Globally older people are increasingly providing care for their grandchildren. A pertinent question across world regions is the extent to which providing care for grandchildren intersects with the ageing process and the implications for grandparents’ wellbeing. This paper examines the relationship between caring for grandchildren and the self-rated health of older African women (n?=?1,397) in South Africa, drawing on data from the National Income Dynamics Study. This is a population which faces significant socio-economic challenges and stresses from the legacy of the HIV epidemic but benefit from a supportive social protection system and strong norms of extended family care. The findings show that prior self-rated health is not associated with assuming primary caregiving responsibilities for grandchildren, suggesting there is no selection effect into caring responsibilities. However, after controlling for prior characteristics, older women who take on primary caring responsibilities for grandchildren have significantly lower odds of reporting poorer self-rated health. Thus, in contrast to the frequent conclusions of negative impacts of custodial grandparenting on grandparent health in the US, this paper indicates that in some cultural contexts grandparents taking on the primary responsibility for grandchildren can be protective for health. Policymakers need to recognise the important caregiving role of grandparents and support them to flourish.