Study links blood levels of inflammatory markers with different aspects of cancer-related fatigue.
Photo by Karolina Grabowska on Pexels
New research reveals that inflammatory responses may play a role in different types of fatigue experienced by many people with cancer. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
Cancer-related fatigue can be a distressing and persistent burden that causes patients to feel physical, emotional, and/or cognitive tiredness or exhaustion. Activation of inflammatory responses by the tumour itself and/or by cancer treatment is thought to be a key biological driver of this symptom, but inflammatory activity across the cancer continuum has not been thoroughly examined.
To investigate, researchers at the University of California, Los Angeles (UCLA) analysed protein markers of inflammation in 192 women with early-stage breast cancer who were examined before radiation or chemotherapy and throughout the 18 months after treatment. At each assessment, women reported on different dimensions of fatigue (general, physical, mental, and emotional) and provided blood that was tested for protein markers of inflammation. These included two pro-inflammatory cytokines (TNF-α and IL-6) and two downstream markers of their activity (sTNF-RII and CRP).
Higher levels of TNF-α, sTNF-RII, and IL-6 were linked with greater general fatigue, which involves feelings of tiredness and exhaustion. These effects remained even after accounting for age, race, education, body mass index, and cancer stage. Similarly, there was a positive association between physical fatigue, which involves feelings of physical weakness and heaviness, and TNF-α, sTNF-RII, and CRP. Conversely, higher levels of TNF-α and sTNF-RII were associated with lower levels of emotional fatigue. No significant associations between mental (or cognitive) fatigue and inflammatory markers were found.
“Our findings indicate that inflammation plays a role in some aspects of cancer-related fatigue, but not others, and that these effects persist well after treatment,” said lead author Julienne E. Bower, PhD, of UCLA. “This is critical for developing targeted treatments for this common and disabling symptom.”
Neurons in the brain of an Alzheimer’s patient, with plaques caused by tau proteins. Credit: NIH
It has been known that brain lithium (Li) levels are depleted in individuals with mild cognitive impairment, a precursor for Alzheimer’s disease. For years, there have been attempts to restore Li levels to prevent Alzheimer’s disease by administering lithium carbonate. But now, it has been shown that the Li from this compound has been sequestered and not actually restoring the endogenous Li levels. Now, scientists have tried using lithium oxide (LiO) salts instead – and the treatment appears to be effective in prevention and even reversal of a mouse model of Alzheimer’s.
Join our QuickNews podcast as the arguments for and against this lithium-based approach are unpacked and debated.
UCLA researchers have uncovered a link between “morning sickness” symptoms and the body’s natural, but complex, inflammatory response to biological and bodily changes during pregnancy.
According to the National Institutes of Health, up to 80% of early-stage pregnant mothers experience some nausea, vomiting and aversions to certain foods and smells. While uncomfortable, these symptoms are not typically a sign that anything is wrong with the health of the mother or the developing fetus, but rather an indication of a delicate balance unique to pregnant women.
“During pregnancy, a mother’s immune system faces a tricky challenge: it has to protect both her and the foetus from infection, but without accidentally attacking the foetus, whose genetic identity is half-foreign because it is half derived from the father. Normally, the immune system attacks anything that seems foreign, so in pregnancy, it has to carefully adjust to keep the foetus safe while still defending against infection,” said UCLA anthropology professor Molly Fox, corresponding author of the study published in Evolution, Medicine and Public Health.
The researchers believe that this delicate balance, which protects mother and foetus, is achieved by a unique mix of inflammatory responses. They function to prevent the mother’s body from rejecting the foetus, alongside adaptive behavioural mechanisms, like nausea, that encourage the mother to avoid foods that are potentially harmful, especially in the first and second trimesters when the foetus is most vulnerable.
“Nausea, vomiting or aversions to foods or smells are not indications that something is going wrong for the mother or the foetus. It’s likely an indication that everything is moving along normally, and a reflection of the body’s healthy and helpful immune response,” said UCLA anthropology professor and paper co-author Daniel Fessler.
