South Africa, at the southern tip of the African continent, is often referred to as “a world in one country” — a multicultural, biodiverse country with a vibrant economy. It is home to eight World Heritage Sites and seven different biomes. The country is divided into nine provinces, each with its own legislature, premier, and executive council. Eleven official languages are recognized (1).
The country covers some 1,219,602 km2 and is home to around 55.91 million people, of which close to 11% are under 4 years of age. The infant mortality rate is estimated at 33.7 per 1,000 live births (2016), a figure which has seen a steady decline from around 48.2 per 1,000 live births in 2002. Similarly, the under-5 mortality rate declined from 70.8 child deaths per 1,000 live births to 44.4 child deaths per 1,000 live births between 2002 and 2016 (2). Despite the decline in these rates over the years, South Africa is still faced with an immense challenge if it wishes to decrease the high death rate in infants. Investigation into unexpected deaths in children are complicated by multiple factors, however, including a significant variation in population density in different regions of the country, a lack of standardized national death investigation protocols, language and culture barriers, and a paucity of resources and funding for medico-legal death investigation and qualified forensic pathologists, especially in the rural regions of the country.
It is nearly impossible to understand the medico-legal death investigation process in South Africa without being mindful of the political history and development of the country, specifically the most recent 100 years or so. The South African political arena is most significantly marked by the process of segregation and the ideology of apartheid, which was consolidated after the 1948 general election, won by the National Party. Government regulated the job market, often with only the white minority being allowed skilled work opportunities. Legislation culminated in the Natives (Urban Areas) Act 1923, entrenching urban segregation. Pass laws controlled African mobility. The introduction of apartheid policies coincided with the adoption by the African National Congress in 1949 of its program of action, expressing the renewed militancy of the 1940s. Mass resistance to white minority and colonial rule in neighboring states led to Portuguese decolonization in the mid-1970s and the abdication to the Zimbabwean regime in 1980. South Africa became increasingly more isolated internationally, with pressure in the form of financial, trade, sport, and cultural sanctions eventually resulting in the announcement of the unbanning of liberation movements and release of political prisoners by FW de Klerk at the opening of Parliament in 1989. This marked the beginning of the end of apartheid and the start of the process of reconciliation and the establishment of a true democracy. This eventually led to South Africa’s first democratic election in April 1994. Currently, South Africa has a constitutional multiparty, three-tier (local, provincial, national) democracy. It is inevitable that policies of segregation, restriction of free movement of citizens, discrepant economic isolation, and governmental oppression will have an influence on the profile of death in infancy. However, despite the progress made over the 21 years since the first democratic election in the country, the legacy of apartheid can still be seen in the profile of medico-legal death investigation in the country.
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