Despite warnings, valproate use in women of childbearing age (WOCBA) has not changed in the Western Cape Province of South Africa over a 3-year period, and sodium valproate (VPA) remains the most commonly prescribed antiepileptic or mood-stabilising medicine among women of childbearing age in the Western Cape Province of South Africa.

Over 3 years, approximately 663 pregnancies were exposed to VPA, with a steady rise in the number of exposures each year (n = 204, 214 and 245, respectively). Contributing factors to these trends are described, including the concerns about drug–drug interactions between antiepileptic/mood-stabilising medicines and antiretrovirals.

Despite significant measures that have been taken at both a national and provincial level, the implementation of new approaches to the treatment of epilepsy in women are hindered by challenges facing clinicians in a resource-limited setting with a high burden of HIV.