Characteristics, availability and uses of vital registration and other mortality data sources in post-democracy South Africa

The value of good-quality mortality data for public health is widely acknowledged. While effective civil registration systems remains the ‘gold standard’ source for continuous mortality measurement, less than 25% of deaths are registered in most African countries. Alternative data collection systems can provide mortality data to complement those from civil registration, given an understanding of data source characteristics and data quality. We aim to document mortality data sources in post-democracy South Africa; to report on availability, limitations, strengths, and possible complementary uses of the data; and to make recommendations for improved data for mortality measurement. Civil registration and alternative mortality data collection systems, data availability, and complementary uses were assessed by reviewing blank questionnaires, death notification forms, death data capture sheets, and patient cards; legislation; electronic data archives and databases; and related information in scientific journals, research reports, statistical releases, government reports and books. Recent transformation has enhanced civil registration and official mortality data availability. Additionally, a range of mortality data items are available in three population censuses, three demographic surveillance systems, and a number of national surveys, mortality audits, and disease notification programmes. Child and adult mortality items were found in all national data sources, and maternal mortality items in most. Detailed cause-of-death data are available from civil registration and demographic surveillance. In a continent often reported as lacking the basic data to infer levels, patterns and trends of mortality, there is evidence of substantial improvement in South Africa in the availability of data for mortality assessment. Mortality data sources are many and varied, providing opportunity for comparing results and improved public health planning. However, more can and must be done to improve mortality measurement by improving data quality, triangulating data, and expanding analytic capacity. Cause data, in particular, must be improved

The Classification of South Africa’s Mixed-Heritage Peoples 1910–2011: A Century of Conflation, Contradiction, Containment, and Contention

Given that South Africa’s first contact with European settlers occurred more than 350 years ago, it is not surprising that the country has large and well-established communities of mixed-heritage peoples. Despite notorious anti-miscegenation legislation—promulgated both before (the Immorality Act No. 5 of 1927) and after (the Prohibition of Mixed Marriages Act No. 55 of 1949) the introduction of ‘formal’ apartheid—the treatment of mixed-heritage peoples was primarily one of containment involving the classification of all non-European and non-Native individuals into a single category (‘Coloured’), which conflated those of mixed heritage with ostensibly ‘non-mixed’ (sub)groups—such as those of Chinese, Malay, and Indian origin. However, the apartheid state also established mechanisms through which officials, members of the public, and individuals themselves could apply to alter ‘population group’ classifications, which resulted in several thousand ‘reclassifications’, both requested and imposed. Nonetheless, for the vast majority of South Africans, their ‘population group’ classification became an ingrained marker of quasi-racial identity that continues to this day, while the introduction of an ‘Other’ census category and legal disputes concerning the composition of the ‘Coloured’ category reveal that mixed-heritage individuals once again pose a substantive dilemma to census takers and policy makers, and also perhaps to their own sense of place in the ‘Rainbow Nation’