Methodology and findings
For the study, the UCLA-led team of anthropologists and epidemiologists collected and analysed blood samples to measure immune system molecules called cytokines. Cytokines are proteins that send signals to help the body launch a quick defence against sickness and regulate inflammation. Participants also filled out questionnaires that asked about morning sickness-related symptoms and food and smell aversions during the early stages of pregnancy. The participants were 58 Latina women in Southern California who were followed beginning in early pregnancy through the postpartum.
Sixty-four percent of study participants experienced odour or food aversions, primarily to tobacco smoke and meat. Sixty-seven percent reported nausea and 66% experienced vomiting.
The study team measured pro-inflammatory cytokines as well as anti-inflammatory cytokines. They found that women who experienced an aversion to tobacco smoke showed a noticeable shift toward a more inflammatory response. Food aversions, nausea and vomiting were also associated with a more pro-inflammatory immune balance.
An evolutionary process?
The correlation is consistent with researchers’ theory that these symptoms may be part of an evolutionary adaptation that helps pregnant mothers’ bodies minimize exposure to harmful substances, though the study’s authors caution that the evidence is not definitive and more research is needed.
They emphasised that the study allowed the team to look at both human biological and behavioural responses during pregnancy.
“In many mammals, the foetal compartment has barriers separating it from the mother’s blood supply, where her immune cells are. But in humans, we have a unique setup – foetal cells are bathed in maternal blood. Humans have the most invasive of all placentas, burrowing deep into maternal tissue. So humans need unique strategies to prevent the mother’s immune system from attacking the foetus,” said Fox.
These immunological changes may induce nausea, which in turn encourages food avoidance that might act as an additional layer of protection, according to the researchers
“Nowadays, you will see labels on packages of ground beef or soft cheese that warn pregnant women to be cautious about these products because of the risks of foodborne illness during pregnancy. Aversions to certain odours and foods, and nausea and even vomiting, appear to be evolution’s way of achieving that same objective,” said Fessler.
Practical implications
The researchers, including first author Dayoon Kwon, who just completed her PhD in epidemiology at UCLA (and is now a postdoctoral fellow at Stanford), said that the study could help bolster recognition that nausea and vomiting are normal symptoms with biological underpinnings associated with healthy pregnancies. The study’s results could help in paving the way for common-sense workplace accommodations, such as more efficient deployment of health care benefits and other helpful resources to reduce stigma, excessive absences and lost productivity.
They also encourage other researchers to continue to look into the questions raised by the study, to not only explore the evolutionary questions, but to work toward providing clinicians with non- or low-invasive measures of prognoses.
Facing off a dual burden of high disease risk and low service access
Photo by Sydney Sims on Unsplash
CAPE TOWN, 08 OCTOBER 2025: South African and international leaders in public health will gather on Friday, 10 October 2025 at the University of Cape Town to convene an in-person scientific seminar: Agents of change and women who use drugs. Women who use drugs (WWUD) in South Africa face compounded health and social vulnerabilities that leave them disproportionately excluded from essential health services. Compared to men, women experience heightened stigma, intimate partner violence, reproductive health challenges, and structural barriers such as childcare responsibilities and lack of women-centred care.1,2 Scientific discussions among academics will focus on how women can be supported through access to harm reduction programming and drug policy reform.
Seminar: Agents of change and women who use drugs
· Date : 10 October 2025
· Time : 13:30 – 15:30 (SAST)
· Venue : Neurosciences Institute Auditorium, UCT/Groote Schuur Hospital, Cape Town
Recent evidence highlights both the scale of drug use and the urgent need for tailored harm reduction. National estimates suggest there are approximately 82 500 people who inject drugs (PWID) in South Africa, with women comprising between 16% and 27% of this population.3 Led by TB HIV Care, a 2023 bio-behavioural survey across four South African sites documented extremely high HIV prevalence among PWID: 72.1% in Tshwane, 49.3% in eThekwini, 45.4% in Mashishing, and 30.3% in Mbombela. Hepatitis C (HCV) prevalence was similarly alarming, reaching 89% in Tshwane and over 75% in multiple sites.3
“The evidence consistently shows that harm reduction works,” says Dr Andrew Scheibe, medical doctor and technical advisor with TB HIV Care in Cape Town, INHSU board member, and fellow co-convener of the upcoming INHSU 2025 conference. “Harm reduction reduces infections, prevents overdose, and connects people to healthcare, yet access across Africa remains the exception rather than the rule.”
