Spearheading the G20 presidency this year, South Africa has laid out its health agenda calling for equitable, multilateral solutions to pressing health challenges of the 21st century. Among key priorities discussed by the G20 Health Working Group is the prospect of universal health coverage through implementation of a National Health Insurance policy. The goal is to provide sustainable, inclusive, and affordable primary health within the region – all of which is crucial to addressing the deep and prevalent disparities in access to care. One group under rightful focus is women, who continue to face some of the most entrenched and complex health inequalities.

It is no secret that women’s health, globally, has long been undermined by chronic underinvestment and systemic setbacks. South Africa is no exception. Women and adolescent girls here face a unique intersection of biological, social, and structural barriers obstructing access to quality care and a basic standard of health. And despite progress, significant gaps remain in reproductive health, HIV prevention, and management of non-communicable diseases.

UNAIDS reports over 800 young women and adolescent girls aged 15-24 become infected with HIV each week in South Africa. Adolescent girls bear the highest risk, and HIV-related infections remain a leading cause of maternal deaths. Overall, AIDS affects women more than men.

This statistically depicted reality becomes even more unsettling when considering issues such as gender-based violence (GBV), mental health challenges, and historical wealth disparities. GBV not only compounds trauma, shame, while increasing HIV vulnerability, but also takes a serious toll on women’s mental health. Moreover, marginalised women and girls facing geographic and educational inequities also struggle with restricted access to appropriate knowledge and care on issues related to their bodily autonomy. Many of these present-day gaps are partly remnants of South Africa’s apartheid-era policies that left a deep divide in both wealth and healthcare access.

Additionally, the threat of non-communicable diseases continues to loom. Cervical cancer, the only one considered eliminable, is the second most common cancer among South African women. UNICEF reports it as the leading cause of cancer-related deaths among women aged 15-44, while WHO recorded nearly 350,000 global deaths in 2022.

Having painted this stark landscape for women’s health in South Africa, it is apparent that urgent, sustained investment and a systemic redesign of inclusive healthcare, are critical for women and girls in underserved communities.

Still, South Africa has demonstrated strong national commitment to tackling paramount issues like HIV. While having the highest number of people living with HIV globally, it has made significant strides in boosting treatment coverage. Since 2010, AIDS-related deaths have fallen by 66% and new infections by 58%. Currently, 74% of its HIV response is funded through domestic resources.

Many key initiatives, however, remain dependent on external donors. Earlier this year, the 90-day suspension of US foreign aid disrupted critical services, especially HIV prevention programmes for young women, adolescent girls, and marginalised groups across Gauteng, Western Cape, and the Northwest. Clinics offering preventative care and PrEP (pre-exposure prophylaxis) medication were forced to close. The impact was serious given the high weekly infection rates among young women.
To soften the blow of funding retractions, the government announced mitigation measures, including a budget allocation for critical medical equipment and strengthening healthcare staffing.

These national efforts unfold alongside growing international momentum around women’s health. At the G20 Health Working Group meeting in March, the South African government, in concurrence with Unitaid and WHO underscored how investment in women’s health is crucial to breaking cycles of poverty and addressing access gaps in low and middle-income countries. Further emphasis was drawn towards the elimination of non-communicable diseases like cervical cancer. During May’s G20 Parliamentary Conference held in Cape Town, 40 G20 MPs signed a historic Statement of Commitment on Women’s Health – pledging to advance maternal health, expand access to family planning, confront medical misogyny, and uphold funding commitments despite global financial pressures.

Returning to the bigger picture, policies and commitments must now translate into a better, reformed reality. Placing universal health on the G20 agenda reaffirms South Africa’s perseverance towards dismantling financial barriers that limit women’s access to care. What matters now is meaningful implementation within the region. This will require sustained political will, accountability, funding, and clear mechanisms to track progress. Additionally, awareness and mitigation of setbacks such as resource gaps, fiscal strain, and governance hurdles is essential.

Now under the G20 spotlight, South Africa has the opportunity to lead by example, driving an inclusive health agenda that puts women and girls at the centre of universal health coverage.