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One year into lockdown, pregnant women remain the most vulnerable and need support

By Christina Laurenzi on behalf of Grow Great | 25 March 2021

First published in Daily Maverick

“This is a decisive measure to save millions of South Africans from infection and save the lives of hundreds of thousands of people. While this measure will have a considerable impact on people’s livelihoods, on the life of our society and our economy, the human cost of delaying this action would be far, far greater,” President Cyril Ramaphosa said in 2020, announcing that the entire country would go into what was expected to be a three-week lockdown.

While the immediate impacts of this bold and necessary action were clear, the longer-term impact and “human costs” of the Covid-19 lockdown have become more evident over the past year. As we mark Human Rights Month – exactly one year from the start of lockdown, 26 March – it is critical to consider these costs, especially among our society’s most vulnerable families and individuals.

During the past year, some of our basic human rights – like the right to adequate food – were tested. The lockdown made access to food challenging, especially for the thousands of families already struggling to put food on the table. Government-provided Covid-19 grants offered one form of support, and local organisations stepped up their relief services. Yet, demand has continued to outpace available support resources.

Pregnant women, who experience increased health and social protection needs for both mother and baby, bore this burden even more significantly. Optimal physical and brain development of the foetus depend in part on sustained access to safe, diverse and healthy foods that provide the macro- and micronutrients necessary to support healthy growth and development of the unborn child.

However, for many women in South Africa, meeting basic nutritional requirements to ensure a healthy pregnancy is a challenge. One-third of pregnant women live in households that run out of money for food and more than 60% of mothers of young children live below the upper-bound poverty line.

These challenges have significant effects on maternal and child health. Current data indicate that 15% of infants in South Africa are born with low birth weight. Low birth weight puts children at risk of stunted growth and development, and stunting has detrimental long-term consequences for children’s health, education and economic prospects across the life course. More than a quarter of children under five in South Africa suffer from stunting.

The Covid-19 pandemic has exacerbated an already dire situation for pregnant women in South Africa. Women have been particularly hard hit by the pandemic and its related economic effects. Women make up the majority of the three million people who lost their jobs during the early lockdown in April-May 2020; those working in the informal sector, which is where many women work, had limited access to a safety net to buffer against this loss.

Income support provided during pregnancy can have positive effects on maternal and child outcomes. Evidence from other low-, middle-, and high-income settings has found that pregnancy income support is linked with an increased number of antenatal visits; reductions in neonatal, infant, and child mortality rates; improvement in birth weight; and declines in malnutrition.

An investment in supporting South Africa’s pregnant women’s access to nutritious food is not only an investment in the health and wellbeing of these women and children, but an investment in South Africa’s economic growth and development.

Although the Child Support Grant provides essential income support to mothers of young children up until the age of 18, this benefit is only granted once infants are born. In addition, the barriers to the uptake of this grant result in only 65% of poor children benefiting from this cash transfer in the first year of life. Extending the Child Support Grant into pregnancy could be transformative, allowing expectant mothers to cater for their nutritional needs early in pregnancy when the developing foetus requires these nutrients the most. However, this approach has not been widely tested in South Africa.

In rapid response to the food insecurity crisis as a result of the pandemic, KfW German Development Bank granted approximately R98-million to the City of Cape Town and its implementing partner, Violence Prevention through Urban Upgrading (VPUU), a public benefit organisation. VPUU works in disadvantaged communities in the Western Cape and beyond to provide Digital Community Care vouchers to vulnerable families and to restart eight neighbourhood economies on the Cape Flats by strengthening the vulnerable through assisting the early childhood development sector, urban gardening, food kitchens, spaza shops and setting up local wi-fi networks towards bridging the digital divide.

Part of this fund was directed to pregnant women specifically in the form of a R300 fortnightly digital food voucher over a period of 16 weeks between November 2020 and March 2021, to a total value of R2,400 per recipient.

Grow Great, in collaboration with Stellenbosch University’s Institute for Life Course Health Research and Embrace Movement for Mothers, partnered with VPUU to undertake a study that aims to provide localised evidence of what pregnancy income support can do for vulnerable pregnant women – and to use this evidence to support the call for greater social protection for poor pregnant women across South Africa.

A total of 2,618 pregnant women completed a baseline SMS-based survey focused on their food security and mental health wellbeing. A subset of these participants, about 600, participated in in-depth telephonic interviews.

Our baseline study findings reveal high levels of hunger, poor mental health and economic insecurity among pregnant women living in disadvantaged communities in the Western Cape.

Almost 40% of pregnant women reported that they had gone to bed hungry at least once in the week preceding the survey; an additional 22% reported that a child in their home had gone to bed hungry in the past seven days. Approximately 61% of women reported that they had felt down, depressed or hopeless to some degree in the past week, and 62% reported having little interest or pleasure in doing things over the same period.

These high levels of hunger and poor mental health occurred against a backdrop of high levels of unemployment. While Statistics SA identified 42% unemployment nationally for Q2 of 2020 (using the expanded definition), almost double this proportion of our study participants (71%) reported being unemployed or not having earned money in the previous month. Furthermore, 83% had no paid work that they planned to return to in the coming month. Unsurprisingly, being unemployed increased the likelihood of study participants reporting maternal and child hunger by 29% and 51%, respectively.

Importantly, pregnant women suffered higher levels of hunger at a time when their needs were greater. Captured in the months following South Africa’s Covid-19 lockdown, the levels of hunger from our study were comparatively higher than evidence gathered during the same period from national surveys with the general population, supporting the arguments made by others that pregnancy places women at increased risk of food insecurity.

These findings emphasise an urgent and critical need for nutrition support strategies for vulnerable pregnant women, whose needs have become increasingly more apparent during the pandemic.

The good news is that more than 95% of the pregnant women who participated in this study have all been receiving R300 fortnightly food vouchers since November 2020 and will continue to do so for a period of 16 weeks. While this intervention provides much-needed rapid relief for this population of women, longer-term strategies are required to meet the needs of the other approximately 700,000 pregnant women in South Africa living below the upper-bound poverty line.

Extending the Child Support Grant into pregnancy is one such strategy that is likely to have a significant impact on the nutritional and mental wellbeing of South Africa’s poor and vulnerable pregnant women.

Considering that intrauterine growth restriction has been found to be associated with much of the global burden of stunting, providing income support for poor and vulnerable pregnant women will also probably contribute to reducing South Africa’s high burden of stunting in the long term, which economists estimate is costing us almost 10% per capita GDP per annum.

An investment in supporting South Africa’s pregnant women’s access to nutritious food is not only an investment in the health and wellbeing of these women and children, but an investment in South Africa’s economic growth and development.

The National Development Plan identifies the provision of social protection to pregnant women and new mothers as critical to addressing poverty, inequality and unemployment. The effects of Covid-19 on the livelihoods of South Africans have made it more urgent than ever for this policy to move from aspiration to action.

The introduction of maternal support is long overdue and making it a reality would be a great affirmation of women and children’s rights by our government.

Read the full report of the CoCare Maternal Support Study here.

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