Sex-based disparities are stark. While HIV prevalence among PWID overall has ranged from 14% to over 70%, women consistently show higher prevalence rates than men. One multi-city study found 18% HIV prevalence among female PWID, compared to 13% among males.4 More recent research in Durban confirmed that women face greater barriers to accessing sexual and reproductive health, harm reduction, and HIV services, often due to fear of arrest, intimate partner control, and lack of programming designed for women.5
“Everyone in our communities deserve health, dignity, and care,” says Mfezi Mcingana, Programme Director: Key Populations at TB HIV Care. “People who use drugs are part of our communities and supporting their access to healthcare, not punishment, builds a safer, healthier society for all”, Mcingana concludes.
Despite the magnitude of risk, women remain underrepresented in harm reduction programmes. In opioid agonist therapy (OAT), fewer than 10% of participants are women.6 Needle and syringe programmes (NSPs) and OAT are limited in coverage, mostly urban-based, and not designed with women’s needs in mind. The absence of services aimed at women perpetuates cycles of preventable morbidity, mortality, and infectious disease transmission.
“While the scale of the challenge is undeniable, pioneering efforts by a few African governments show what harm reduction leadership can look like,” says Angela McBride, Executive Director of the South African Network of People Who Use Drugs (SANPUD), INHSU board member, and co-convener of INHSU 2025. “Harm reduction means putting health and human rights before punishment, shifting away from criminalisation and towards evidence-based, rights-affirming policies.”
To address this gap, investment in women-centred harm reduction is essential. Priorities include scaling up OAT and NSPs with women-specific entry points, integrating sexual and reproductive health services into harm reduction sites, providing childcare support, and ensuring protection from intimate partner violence. Without these interventions, WWUD in South Africa will continue to be excluded from public health progress and national HIV/HCV response goals.
References:
Shirley-Beavan, S., Roig, A., Burke-Shyne, N., Daniels, C. and Csak, R. (2020). Women and barriers to harm reduction services: a literature review. Harm Reduction Journal, 17(74). Available here.
Harm Reduction International & South African Network of People Who Use Drugs (SANPUD) (2020). Barriers to harm reduction for women who use drugs in South Africa. London: Harm Reduction International. Available here.
SANPUD (2023). South African bio-behavioural survey and population size estimation among people who inject drugs. Johannesburg: South African Network of People Who Use Drugs. Available here.
Scheibe, A., Young, K., Moses, L., Basson, R., Versfeld, A., Spearman, C.W. and Sonderup, M.W. (2016). HIV prevalence and risk among people who inject drugs in South Africa. International Journal of Drug Policy, 30, pp.107–113. Available here.
Milford, C., Cavanagh, T., Bosman, S., Chetty, T. and Rambally, G. (2024). Access to and acceptability of sexual and reproductive health, harm reduction and other essential health services among people who inject drugs in Durban, South Africa. Harm Reduction Journal, 21(123). Available here.
INHSU (2021). Gender and opioid substitution therapy access in Tshwane, South Africa. International Network on Health and Hepatitis in Substance Users. Available here.
For over two decades, finasteride – a prescription drug taken by millions of men to treat hair loss – has carried troubling signals of deeper harm: depression, anxiety, and in some cases, suicide.
A new review by Prof Mayer Brezis of the Hebrew University of Jerusalem argues that the medical and regulatory community failed the public by repeatedly overlooking evidence of finasteride’s potentially psychiatric effects.
The review, published in The Journal of Clinical Psychiatry, compiles data from eight major studies conducted between 2017 and 2023, showing a consistent pattern: users of finasteride were significantly more likely to experience mood disorders and suicidal thoughts than those not taking the drug. Findings come from multiple countries and data systems, including the US FDA, as well as national health records in Sweden, Canada, and Israel.
“The evidence is no longer anecdotal,” said Prof. Brezis, professor emeritus of medicine and public health. “We now see consistent patterns across diverse populations. And the consequences may have been tragic.”
According to the paper, hundreds of thousands of people may have suffered from depression related to finasteride, and hundreds – possibly more – may have died by suicide.
