From school rules to scalp health: how South Africa’s Black hair conversation has changed

A decade after the Pretoria Girls High protests, doctors say acceptance must continue to be matched by awareness

In 2016, Black girls’ hair became a national debate after pupils at Pretoria Girls High challenged school rules governing how they could wear it. What began as a dispute over a school dress code quickly became a national conversation: a public reckoning that treated some forms of Black hair more aesthetic than others, raising important questions around identity and dignity.

A lot has changed since then. Natural hair is far more visible in public life and South African schools. National guidelines requiring schools to consider religious and cultural diversity in uniform policy have existed since 2006, and recent scrutiny, including a 2023 South African Human Rights Commission inquiry, continues to push for more consistent enforcement.

“Acceptance and conversation around natural hair have shifted compared to decades ago. There is greater awareness that Black hair has its own unique characteristics and deserves to be assessed and treated accordingly,” says Dr Kashmal Kalan, Medical Director at Alvi Armani. “Patients are asking more questions when coming in for consultations. They want to understand why their hair is changing or thinning: is it genetic, a natural part of getting older, or due to prolonged chemical processing and styling practices.”

Patients also want to know whether changes to their hair or scalp are temporary or permanent. It is not unusual for a patient’s hair history to reveal that tight braiding, extensions, ponytails or similar hairstyles started during childhood or the school years and continued into adulthood. A patient may only notice obvious thinning in their twenties or thirties, even though the process has been developing gradually for years.

This is also why the term “protective hairstyle” needs some context. Medically, the issue is not the name of the hairstyle. It is how much tension is placed on the follicle, how often the style is repeated and how long that pattern continues.

South African research has been examining the relationship between hair practices and traction alopecia for years. A 2007 study of more than 1,000 schoolchildren found traction alopecia in 17.1% of girls, with prevalence increasing from 8.6% in the first year of school to 21.7% in the final year. A 2008 study reported traction alopecia in 31.7% of African women aged between 18 and 86.

“Traction alopecia is not a process that happens overnight. There could be a period where the follicles are stressed yet still capable of recovery, but early intervention is critical. If that tension continues for long enough, permanent damage and scarring can occur. Once prolonged inflammation and injury have caused scarring and destruction of the follicle, spontaneous regrowth becomes much less likely.”

The scalp can give you warning signs long before the hair loss becomes obvious. Significant pain should not simply be accepted as a normal part of having your hair done.

“If that happens, the hairstyle should be loosened or adjusted rather than waiting several days and hoping the discomfort disappears. Persistent tenderness, bumps around the follicles, a pulling sensation or progressive thinning around the hairline should also prompt attention. The frontal hairline and temples are among the areas most commonly affected by repeated traction.”

“The point is not to make people wary of styling their hair. You should absolutely be able to enjoy different hairstyles. The important thing is to pay attention to what the scalp is telling you.”

Kalan is hopeful that the progress made over the past decade opens the door to a broader conversation about hair health.

“One of the biggest strides our country has made is recognising that natural Black hair should not be viewed as something that needs to be corrected or controlled in order to be acceptable,” he concludes. “The goal is not to tell people how they should wear their hair. It is to give them enough information to enjoy their hair and their culture while protecting the follicles they will hopefully still have many decades from now.”