South Africa already knows what kills women. The harder question, raised at a global conference in Cape Town this week, is why that knowledge has not been enough to stop it.
Intimate-partner femicide is rising again in South Africa, and most women who report rape never see their attackers convicted. This is not a country short on research. It has decades of evidence documenting where women face the greatest danger, how alcohol and firearms fuel lethal violence, and why rape cases collapse at every stage of the criminal justice system. It has progressive laws, a national strategy, and interventions proven to save lives. The gap is no longer about missing information. It is about failing to act on what is already known.
That disconnect became the central challenge at the 16th World Conference on Injury Prevention and Safety Promotion, which opened in Cape Town on Wednesday. Researchers, policymakers and civil society representatives from more than 80 countries gathered under the theme Ubuntu: United for a Safer Future, hosted by the Foundation for Professional Development and co-hosted by the South African Medical Research Council (SAMRC), with support from the World Health Organisation. The conference marks 30 years since the World Health Assembly first declared violence a major public health problem. According to the WHO, violence and injuries kill approximately 4.8 million people annually and account for nearly 8% of global mortality.
SAMRC president and chief executive Ntobeko Ntusi told delegates that safety could not be created by any single profession, institution or country working alone. “Evidence alone does not change the world,” he said. “It must be translated into action. Action must be implemented at scale, and implementation must be sustained.”
Behind every injury statistic lies a person, a family and a societal question: could something have been done differently? In many cases, Ntusi said, the answer is yes. A road death might involve road design, speed, alcohol, vehicle standards, policing and access to trauma care. Addressing one factor in isolation rarely produces lasting change. “The science of prevention is a science of systems,” he said.
South Africa’s femicide data shows precisely what happens when political commitment and institutional performance fail to keep pace with research. The age-standardised intimate-partner femicide rate declined from 9.5 per 100,000 women in 1999 to 4.9 in 2017. It then rose to 5.5 in 2020-21, approximately five times the global rate. Overall femicide fell from 24.2 per 100,000 women in 1999 to 10.6 in 2020-21, while non-intimate-partner femicide dropped from 11.4 to 4.1 over the same period.
SAMRC executive scientist Rachel Jewkes traced the country’s progress and subsequent reversal. Earlier declines were partly driven by stronger gun-control legislation and enforcement. Those gains were then undermined as corruption weakened state institutions and law enforcement deteriorated. South Africa’s experience demonstrated that progress won through activism, research and legislation was not irreversible.
The country moved from treating violence against women as a private matter to what Jewkes described as an “era of implementation” after 2002, when laws, regulations and services were strengthened. Growing corruption and institutional decay from about 2012 brought stagnation and deterioration. Renewed activism from 2017 returned gender-based violence to the political agenda and led to adoption of the national strategic plan on gender-based violence and femicide.
Yet a fundamental disconnect persists between the priority the government claims to give the issue and the quality of services women actually receive. Research tracking reported rape cases shows them falling away at every stage of the criminal justice process, from suspect arrest and prosecution referral through trial commencement to eventual conviction.
Evidence from the Covid-19 lockdown period illustrated the relationship between alcohol availability and fatal violence against women. When alcohol sales were prohibited and a stay-at-home curfew was imposed during 2020 and 2021, South Africa recorded an average of about 82 femicides monthly. During periods without either restriction, the monthly average reached 218. Published research found that overall femicide was 63% lower under the strictest combination of alcohol and movement restrictions. Although the two measures operated simultaneously, making alcohol the sole cause unclear, Jewkes said the evidence strengthened the case for regulating the alcohol industry as part of the response to gender-based violence.
Meanwhile, Johns Hopkins University associate professor Abdul Bachani said the field had generated substantial knowledge over 30 years, yet the persistence of violence and injury showed progress had been insufficient. “The most important question for this conference is therefore not simply what more do we need to know, but rather what do we need to do differently with what we already know?” he said.
Implementation takes place within political, institutional and economic systems where interventions can fail because financing is not sustained, state capacity is weak, responses are fragmented or political incentives are misaligned. University of Cape Town professor Shanaaz Mathews emphasised that prevention could not focus only on the person immediately affected while ignoring inequality, gendered power, unsafe environments and institutional failures that allow perpetrators to escape accountability.
Researcher K.L. Dunkle warned that an intervention could reduce violence without achieving equity. Preliminary findings from an intimate-partner violence prevention programme in Rwanda showed that violence among women with disabilities declined from 60% at the start to 43% at conclusion. Among women without disabilities, it fell from 46% to 31%. Both groups benefited. But women with disabilities ended the programme with almost the same prevalence of violence as women without disabilities had at the beginning. Disability had not been considered when the programme was designed, women with disabilities had not been consulted, and the findings excluded those unable to access the intervention at all.
“If we don’t centre the people most affected, we get it wrong,” a presentation slide warned. “We miss inequities. We miss system barriers. We miss critical questions. We miss feasible solutions.”
The conference is expected to finalise the Ubuntu Cape Town declaration for a safer world and a national consensus plan setting out priorities for South Africa. South Africa already has the policies, the research and the experience showing what can save lives. Whether its institutions will turn that knowledge into real protection, and whether the women most exposed to harm will have any say in how that is done, remains the question the declaration will need to answer.