A Delayed Response, With a High Cost
While the FDA acknowledged depression as a potential side effect in 2011 and added suicidality in 2022, concerns had already been raised as early as 2002. Internal FDA documents from 2010, cited in Prof Brezis’ paper, reveal large portions blacked out as “confidential” – including estimates of how many users could have been affected.
By 2011, the FDA had recorded just 18 suicides linked to finasteride. Based on global usage, he argues, the number should have been ranged in the thousands. “It wasn’t just underreporting,” he wrote. “It was a systemic failure of pharmacovigilance.”
Unlike weight-loss or psychiatric medications, which receive intense post-marketing scrutiny, finasteride’s “cosmetic” status may have shielded it from investigation. Notably, none of the studies cited in Brezis’ review were initiated by Merck, the original manufacturer, or requested by regulators.
A Cosmetic Drug With Life-Altering Risks
Finasteride works by blocking the conversion of testosterone into dihydrotestosterone (DHT). In the process, it may also disrupt neurosteroids like allopregnanolone, which are linked to mood regulation in the brain. Animal studies show long-term effects on neuroinflammation and even structural changes in the hippocampus.
For some patients, the harm does not end when the drug is stopped. Reports of “post-finasteride syndrome” describe lingering symptoms – insomnia, panic attacks, cognitive dysfunction, and suicidal thoughts – that persist months or years after discontinuation.
Regulatory Gaps and Corporate Silence
The report is particularly critical of the FDA and Merck. Despite having access to millions of patient records, neither acted in time. Brezis suggests that industry silence was strategic, motivated by market pressures and legal liability -echoing past controversies like Merck’s handling of Vioxx.
“Nothing is more important to Organon than the safety of our medicines,” the company recently stated. Yet none of the safety studies cited were initiated by the manufacturer.
The FDA, meanwhile, took five years to respond to a citizen petition calling for a black-box warning. Its final decision was to add suicidal ideation to the label – but not as a formal warning.
What Now?
Brezis is calling for immediate changes in how drugs like finasteride are approved, monitored, and prescribed. His recommendations include:
Suspending marketing of the drug for cosmetic purposes until safety is re-established.
Rquiring mandatory post-approval studies with strict enforcement.
Systematically recording drug histories in suicide investigations.
For many patients, those reforms will come too late.
The paper, “Failing Public Health Again? Analytical Review of Depression and Suicidality from Finasteride” was published in The Journal of Clinical Psychiatry and is available here.
Colourised scanning electron micrograph of HIV (yellow) infecting a human T9 cell (blue). Credit: NIH
For over three decades, HIV has played an elaborate game of hide-and-seek with researchers, making treating – and possibly even curing – the disease a seemingly insurmountable obstacle to achieve.
But scientists at Case Western Reserve University have made a breakthrough discovery that could fundamentally change strategies for treating HIV.
The team identified for the first time how HIV enters a dormant state in infected cells that allows the virus to “hide” from the immune system and current treatments.
The researchers believe the finding, just published in Nature Microbiology, challenges decades of scientific assumptions and opens a new approach to possibly eliminating the deadly virus.
“This discovery rewrites what we thought we knew about how HIV goes into this stealth mode in the human body,” said study lead Saba Valadkhan, an associate professor in the Department of Molecular Biology and Microbiology at the Case Western Reserve School of Medicine. “We’ve shown that HIV actually orchestrates its own survival by reprogramming host cells to create the perfect hiding place.”
The team discovered that HIV uses a clever survival trick that explains why it’s been impossible to cure. After HIV invades a cell, it sneaks its genetic code into the cell’s DNA, then tricks the cell into going to sleep, which also puts the virus to sleep, making both completely invisible. This tactic makes the infected cell invisible to the immune system and unreachable by even today’s most advanced HIV drugs. The virus stays hidden in these dormant cells until the right moment to “wake up” and spread again, creating an undetectable reservoir that ensures HIV never goes away completely.
“What we’ve uncovered is that HIV doesn’t just randomly go dormant – it actively manipulates the host cell to create conditions for its own survival,” said study collaborator Jonathan Karn, Distinguished University Professor and chair of the Department of Molecular Biology and Microbiology. “This gives us specific targets to attack.”
