3 VULNERABILITY TAKES ITS TOLL ON MENTAL HEALTH

Maternal stresses were greatly increased by the Covid-19 pandemic, lockdown and the economic recession. Dr Simone Honikman, founder and director of the Perinatal Mental Health Project (PMHP) in Cape Town, says that for women already living in poverty, becoming pregnant can often catalyse a scenario of psychological distress, hunger in the household and impaired capacity to take up health or social services. According to the PMHP, studies have found that about one in three women living in adversity in South Africa will experience a common mental illness (depression and/or anxiety) during or after pregnancy.

Honikman explains that when caregivers (mothers, fathers, grandparents and child minders) of young children are psychologically in good shape, they are able to manage the challenges associated with childcare and socio-economic adversity. A caregiver who is mentally well has agency, a sense of purpose, and is best able to plan, problem solve, and access public health and welfare resources.

Healthy engagement with children – whether it relates to communication, stimulation, play or discipline – requires a caregiver who has the capacity to connect at an emotional level with their child. A person who is depressed or anxious usually finds it hard to read the cues of others, especially infants or children who are still learning to communicate their needs and responses. Caregivers with these common mental disorders may respond to infants harshly, withdraw from them, or engage in an intrusive manner.

Thus, PMHP strongly advocates that pregnant women in South Africa have access to financial assistance through a government grant. Global evidence has demonstrated the benefit of a Maternal Support Grant (also called the Maternity Support Grant or MSG) for both mother and infant. Grow Great, Embrace and their partners in the Western Cape have shown that providing digital food vouchers to pregnant women mitigates food insecurity and symptoms of mental distress in mothers (See case study).

“A Maternal Support Grant has significant long-term physical and mental health benefits for mother and baby. It is timebound, ringfenced and essentially easier to budget for and thus could actually be a cost-saver to government in the long term,” argues Embrace’s Mentor.

Case Study: MATERNAL SUPPORT

In 2020/21 the CoCare Maternal Support Study conducted by Grow Great, Embrace and partners in the Western Cape found that vulnerable pregnant women who received digital food vouchers reported improvements in maternal hunger, mental health and dietary diversity between baseline and endline results.

INTERVENTION:

› 584 pregnant women in the Western Cape participated in the baseline telephonic survey and received R300 digital food vouchers every two weeks between November 2020 and April 2021.

RESULTS:

› At baseline, 39% of respondents indicated that they had gone to bed hungry in the past seven days. Pregnant women who had experienced hunger in the past week were almost twice as likely to report feeling down, depressed or hopeless. These odds increased when pregnant women reported that a child in their household had gone to bed hungry.

› Respondents who reported receiving no direct social grant income were 63% more likely to report mental health symptoms, such as “having little interest or pleasure in doing things”.

› In order to determine the potential impact of receiving digital food vouchers during pregnancy, participants were contacted in March/April 2021 and again in October/ November 2021. Maternal hunger had significantly decreased at follow-up by 14% versus 39% at baseline. Child hunger also decreased by 9% compared with 22% at baseline.

LEARNINGS:

› These findings supported the evidence base that cash transfers provided to poor and economically vulnerable pregnant women and new mothers can have a significantly positive impact on their food security and that of their children, as well as on maternal mental health.

› The study helped to dispel some of the harmful myths around mothers’ misuse of grants and cash transfers. Follow-up reports documented how vouchers were utilised and showed that recipients had redeemed the vouchers to purchase food, baby items and electricity. This negated popular myths that women use grants irresponsibly and demonstrated that, when given the chance, mothers would most likely act in the best interests of their children.

› The study makes a case for why unconditional cash transfers, and not just food parcels, are a better option for pregnant women to meet their needs and the needs of their unborn children, and why we need to ensure that our social security system recognises, respects and protects the dignity, autonomy and agency of mothers.

Extending the child support grant into pregnancy is one way to support pregnant women living in low-resource communities. As Mentor notes, it is important to change public perception that “because such a grant is timebound (a few months while a woman is pregnant), it can’t possibly be an effective intervention.” She concludes: “Of course, it can't be a standalone intervention. Pregnant women need wrap-around support, but the financial assistance through a Maternal Support Grant signifies that pregnancy has financial implications requiring financial support.”

The MSG should not be seen as a competition for a BIG; rather it is an acutely targeted intervention likely to have significant impact on the core drivers of stunting.

Costing Study Of Msg Conducted In 2021

To arrive at an estimate of the approximate financial cost of implementing a maternal grant, we need estimates of the annual number of eligible pregnant women.

In a 2021 study conducted by Debbie Budlender, commissioned by the Soul City Institute15 , an estimate of 1.1 million pregnancies per year was used, and it was assumed that 75% would qualify in terms of the child support grant means test. According to the Budlender study, the 75% was based on previous estimates and research16. In practice, not all women who are eligible will apply for the grant, especially in the first few years. The use of 75% will thus produce a worst-case scenario in terms of the size of the cost to government.

It is assumed that all women apply for the grant in time to receive it for the full six months of the second and third trimester. Again this produces an over-estimate because not all women will apply so early.

For the value of the grant, the 2021 study used the value of R460 per month.17

These estimates produce a maximum annual budget of R2.23 billion for the maternal grant. This constitutes only 1.2% of the total grant budget for 2021/22.

R460

15 https://www.soulcity.org.za/projects/previous-projects/re-engineering-primaryhealth-care/campaign-for-the-accelerated-reduction-of-maternal-mortality-inafrica-carmma

16 Delany A, Jehoma S & Lake L (eds) (2016) South African Child Gauge 2016. Cape Town: Children’s Institute, University of Cape Town. ISBN: 978-0-7992-2531-0.

17 The Child Support Grant increased to R500 on 1 April 2023 (an increase of R20 since the last adjustment to the grant).

2.2bn

1.2% grant per month annual budget of total grant budget