OBJECTIVE To determine: (i) the national status of newborn hearing screening services in the private health care sector of South Africa; (ii) screening approaches implemented; and (iii) challenges to screening implementation. METHODS A descriptive national survey in the private sector of South Africa was conducted within a quantitative paradigm. METHODS All private health sector institutions with obstetric units (N=166) were surveyed telephonically and self-administered questionnaires were subsequently sent to all audiologists in private practice (N=87) who provide newborn hearing screening services at the units with hearing screening. RESULTS Nationally 53% of private sector obstetric units offer some form of newborn hearing screening. Universal hearing screening was only offered by 14% of units, while the most common approaches were universal screening on some days of the week (18%) and screening on request (18%). The most prominent challenge to successful screening implementation was the apparent omission of newborn hearing screening from maternity birthing packages at the health care institutions. CONCLUSIONS The vast majority of newborns nationally are not screened for hearing loss, and existing programmes are not sufficiently systematic and integrated to ensure adequate coverage. Hospital management and paediatric health services must prioritise hearing screening as part of standard of care birthing services.