The findings may extend far beyond HIV treatment. The researchers believe similar dormancy actions could be triggered by other viruses – including herpes, hepatitis and other retroviruses – potentially leading to new therapies for many viral diseases.
“We may have uncovered new tactic viruses use to trick the host cells to do their bidding,” Valadkhan said.
This discovery is also important for protecting public health worldwide because viruses like HIV – which can permanently insert themselves into a person’s DNA – could potentially be used as future viral threats and pandemic preparedness.
Poor sleep may accelerate brain ageing, a new study shows. Photo by Andrea Piacquadio
People who sleep poorly are more likely than others to have brains that appear older than they actually are. This is according to a comprehensive brain imaging study from Karolinska Institutet, published in the journal eBioMedicine. Increased inflammation in the body may partly explain the association.
Poor sleep has been linked to dementia, but it is unclear whether unhealthy sleep habits contribute to the development of dementia or whether they are rather early symptoms of the disease. In a new study, researchers at Karolinska Institutet have investigated the link between sleep characteristics and how old the brain appears in relation to its chronological age.
The study includes 27 500 middle-aged and older people from the UK Biobank who underwent magnetic resonance imaging (MRI) of the brain. Using machine learning, the researchers estimated the biological age of the brain based on over a thousand brain MRI phenotypes.
Low-grade inflammation
The participants’ sleep quality was scored based on five self-reported factors: chronotype (being a morning/evening person), sleep duration, insomnia, snoring, and daytime sleepiness. They were then divided into three groups: healthy (≥ 4 points), intermediate (2-3 points), or poor (≤ 1 point) sleep.
“The gap between brain age and chronological age widened by about six months for every 1-point decrease in healthy sleep score,” explains Abigail Dove, researcher at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, who led the study. “People with poor sleep had brains that appeared on average one year older than their actual age.”
To understand how poor sleep can affect the brain, the researchers also examined levels of low-grade inflammation in the body. They found that inflammation could explain just over ten per cent of the link between poor sleep and older brain age.
“Our findings provide evidence that poor sleep may contribute to accelerated brain ageing and point to inflammation as one of the underlying mechanisms,” says Abigail Dove. “Since sleep is modifiable, it may be possible to prevent accelerated brain ageing and perhaps even cognitive decline through healthier sleep.”
Several possible explanations
Other possible mechanisms that could explain the association are negative effects on the brain’s waste clearance system, which is active mainly during sleep, or that poor sleep affects cardiovascular health, which in turn can have a negative impact on the brain.
Participants in the UK Biobank are healthier than the general UK population, which could limit the generalisability of the findings. Another limitation of the study is that the results are based on self-reported sleep.
The study was conducted in collaboration with researchers from the Swedish School of Sport and Health Sciences, and Tianjin Medical University and Sichuan University in China, among others. It was funded by the Alzheimer’s Foundation, the Dementia Foundation, the Swedish Research Council, the Loo and Hans Osterman Foundation for Medical Research, and the Knowledge Foundation. The researchers report no conflicts of interest.
New study uncovers natural hormone shift that could transform type 2 diabetes treatment
A 3D map of the islet density routes throughout the healthy human pancreas. Source: Wikimedia CC0
A new study from Duke University School of Medicine is challenging long-standing views on blood sugar regulation — and pointing to a surprising new ally in the fight against type 2 diabetes.
Published in Science Advances, the research reveals that pancreatic alpha cells, once thought to only produce glucagon – a hormone that raises blood sugar to maintain energy when fasting or exercising – also generate GLP-1, a powerful hormone that boosts insulin release from beta cells and helps regulate glucose. GLP-1 is the same hormone mimicked by blockbuster drugs like semaglutide.
Using mass spectrometry, Duke researchers found that human alpha cells may naturally produce far more bioactive GLP-1 than previously believed.
Led by Duke scientist Jonathan Campbell, PhD, the team of obesity and diabetes researchers analysed pancreatic tissue from mice and from humans across a range of ages, body weights, and diabetes statuses. They found that human pancreatic tissue produces much higher levels of bioactive GLP-1 and that this production is directly linked to insulin secretion.
