South African Demographic and Health Survey 1998

The South African Demographic and Health Survey (SADHS) of 1998 was the first nationally representative household survey that combined demographic, health, and nutrition information in postapartheid South Africa. Conducted by Statistics South Africa (Stats SA) in partnership with the Ministry of Health and the United Nations Population Fund (UNFPA), the SADHS was designed to generate baseline data for health planning, programme evaluation and policy formulation.

Objectives

• Measure fertility, family planning use and reproductive health indicators.
• Assess child health outcomes, including immunisation coverage, nutrition status, and morbidity.
• Collect data on adult health, HIV/AIDS knowledge, and risk behaviours.
• Provide information on women's empowerment, education, and economic participation.

Survey Design and Methodology

The 1998 SADHS employed a stratified twostage probability sample. The first stage selected enumeration areas (EAs) from each of South Africas nine provinces, using the 1996 census frame as a sampling frame. In the second stage, households within the chosen EAs were listed and a systematic sample of households was drawn. The final sample comprised 5,124 households, representing roughly 21,000 individuals.

Data collection took place between August 1998 and March 1999. Trained interviewers administered a structured questionnaire in the respondents preferred language (English, Afrikaans, Zulu, Xhosa, and other official languages). The questionnaire covered four modules:

1. Household roster demographic composition, assets, and housing characteristics.
2. Womens questionnaire fertility history, family planning, antenatal care, delivery, and health knowledge.
3. Mens questionnaire sexual behaviour, HIV/AIDS awareness, and labour market participation.
4. Child health module birth history, nutrition, immunisation, and illness episodes.

Key Findings

Fertility and Family Planning

The total fertility rate (TFR) in 1998 was 2.6 children per woman, a modest decline from the 1993 figure of 2.9. Contraceptive prevalence among married women aged 1549 was 53%, with the pill and injectable hormones being the most common methods. Notably, unmet need for contraception stood at 20%, highlighting gaps in service delivery.

Maternal Health

Approximately 94% of women reported receiving antenatal care (ANC) for their most recent pregnancy, yet only 65% attended the recommended four or more visits. Skilled birth attendance rose to 71% compared with 66% in the previous national health survey, indicating improved access to formal health facilities. However, 18% of deliveries still occurred at home, disproportionately in rural provinces.

Child Health and Nutrition

Immunisation coverage showed encouraging progress: 84% of children 1223 months received the full routine vaccine series (BCG, DTP, Polio, and measles). The prevalence of stunting among children under five was 31%, with higher rates in the Eastern Cape and Limpopo provinces. Severe wasting affected 5% of the same age group. The incidence of diarrhoea in the two weeks preceding the survey was reported by 22% of caregivers, while 18% indicated that the child had experienced symptoms of acute respiratory infection.

HIV/AIDS Awareness

Awareness of HIV/AIDS was widespread; 88% of respondents had heard of the disease. Nevertheless, misconceptions persisted: 27% believed that casual contact could transmit HIV, and 15% thought that a healthylooking person could not be infected. Condom use at last sexual intercourse among men aged 1549 was reported at 13%, a figure that underscores the need for intensified behaviour change communication.

Womens Empowerment

Education levels had risen, with 61% of women aged 2549 having completed secondary school or higher. Yet, 38% of women reported being unable to make decisions about their own health without a partners consent. Employment remained genderbiased: only 30% of women aged 1564 were employed in the formal sector compared with 55% of men.

Regional Variation

Geographic disparities were evident across the nine provinces (see Table 1). The Western Cape and Gauteng consistently outperformed other provinces on indicators such as ANC attendance, skilled birth attendance, and household wealth. In contrast, the provinces of KwaZuluNatal, Eastern Cape, and Limpopo exhibited higher fertility, lower contraceptive use, and greater unmet need.

Impact and Legacy

The 1998 SADHS became the reference point for subsequent surveys (2003, 2009, 2016) and shaped national health strategies. Key policy outcomes derived from the data include:

• Reproductive Health Programme Expanded contraceptive method mix and introduced communitybased distribution of injectables.
• Child Survival Initiative Targeted nutrition supplementation in provinces with high stunting rates.
• HIV/AIDS Prevention Integrated HIV education into school curricula and scaled up condom distribution.
• Womens Empowerment Agenda Promoted gendersensitive legal reforms and increased access to microfinance.

Data Access

The full dataset and questionnaire files are publicly available through the Demographic and Health Surveys (DHS) Programme website. Researchers can request the anonymised microdata for secondary analysis by completing a brief registration form. The dataset includes variables on household assets, health behaviours, biomarkers, and geographic identifiers (province and urban/rural status).

Further Reading

• Stats SA (1999). South African Demographic and Health Survey 1998 Final Report. Pretoria: Stats SA.
• UNFPA (1999). Using SADHS Data for Policy Development. New York: UNFPA.
• Bhutta, Z. A., et al. (2000). Nutritional status of children in South Africa: findings from the 1998 SADHS. Public Health Nutrition, 3(5), 587594.

Data source: Statistics South Africa, Demographic and Health Survey, 1998. 2024 All rights reserved.