are less likely to complete secondary school and more likely to have a higher fertility rate, with more negative health outcomes,' the report stated. The children of teenage mothers also suffer, being more likely to experience poor health, educational challenges, and economic hardship, perpetuating intergenerational cycles of poverty.
The Health Department confirmed receipt of questions from the Sunday Independent, but did not respond by the time of compiling this report. The Department of Social Development also did not respond to questions by the time of compiling this report.
While the UNAIDS report highlights significant gaps and costs associated with inaction, it is important to note that the South African government has, in recent years, made substantial new investments in health and social development, particularly since the 2025/26 national budget.
In May this year, Finance Minister Enoch Godongwana announced that the total health budget would rise from R277bn in 2024/25 to R296bn in 2025/26, with a projected increase to R329bn by 2027/28. This expanded allocation is specifically aimed at strengthening public health infrastructure, improving access to chronic medications, and addressing critical staffing shortages.
Notably, an additional R20.8 billion over three years is being used to employ 800 post-community service doctors and 9 300 healthcare professionals in public hospitals and clinics, a move intended to address the chronic shortage of medical staff and improve service delivery in underserved areas.
Further, more than R6 billion has been allocated for strategic health infrastructure projects, including the construction and refurbishment of hospitals and allied health facilities, with the aim of reducing disparities in access to tertiary care.
The government is also maintaining and increasing funding for the central chronic medication dispensing and distribution programme, which now benefits an estimated 40% of antiretroviral treatment (ARV) clients by improving access to chronic medications through alternative pick-up points.
In addition, R9.9bn has been earmarked for the rollout of National Health Insurance (NHI), reinforcing the government's commitment to universal health coverage and improved access to essential health services.
While South Africa had made progress in HIV treatment, the disease continued to take a heavy toll on young people, particularly adolescent girls and young women who accounted for a disproportionate share of new infections. The lifetime cost of HIV for young South Africans aged 15-24 totalled $11bn, with young women bearing the brunt at $8.2bn compared to $2.7bn for young men.
'A delayed HIV diagnosis results in the delayed start of antiretroviral therapy, with negative impacts on a person's health and higher long-term treatment costs,' the report cautioned. The economic impact extended beyond healthcare, as people living with HIV faced reduced productivity and earning potential.
Perhaps most shocking were the figures on GBV, which cost South Africa $12.4bn per cohort of young women aged 15-24. This includes direct costs to survivors ($11bn), government expenses ($224 million), civil society costs ($387m), and business impacts ($796m).
'GBV has serious consequences for women's physical health, as well as their sexual and reproductive health and mental health,' the report found. 'It is also a fundamental violation of women's human rights and has adverse economic and social consequences for men, women, their children, families and communities.'
The report highlighted how GBV intersected with other issues — survivors were at higher risk of HIV infection, and women with less education faced greater vulnerability to violence. 'The prevalence of physical violence was greater among less educated women than those with secondary education or higher,' the report noted, drawing on 2016 Demographic and Health Surveys (DHS) data.
Health sector experts, including researchers from the South African Medical Research Council (SAMRC), have acknowledged that the 2025 budget boost signals a government that is responding to dire public health needs, particularly for the more than 80% of the population reliant on public health services.
They highlight the increased investment in human resources for health, early childhood development, and social grants as positive steps. However, they also stress the need for strong accountability measures and efficient translation of these funds into improved health outcomes.
Despite these substantial investments, experts and civil society organisations continue to call for further improvements, including enhanced accountability, more robust monitoring and evaluation, and greater focus on addressing the root causes of health disparities. The government itself has acknowledged these challenges and has committed to ongoing reforms and targeted spending to address them.
The report identified several critical areas where government action (or inaction) was exacerbating these problems: The Education-Health Divide: A persistent lack of coordination between the health and education sectors undermined efforts to provide comprehensive sexuality education (CSE). 'This divide needs to be overcome so high-quality, evidence-based, comprehensive sexuality education can be provided both in and out of school to young people,' the report stated.
A persistent lack of coordination between the health and education sectors undermined efforts to provide comprehensive sexuality education (CSE). 'This divide needs to be overcome so high-quality, evidence-based, comprehensive sexuality education can be provided both in and out of school to young people,' the report stated. Inaccessible Youth-Friendly Services: Despite legal provisions allowing adolescents to access contraception, many faced judgmental healthcare providers. 'Health care providers believe that young women should not be having sex before marriage,' the report found, leading to limited contraceptive options and missed opportunities for prevention.
Despite legal provisions allowing adolescents to access contraception, many faced judgmental healthcare providers. 'Health care providers believe that young women should not be having sex before marriage,' the report found, leading to limited contraceptive options and missed opportunities for prevention. School Retention Failures: While policies existed to allow pregnant learners to remain in school, implementation was inconsistent. 'Only a few schools have formal or effective mechanisms in place to offer opportunities for girls to catch up on missed work,' the report noted, with 33% of pregnant girls not returning to school.
The report outlined clear, actionable solutions that would more than pay for themselves through economic benefits: Integrated SRHR Services: Combining HIV prevention, contraception, and GBV services in youth-friendly spaces could dramatically reduce costs. The report highlighted successful models such as the O3 Programme that linked schools with health services.
Combining HIV prevention, contraception, and GBV services in youth-friendly spaces could dramatically reduce costs. The report highlighted successful models such as the O3 Programme that linked schools with health services. Comprehensive Sexuality Education: 'School-based CSE, when delivered effectively using engaging and interactive game-based methods, empowers young people to make informed decisions about relationships,' the report stated. This required proper training for educators and collaboration with health providers.
'School-based CSE, when delivered effectively using engaging and interactive game-based methods, empowers young people to make informed decisions about relationships,' the report stated. This required proper training for educators and collaboration with health providers. Economic Support for Young Parents: Programmes that helped adolescent parents complete their education, including childcare support and flexible schooling, could recover millions in lost earnings potential. The report cites Nacosa's successful peer education and remedial teaching initiatives.
Programmes that helped adolescent parents complete their education, including childcare support and flexible schooling, could recover millions in lost earnings potential. The report cites Nacosa's successful peer education and remedial teaching initiatives. GBV Prevention Investments: Community-based programmes such as Stepping Stones and Sonke Gender Justice's One Man Can campaign have proven effective at changing harmful gender norms. The report called for scaling these interventions alongside clinical services for survivors.
The report's conclusion was unequivocal: 'Business as usual is not going to work. Different approaches are needed to generate change.' It challenged policymakers to view SRHR not as an expense, but as an investment with measurable economic returns.
'Understanding the cost of inaction helps to re-evaluate current approaches,' the report stated. 'Costing activities, including the cost of inaction in the cost-benefit analysis, will enable appropriate investment decisions for activities that provide real change, both now and also in the health and economic livelihoods of the next generations.'
For South Africa, the choice is clear: continue paying the astronomical costs of inaction, or invest strategically in the health and rights of young people to unlock their full economic potential. The numbers show there's only one fiscally responsible option. Get the real story on the go: Follow the Sunday Independent on WhatsApp.
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