“Alpha cells are more flexible than we imagined,” said Campbell, an associate professor in the Division of Endocrinology in the Department of Medicine and a member of the Duke Molecular Physiology Institute. “They can adjust their hormone output to support beta cells and maintain blood sugar balance.”
This flexibility could change the approach to treating type 2 diabetes, where beta cells in the pancreas can’t make enough insulin to keep blood sugar at a healthy level. By boosting the body’s own GLP-1 production, it may offer a more natural way to support insulin and manage blood sugar.
Switching gears
In mouse studies, when scientists blocked glucagon production, they expected insulin levels to drop. Instead, alpha cells switched gears – ramping up GLP-1 production, improving glucose control, and triggering stronger insulin release.
“We thought that removing glucagon would impair insulin secretion by disrupting alpha-to-beta cell signaling,” Campbell said. “Instead, it improved it. GLP-1 took over, and it turns out, it’s an even better stimulator of insulin than glucagon.”
To test this further, researchers manipulated two enzymes: PC2, which drives glucagon production, and PC1, which produces GLP-1. Blocking PC2 boosted PC1 activity and improved glucose control. But when both enzymes were removed, insulin secretion dropped and blood sugar spiked – confirming the critical role of GLP-1.
Implications for diabetes treatment
While GLP-1 is typically made in the gut, the study confirms that alpha cells in the pancreas can also release GLP-1 into the bloodstream after eating. This helps to lower blood sugar by increasing insulin and reducing glucagon levels.
Common metabolic stressors, like a high-fat diet, can increase GLP-1 production in alpha cells – but only modestly. That opens the door to future research: If scientists can find ways to safely boost GLP-1 output from alpha cells they may be able to naturally enhance insulin secretion in people with diabetes.
But measuring GLP-1 accurately hasn’t been easy. The team developed a high-specificity mass spectrometry assay that detects only the bioactive form of GLP-1 – the version that actually stimulates insulin — not the inactive fragments that often muddy results.
“This discovery shows that the body has a built-in backup plan,” Campbell said. “GLP-1 is simply a much more powerful signal for beta cells than glucagon. The ability to switch from glucagon to GLP-1 in times of metabolic stress may be a critical way the body maintains blood sugar control.”
A project to test how drones can be integrated into the UK’s 999 emergency response system to rapidly deliver defibrillators to patients experiencing out-of-hospital cardiac arrest (OHCA) has been launched by the University of Surrey, Air Ambulance Charity Kent Surrey Sussex, South East Coast Ambulance Service NHS Foundation Trust.
With survival rates for OHCA in the UK currently below 10%, a key challenge is the delay in delivering life-saving defibrillation. While public Automated External Defibrillators (AEDs) are widely available, getting them to a patient in time is often difficult. This 16-month project will explore using drones to rapidly deliver AEDs to the scene of an emergency.
This research is the first step towards integrating drone technology into our emergency response systems. Our ultimate goal is to develop and test the procedures needed to seamlessly introduce drone delivery of AEDs into the 999-emergency system
The initiative, which has been funded by the National Institute for Health and Care Research (NIHR), will be divided into two sections: in the first, researchers will develop and refine the drone delivery process through a series of simulations, coordinating 999 call taking, Air Traffic Control, ambulance dispatch and drone operators.
In the second part, interviews will be conducted with a diverse group of people -including OHCA survivors, family members, responders and members of the public – to understand the public’s perception of drone technology, including any barriers or concerns, and to ensure ease of use for responders.
This project is a great example of how NIHR’s RfPB programme supports life-saving innovation. Using drones to deliver defibrillators could help emergency teams reach patients faster, improve survival after cardiac arrest, and bring cutting-edge technology directly to the NHS frontline, while working with the public to ensure it’s used safely and effectively.
Professor Kevin Munro, Director of the NIHR Research for Patient Benefit (RfPB) Programme
Rapid intervention is vital in managing out-of-hospital cardiac arrests. As demand continues to grow, the opportunity to integrate this technology into future healthcare systems represents real progress in ensuring ambulance services can work with the communities they serve to strengthen the chain of survival and give patients the best chance of a positive outcome Being a partner in this research, we are eager to explore how this new initiative could strengthen our cardiac arrest care pathway.
Dr Craig Mortimer, Research Manager at South East Coast Ambulance Service NHS Foundation Trust (SECAmb)
Webber Wentzel’s Pro Bono team represented Mr and Mrs van Wyk in a landmark case that has resulted in the Constitutional Court confirming that South Africa’s statutory four months of parental leave may be shared between both parents. The ruling marks a significant step toward gender equality in the workplace and family law.
The case challenged the unequal parental leave provisions under section 25 of the Basic Conditions of Employment Act (BCEA), which granted birthing mothers up to four months of maternity leave while limiting fathers to only 10 days.
Webber Wentzel argued that section 25 of the BCEA unfairly discriminated against fathers and placed an undue burden on birthing mothers by not allowing families to decide who should be the primary caregiver. The court agreed and criticised the 10-day leave for fathers by rejecting the cultural norms that reinforce gendered parenting roles as inconsistent with constitutional values.
The application was supported by the Commission for Gender Equality (CGE) and Sonke Gender Justice (Sonke). CGE advocated for equal parental leave for adoptive and surrogacy-commissioning parents, which the court partially granted. Sonke’s request for an equal 16-week leave for both parents was not granted.
The Constitutional Court, in a unanimous judgment delivered by the Honourable Justice Tshiqi, confirmed that sections 25, 25A, 25B and 25C of the BCEA, along with corresponding provisions of the Unemployment Insurance Fund Act (UIF Act), are unconstitutional. The Court held that these provisions violate the rights to equality and human dignity under sections 9 and 10 of the Constitution.
The Minister of Employment and Labour accepted that differentiation exists between birthing mothers and other categories of parents is automatically unfair as it is based on grounds specified in section 9(3) of the Constitution. Further, the Minister acknowledges that there is a need for reform in the current legislation pertaining to the parental leave regime contained in the BCEA.
As a result of the ruling in the Constitutional Court, the 4 months of maternal and the 10 days of parental leave will be combined into a total of 4 months and 10 days, which parents may now share as they choose. If no agreement is reached, the leave will be split equally. Where only one parent is employed, that parent will be entitled to the 4 consecutive months of parental leave.
The Constitutional Court also confirmed that the same parental leave provisions apply to adoptive parents and commissioning parents in a surrogacy arrangement.
The Constitutional Court has suspended the declaration of invalidity of the relevant BCEA and UIF Act provisions for a period of 36 months, to allow the legislature to remedy the necessary constitutional defects. In the interim, the following principles will apply:
A single parent or a parent who is the only employed parent is entitled to four months’ consecutive parental leave.
Parents who are both employed may share the allocated parental leave of four months and 10 days between them, concurrently or consecutively.
An adoptive parent of a child younger than two years is entitled to four months’ consecutive parental leave.
If an adoption order is granted in respect of two parents, they may share the allocated parental leave of four months and 10 days between them, concurrently or consecutively.
A commissioning parent is entitled to four months’ consecutive parental leave.
Where there are two commissioning parents, they may share the allocated parental leave of four months and 10 days between them, concurrently or consecutively.
Employers are encouraged to review and, where necessary, update their leave policies and employment contracts to reflect the new parental leave framework.
“This judgment is a powerful affirmation of the constitutional rights to equality and dignity,” said Nkosinathi Thema, senior associate, Webber Wentzel. “It recognises that caregiving is not the exclusive responsibility of mothers and that both parents should have the freedom to decide how best to care for their child.”
The Webber Wentzel team comprised Ayanda Khumalo, Nkosinathi Thema and Lize-Mari Doubell. Counsel Nasreen Rajab-Budlender SC, Liam Minné and Sanan Mirzoyev appeared on a pro bono basis.
Founded in 1868, Webber Wentzel is a leading full-service law firm providing clients with innovative solutions to their most complex legal and tax issues across Sub-Saharan Africa. With over 450 lawyers, their multi-disciplinary expertise is consistently ranked top tier in leading directories and awards, both in South Africa and on the African continent. Their collaborative alliance with Linklaters and their deep relationships with outstanding law firms across Africa provide clients with market-leading support wherever they do business.
